S.B. 819                                                  VETOES

6. ANY OTHER PENALTIES THAT MAY BE IMPOSED BY THE
SECRETARY;

(VI)    MEET THE SOLVENCY AND CAPITAL REQUIREMENTS FOR
HEALTHCHOICE MANAGED CARE ORGANIZATIONS UNDER THE INSURANCE ARTICLE;

(VII)  TO THE EXTENT PRACTICABLE, ALLOW WAIVER ENROLLEES,
WHO MEET THE NURSING HOME LEVEL OF CARE, TO SELECT A NURSING HOME,
ASSISTED LIVING FACILITY, OR ADULT DAY CARE FACILITY PROVIDED THAT THE
NURSING HOME, ASSISTED LIVING FACILITY, OR ADULT DAY CARE FACILITY IS
LICENSED BY THE DEPARTMENT AND THE PROVIDER MEETS THE
DEPARTMENT-APPROVED CREDENTIALING REQUIREMENTS OF THE COMMUNITY
CARE ORGANIZATION;

(VIII) SUBMIT TO THE DEPARTMENT UTILIZATION AND OUTCOME
REPORTS AS DIRECTED BY THE DEPARTMENT;

(IX) PROVIDE TIMELY ACCESS TO, AND CONTINUITY OF, HEALTH
AND LONG-TERM CARE SERVICES FOR ENROLLEES;

(X)     DEMONSTRATE ORGANIZATIONAL CAPACITY TO PROVIDE
SPECIAL POPULATION SERVICES, INCLUDING OUTREACH, CASE MANAGEMENT, AND
HOME VISITING, DESIGNED TO MEET THE INDIVIDUAL NEEDS OF ALL ENROLLEES;

(XI)    PROVIDE ASSISTANCE TO ENROLLEES IN SECURING
NECESSARY HEALTH AND LONG-TERM CARE SERVICES; AND

(XII)  COMPLY WITH ALL RELEVANT PROVISIONS OF THE FEDERAL
BALANCED BUDGET ACT OF 1997 (P.L. 105-33).

(L) A COMMUNITY CARE ORGANIZATION MAY NOT HAVE FACE-TO-FACE OR
TELEPHONE CONTACT OR OTHERWISE SOLICIT AN INDIVIDUAL FOR THE PURPOSE
OF ENROLLMENT UNDER THE PROGRAM.

(M) (1) IN ARRANGING FOR THE BENEFITS REQUIRED UNDER SUBSECTION
(D) OF THIS SECTION, THE COMMUNITY CARE ORGANIZATION SHALL:

(I)      A. REIMBURSE NURSING HOMES NOT LESS THAN THE
MEDICAID-ESTABLISHED RATE BASED ON THE WAIVER RECIPIENT'S MEDICAL
CONDITION PLUS ALLOWABLE ANCILLARY SERVICES, AS ESTABLISHED BY THE
DEPARTMENT BASED ON ITS NURSING HOME MEDICAID RATE SETTING
METHODOLOGY; OR

B. FOR WAIVER RECIPIENTS THAT WOULD HAVE BEEN PAID
BY THE MEDICARE PROGRAM FOR SERVICES PROVIDED, REIMBURSE NURSING
HOMES NOT LESS THAN THE APPLICABLE REIMBURSEMENT RATE PAYABLE BY
MEDICARE FOR THAT WAIVER RECIPIENT;

(II)     REIMBURSE NURSING HOMES IN ACCORDANCE WITH THE
DEPARTMENT'S POLICY ON LEAVE OF ABSENCE AS PROVIDED UNDER § 15-117 OF
THIS SUBTITLE;

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