Ch. 289

2003 LAWS OF MARYLAND

Preamble

WHEREAS, The United State Department of Health and Human Services has
established a federal grant program to encourage innovative integrated health care
delivery systems to serve uninsured and underinsured persons with greater efficiency
and improved quality of care and to further maximize reimbursements to health care
providers that provide these services; and

WHEREAS, The Community Access Program grants, as authorized in the
Federal Register, allow for the establishment of local programs to reorganize and
reintegrate local health care delivery systems; now, therefore,

SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF
MARYLAND, That the Laws of Maryland read as follows:

Article - Insurance

SUBTITLE 16. COORDINATION OF HEALTH CARE PROVIDER REIMBURSEMENTS.
15-1601.

(A)     (1) A PROGRAM OPERATING IN THIS STATE INITIATED UNDER A
COMMUNITY ACCESS PROGRAM GRANT FROM THE UNITED STATES DEPARTMENT OF
HEALTH AND HUMAN SERVICES MAY ESTABLISH A PILOT PROGRAM TO COORDINATE
HEALTH CARE PROVIDER REIMBURSEMENTS IN ORDER TO TEST INNOVATIONS IN
PAYMENT FOR HEALTH CARE SERVICES TO BE PERMANENTLY IMPLEMENTED IF
SUCCESSFUL.

(2) THE PILOT PROGRAM ESTABLISHED UNDER PARAGRAPH (1) OF THIS
SUBSECTION SHALL MEET THE FEDERAL GRANT REQUIREMENTS AND THE
REQUIREMENTS OF THIS SECTION.

(B)     (1) A PILOT PROGRAM CREATED UNDER THIS SECTION MAY:

(I)      ENROLL PARTICIPANTS WHO DO NOT HAVE INSURANCE AND
WHOSE INCOME IS AT OR BELOW 300% OF THE FEDERAL POVERTY LEVEL;

(II)     COORDINATE PAYMENTS FROM ENROLLEES AND EMPLOYERS
OF ENROLLEES TO BE USED TO OBTAIN AVAILABLE FUNDING TO ASSIST IN
PROVIDING REIMBURSEMENTS TO HEALTH CARE PROVIDERS OF ENROLLEES; AND

(III)   ENTER INTO AGREEMENTS WITH HEALTH CARE PROVIDERS TO
COORDINATE AND OTHERWISE PROVIDE SERVICES TO ENROLLEES.

(2) AGREEMENTS THAT ARE ENTERED INTO UNDER PARAGRAPH (1)(III)
OF THIS SUBSECTION ARE CONTINGENT ON THE HEALTH CARE PROVIDER AGREEING
TO THE PROVISION OF PAYMENT BY THE PILOT PROGRAM BASED ON AVAILABLE
FUNDING TO THE PILOT PROGRAM FOR THE HEALTH CARE SERVICES BEING
PROVIDED.

(C)     (1) IF A HEALTH CARE PROVIDER PARTICIPATING IN THE PILOT
PROGRAM NO LONGER ACCEPTS THE REIMBURSEMENT FROM AN ENROLLEE OF THE

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