Ch. 399

2004 LAWS OF MARYLAND

(xii) Provide or arrange to provide all Medicaid-covered services
required to comply with State statutes and regulations mandating health and mental
health services for children in State supervised care:

1.       According to standards set by the Department; and

2.       Locally, to the extent the services are available locally;

(xiii) Submit to the Department aggregate information from the
quality assurance program, including complaints and resolutions from the enrollee
and provider grievance systems, the enrollee hotline, and enrollee satisfaction
surveys;

(xiv) Maintain as part of the enrollee's medical record the following
information:

1.       The basic health risk assessment conducted on
enrollment;

2.       Any information the managed care organization receives
that results from an assessment of the enrollee conducted for the purpose of any early
intervention, evaluation, planning, or case management program;

3.       Information from the local department of social services
regarding any other service or benefit the enrollee receives, including assistance or
benefits under Article 88A of the Code; and

4.       Any information the managed care organization receives
from a school-based clinic, a core services agency, a local health department, or any
other person that has provided health services to the enrollee; [and]

(xv) Upon provision of information specified by the Department
under paragraph (19) of this subsection, pay school-based clinics for services provided
to the managed care organization's enrollees; AND

(XVI) IF A DIAGNOSTIC OR EMERGENCY DENTAL SERVICE INDICATES
THAT A THERAPEUTIC TREATMENT IS REQUIRED:

1. PROVIDE OR ARRANGE TO PROVIDE THE THERAPEUTIC
TREATMENT; AND

2. FOLLOW UP TO ASSURE THAT THE ENROLLEE RECEIVED
THE REQUIRED THERAPEUTIC TREATMENT IN COORDINATION WITH PARTICIPATING
DENTISTS, ENROLLEES, AND FAMILIES OF ENROLLEES, DEVELOP A PROCESS TO
ARRANGE TO PROVIDE DENTAL THERAPEUTIC TREATMENT TO INDIVIDUALS UNDER
21 YEARS OF AGE THAT REQUIRES:

1. A PARTICIPATING DENTIST TO NOTIFY A MANAGED CARE
ORGANIZATION WHEN AN ENROLLEE IS IN NEED OF THERAPEUTIC TREATMENT AND
THE DENTIST IS UNABLE TO PROVIDE THE TREATMENT;

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