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PARRIS N. GLENDENING, Governor
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S.B, 497
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(6) REQUIRE THE HEALTH MAINTENANCE ORGANIZATION TO INCLUDE
A COPY OF EACH CURRENT ANNUAL FINANCIAL STATEMENT OBTAINED UNDER ITEM
(2) OF THIS SUBSECTION IN ITS ANNUAL REPORT FILED UNDER § 19-717 OF THIS
SUBTITLE.
(D) A SEGREGATED FUND ESTABLISHED AS A RESULT OF AN ADMINISTRATIVE
SERVICE PROVIDER CONTRACT MAY NOT BE CONSIDERED AN ASSET OR AN ACCOUNT
OF THE CONTRACTING PROVIDER FOR THE PURPOSES OF DETERMINING THE ASSETS
AND ACCOUNTS OF A BANKRUPT CONTRACTING PROVIDER.
(E) IN DETERMINING THE SUFFICIENCY OF A SEGREGATED FUND, THE
COMMISSIONER MAY CONSIDER WHETHER EXTERNAL PROVIDERS ARE OWNED OR
CONTROLLED BY THE CONTRACTING PROVIDER
(F) THE SEGREGATED FUND OR OTHER RESOURCES ESTABLISHED AS A
RESULT OF AN ADMINISTRATIVE SERVICE PROVIDER CONTRACT:
(1) SHALL BE HELD IN TRUST FOR PAYMENT TO EXTERNAL PROVIDERS;
AND
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(2) MAY NOT BE CONSIDERED AN ASSET OR AN ACCOUNT OF THE
CONTRACTING PROVIDER FOR THE PURPOSE OF DETERMINING THE ASSETS OR
ACCOUNTS OF A BANKRUPT CONTRACTING PROVIDER.
[(d)] (E) (G) The health maintenance organization and the contracting
provider shall comply with the plan.
[(e)] (F) (H) (1) The health maintenance organization shall monitor the
contracting provider to assure compliance with the plan, and the health maintenance
organization shall notify the contracting provider whenever a failure to comply with
the plan occurs.
(2) (I) [Upon] SUBJECT TO SUBPARAGRAPH (II) OF THIS PARAGRAPH,
UPON the failure of the contracting provider to comply with the plan following notice
of noncompliance, or upon termination of the administrative service provider contract
for any reason, the health maintenance organization shall NOTIFY THE
COMMISSIONER AND SHALL assume the FINANCIAL RESPONSIBILITY FOR AND THE
administration of any payments due UNDER THE ADMINISTRATIVE SERVICE
PROVIDER CONTRACT from the contracting provider to external providers on behalf of
the contracting provider, AS REQUIRED UNDER § 19-722 OF THIS SUBTITLE.
(II) THE FINANCIAL AND ADMINISTRATIVE RESPONSIBILITIES OF A
HEALTH MAINTENANCE ORGANIZATION UNDER AN ADMINISTRATIVE SERVICE
PROVIDER CONTRACT:
1. ARE NOT LIMITED BY THE VALUE OF THE ASSETS OF A
SEGREGATED FUND ESTABLISHED UNDER AN ADMINISTRATIVE SERVICE PROVIDER
CONTRACT;
2. EXIST IRRESPECTIVE OF WHETHER THE CONTRACTING
PROVIDER IS INSOLVENT; AND
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- 3915 -
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