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PARRIS N. GLENDENING, Governor
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S.B. 466
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B. The rate as of January 1, 2001 that the health
maintenance organization paid in the same geographic area, AS PUBLISHED BY THE
CENTERS FOR MEDICARE & MEDICAID SERVICES, for the same covered service, to a
similarly licensed provider; and
3. Any other health care provider at the greater of:
A. 125% of the rate the health maintenance organization
pays in the same geographic area, AS PUBLISHED BY THE CENTERS FOR MEDICARE &
MEDICAID SERVICES, for the same covered service, to a similarly licensed provider
under written contract with the health maintenance organization; or
B. The rate as of January 1, 2000 that the health
maintenance organization paid in the same geographic area, AS PUBLISHED BY THE
CENTERS FOR MEDICARE & MEDICAID SERVICES, for the same covered service, to a
similarly licensed provider not under written contract with the health maintenance
organization.
(2) A health maintenance organization shall disclose, on request of a
health care provider not under written contract with the health maintenance
organization, the reimbursement rate required under paragraph (1)(ii)2 and 3 of this
subsection.
(3) (i) Subject to subparagraph (ii) of this paragraph, a health
maintenance organization may require a trauma physician not under contract with
the health maintenance organization to submit appropriate adjunct claims
documentation and to include on the uniform claim form a provider number assigned
to the trauma physician by the health maintenance organization.
(ii) If a health maintenance organization requires a trauma
physician to include a provider number on the uniform claim form in accordance with
subparagraph (i) of this paragraph, the health maintenance organization shall assign
a provider number to a trauma physician not under contract with the health
maintenance organization at the request of the physician.
(4) A trauma center, on request from a health maintenance organization,
shall verify that a licensed physician is credentialed or otherwise designated by the
trauma center to provide trauma care.
Chapter 275 of the Acts of 2000
SECTION 5. AND BE IT FURTHER ENACTED, That Sections 2 and 4 of this
Act shall take effect October 1, 2000. [Sections 2 and 4 of this Act shall remain
effective for a period of 1 year and 9 months and, at the end of June 30, 2002, 2005,
with no further action required by the General Assembly, Sections 2 and 4 of this Act
shall be abrogated and of no further force and effect.]
Chapter 423 of the Acts of 2001
SECTION 3. AND BE IT FURTHER ENACTED, That this Act shall take
effect October 1, 2001. fit shall remain effective until the taking effect of the
termination provision specified in Section 5 of Chapter 275 of the Acts of the General
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- 4625 -
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