ROBERT L. EHRLICH, JR., Governor                                Ch. 4

(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;

(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

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