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Health Maintenance Organizations —
SEE ALSO Managed Care Organizations
Administrative service provider contracts, responsibility of HMO
for claims or payments for health care services and
establishment of segregated fund, provisions added and altered;
contracting providers, registration and reports to HMOs,
required; annual carrier reports, provisions altered ...................
Adverse decision or grievance decision, notice to member,
requirements altered ......................................................................
Benefits for specified disease or diagnosis, prohibited from being
subject to different copayment amounts, coinsurance,
deductibles, or maximum limits than those that apply to all
Carrier requirement that to serve on a provider panel a provider
must also serve on another provider panel, prohibition added;
notice to carrier of provider's intent to terminate participation
on provider panel, requirements added ........................................
Denial of reimbursement to health care provider for preauthorized
or approved services to patient, prohibitions added ....................
Dental plan organizations, capital and surplus requirements,
provisions altered ...........................................................................
Examination of affairs, transactions, accounts, records, and assets
of private review agents and health maintenance organizations
by Insurance Commissioner, provisions altered and added........
Habilitative services for children, coverage for, requirements
added ..............................................................................................
Hair prosthesis for hair loss from chemotherapy or radiation
treatment for cancer, coverage for, requirements added .............
Health Care Commission -
Authority to develop payment system for all State health care
practitioners, repealed; information on charges by
practitioners and reimbursements from payors, requirements
added ...........................................................................................
Fees assessed on hospitals, nursing homes, payors, and health
care practitioners and Health Services Cost Review
Commission user fees assessed on hospitals, restrictions on
use, provisions clarified ..............................................................
In vitro fertilization, coverage eligibility requirements and
limitations, provisions altered.......................................................
Internal appeal process for members and providers to dispute
coverage decisions by carrier, and filing of complaints with
Insurance Commissioner, requirements added ............................
Maryland Children's Health Care Program, name changed from
Children and Families Health Care Program, eligibility
expanded, and provisions for participation under private option
plan, added; medical assistance for pregnant women, eligibility
expanded .........................................................................................
|
323
329
371
449
253
254
355
31
465
92
326
64
375
282
283
371
15
|
1920
1970
2101
2460
1558
1560
2039
375
2502
685
1953
585
2120
1656
1660
2101
156
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