Ch. 461

2003 LAWS OF MARYLAND

CHAPTER 461
(House Bill 974)

AN ACT concerning

Health Maintenance Organizations - Patient Access to Choice of Provider

FOR the purpose of altering certain standards of care for health maintenance
organizations by requiring those standards to include a requirement that a
health maintenance organization shall assure that each member shall have the
opportunity to select a certified nurse practitioner from those available to the
health maintenance organization; authorizing the members of a health
maintenance organization to select a certified nurse practitioner as the
member's primary care provider under certain circumstances; providing that a
member who selects a certified nurse practitioner as a primary care provider
shall be provided certain information about the nurse practitioner's
collaborating physician; providing for the construction of this Act; and generally
relating to health maintenance organizations and certified nurse practitioners.

BY repealing and reenacting, with amendments,
Article - Health - General
Section 19-705.1
Annotated Code of Maryland
(2000 Replacement Volume and 2002 Supplement)

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

Article - Health - General

19-705.1.

(a)     The Secretary shall adopt regulations that set out reasonable standards of
quality of care that a health maintenance organization shall provide to its members.

(b)     The standards of quality of care shall include:

(1)     (i) A requirement that a health maintenance organization shall
provide for regular hours during which a member may receive services, including
providing for services to a member in a timely manner that takes into account the
immediacy of need for services; and

(ii) Provisions for assuring that all covered services, including any
services for which the health maintenance organization has contracted, are accessible
to the enrollee with reasonable safeguards with respect to geographic locations;

(2)     A requirement that a health maintenance organization shall have a
system for providing a member with 24-hour access to a physician in cases where
there is an immediate need for medical services, and for promoting timely access to
and continuity of health care services for members, including:

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