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Martin O'Malley, Governor
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S.B. 953
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(E) A CARRIER MAY NOT DENY A CLAIM SUBMITTED BY THE PROGRAM
SOLELY ON THE BASIS OF THE DATE OF SUBMISSION OF THE CLAIM, THE TYPE
OR FORMAT OF THE CLAIM FORM, OR FAILURE OF THE PROGRAM TO PRESENT
PROPER DOCUMENTATION AT THE POINT OF SALE THAT IS THE BASIS OF THE
CLAIM, IF:
(1) THE CLAIM IS SUBMITTED BY THE PROGRAM WITHIN 3 YEARS
AFTER THE ITEM OR SERVICE WAS PROVIDED; AND
(2) THE PROGRAM COMMENCES AN ACTION TO ENFORCE ITS
RIGHTS WITH RESPECT TO THE CLAIM WITHIN 6 YEARS OF
SUBMISSION OF THE CLAIM BY THE PROGRAM.
(D) AS A CONDITION OF DOING BUSINESS IN THE STATE, A CARRIER
SHALL COMPLY WITH THE REQUIREMENTS SET FORTH IN § 42 U.S.C.
l396A(A)(25)(I) THROUGH (IV).
(F)(E) A CARRIER SUBJECT TO THIS SECTION MAY NOT REJECT,
DENY, LIMIT, CANCEL, REFUSE TO RENEW, INCREASE THE RATES OF, AFFECT
THE TERMS OR CONDITIONS OF, OR OTHERWISE AFFECT A HEALTH INSURANCE
POLICY OR CONTRACT FOR A REASON BASED WHOLLY OR PARTLY ON:
(1) THE ELIGIBILITY OF THE INDIVIDUAL FOR RECEIVING
BENEFITS UNDER THE PROGRAM; OR
(2) THE RECEIPT BY AN INDIVIDUAL OF BENEFITS UNDER THE
PROGRAM.
19-706.
(JJJ) THE PROVISIONS OF § 15-144 OF THIS ARTICLE APPLY TO HEALTH
MAINTENANCE ORGANIZATIONS.
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect
June 1, 2007.
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May 17, 2007
The Honorable Thomas V. Mike Miller, Jr.
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- 4507 -
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