ROBERT L. EHRLICH, JR., Governor                            S.B. 819

(III)   REIMBURSE ADULT DAY CARE FACILITIES NOT LESS THAN THE
RATE DETERMINED BY THE DEPARTMENT FOR THE MEDICAL ASSISTANCE PROGRAM;

(IV)    REIMBURSE HOSPITALS IN ACCORDANCE WITH THE RATES
ESTABLISHED BY THE HEALTH SERVICES COST REVIEW COMMISSION;

(V)     FOR ENROLLEES WITH COMPLEX. LONG-TERM CARE NEEDS.
USE A COMPREHENSIVE CARE AND SUPPORT MANAGEMENT TEAM. INCLUDING THE
PRIMARY CARE PROVIDER, NURSE MANAGER, CASE MANAGER. AND OTHERS AS
APPROPRIATE; AND

(VI)    REIMBURSE A HOSPITAL EMERGENCY FACILITY AND PROVIDER
FOR:

1.       HEALTH CARE SERVICES THAT MEET THE DEFINITION OF
EMERGENCY SERVICES UNDER § 19-701 OF THIS ARTICLE;

2.       MEDICAL SCREENING SERVICES RENDERED TO MEET THE
REQUIREMENTS OF THE FEDERAL EMERGENCY MEDICAL TREATMENT AND ACTIVE
LABOR ACT;

3.       MEDICALLY NECESSARY SERVICES IF THE COMMUNITY
CARE ORGANIZATION AUTHORIZED. REFERRED, OR OTHERWISE ALLOWED THE
ENROLLEE TO USE THE EMERGENCY FACILITY AND THE MEDICALLY NECESSARY
SERVICES ARE RELATED TO THE CONDITION FOR WHICH THE ENROLLEE WAS
ALLOWED TO USE THE EMERGENCY FACILITY; AND

4.       MEDICALLY NECESSARY SERVICES THAT RELATE TO THE
CONDITION PRESENTED AND THAT ARE PROVIDED BY THE PROVIDER IN THE
EMERGENCY FACILITY TO THE ENROLLEE IF THE COMMUNITY CARE ORGANIZATION
FAILS TO PROVIDE 24-HOUR ACCESS TO A PHYSICIAN AS REQUIRED BY THE
DEPARTMENT.

(2)     A PROVIDER MAY NOT BE REQUIRED TO OBTAIN PRIOR
AUTHORIZATION OR APPROVAL FOR PAYMENT FROM A COMMUNITY CARE
ORGANIZATION IN ORDER TO OBTAIN REIMBURSEMENT UNDER PARAGRAPH (1) (VI)
OF THIS SUBSECTION.

(3)      NOTHING IN THIS SUBSECTION PROHIBITS A COMMUNITY CARE
ORGANIZATION FROM PROVIDING A BONUS OR INCENTIVE FOR QUALITY
IMPROVEMENTS.

(N) SAVINGS FROM THE PROGRAM DEVELOPED UNDER THIS SECTION MAY
SHALL BE USED TO:

(1)      ASSIST MEDICALLY AND FUNCTIONALLY IMPAIRED INDIVIDUALS IN
THE COMMUNITY, OR WHEN DISCHARGED FROM A HOSPITAL, TO RECEIVE HOME-
AND COMMUNITY-BASED WAIVER SERVICES;

(2)      INCREASE REIMBURSEMENT RATES TO COMMUNITY PROVIDERS;
AND

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