Ch. 441                                    2003 LAWS OF MARYLAND

(4)] "Adjunct claims documentation" means an abstract of an enrollee's
medical record which describes and summarizes the diagnosis and treatment of, and
services rendered to, the enrollee.

(b) (1) In addition to any other provisions of this subtitle, for a covered
service rendered to an enrollee of a health maintenance organization by a health care
provider not under written contract with the health maintenance organization, the
health, maintenance organization or its agent:

(i) Shall pay the health care provider within 30 days after the
receipt of a claim in accordance with the applicable provisions of this subtitle; and

(ii) Shall pay the claim submitted by:

1.       A hospital at the rate approved by the Health Services
Cost Review Commission; and

2.       Any other health care provider at the rate billed or at the
usual, customary, and reasonable rate.

(2) A health maintenance organization that pays a health care provider
at the usual, customary, and reasonable rate:

(i) Except for services rendered to medical assistance recipients or
for services rendered under a contract entered into under § 1876(g) of the federal
Social Security Act (42 U.S.C. § 1395mm), may not use Medicare, Medicaid, or
workers' compensation payments as part of any methodology used to determine a
payment at the. usual, customary, and reasonable rate; and

(ii) On request of the health care provider, shall disclose the
methodology used to determine the amount of payment.

SECTION 5. AND BE IT FURTHER ENACTED, That Section 4 of this Act shall
take effect on the taking effect of the termination provision specified in Section 3 of
Chapter 423 of the Acts of the General Assembly of 2001. If that termination provision
takes effect, Section 3 of this Act shall be abrogated and of no further force and effect.
This Act may not be interpreted to have any effect on that termination provision.

SECTION 6. AND BE IT FURTHER ENACTED, That, subject to the provisions
of Section 5 of this Act, this Act shall take effect October 1, 2003.

Approved May 22, 2003.

CHAPTER 441
(House Bill 668)

AN ACT concerning

Mental Hygiene Administration - Emergency Evaluation - Standards and

Content

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