reglab/housing_qa huggingface dataset:
MD. Health - General Code Ann. §  19-703 (2021)
2021 Maryland Statutes|Health - General|Title 19 - Health Care Facilities|Subtitle 7 - Health Maintenance Organizations|Section 19-703 - Scope of Subtitle

    (a)    This subtitle does not:        (1)    Authorize any person to engage directly or indirectly in the practice of any health occupation except as otherwise authorized by law;        (2)    Authorize any person to regulate, interfere, or intervene in the relationship between any provider of health care services and the patients of the provider; or        (3)    Prohibit any health maintenance organization from meeting the requirements of any federal law that authorizes the health maintenance organization to:            (i)    Receive federal financial assistance; or            (ii)    Enroll beneficiaries assisted by federal funds.    (b)    A health maintenance organization or a part of it that is also a community health center organized under the federal Public Health Service Act and receives federal funds under 42 U.S.C. § 254c is not required to provide hospitalization for individuals for whom services are provided by those funds.    (c)    Health maintenance organizations shall offer as an option to all of their members or subscribers benefits for hospice services provided by a hospice care program, as defined in § 19–901(c) of this title.    (d)    Health maintenance organizations shall provide continuation coverage required under §§ 15–407 through 15–409 of the Insurance Article.    (e)    Notwithstanding any other provision of this subtitle, a health maintenance organization may provide a limited set of health benefits if the limited set of health benefits is for subscribers or members who are enrolled in a county program to provide health care services for low–income individuals.    (f)    (1)    In addition to the requirements of § 15–10B–09 of the Insurance Article, whenever a mother is required to remain hospitalized after childbirth for medical reasons and the mother requests that the newborn remain in the hospital, a health maintenance organization shall provide as part of its hospitalization services provided to members and subscribers payment for the cost of additional hospitalization for the newborn for up to 4 days.        (2)    The attending physician or certified nurse midwife of the mother, or the designee of the attending physician or certified nurse midwife, shall provide notice to the mother of the provisions of paragraph (1) of this subsection.
MD. Health - General Code Ann. §  19-704 (2021)
2021 Maryland Statutes|Health - General|Title 19 - Health Care Facilities|Subtitle 7 - Health Maintenance Organizations|Section 19-704 - Corporate Practice of Medicine

    A health maintenance organization may operate as authorized by this subtitle notwithstanding any prohibition against the corporate practice of medicine.
MD. Health - General Code Ann. §  19-705 (2021)
2021 Maryland Statutes|Health - General|Title 19 - Health Care Facilities|Subtitle 7 - Health Maintenance Organizations|Section 19-705 - Rules and Regulations

    (a)    (1)    The Secretary may adopt rules, regulations, and standards for the quality of health care services provided by a health maintenance organization through its benefit packages.        (2)    With the advice of the Department, the Commissioner shall adopt reasonable rules and regulations as necessary to carry out any other provisions of this subtitle.    (b)    (1)    The Commissioner and the Department shall adopt joint internal procedures to help them work together to carry out their duties under this subtitle.        (2)    The joint internal procedures shall establish means by which the Commissioner and the Department may inform each other promptly on matters that affect any health maintenance organization, including:            (i)    Any important action, change, or rearrangement that a health maintenance organization may undertake; and            (ii)    Any regulatory problem.
MD. Health - General Code Ann. §  19-705.2 (2021)
2021 Maryland Statutes|Health - General|Title 19 - Health Care Facilities|Subtitle 7 - Health Maintenance Organizations|Section 19-705.2 - Complaints of Members and Subscribers

    (a)    With the advice of the Secretary, the Commissioner shall adopt regulations to establish a system for the receipt and timely investigation of complaints of members and subscribers of health maintenance organizations concerning the operation of any health maintenance organization in this State.    (b)    The complaint system shall include:        (1)    A procedure for the timely acknowledgment of receipt of a complaint;        (2)    Criteria that the Secretary shall adopt by regulation for determining the appropriate level of investigation for a complaint concerning quality of care, including:            (i)    A determination as to whether the member or subscriber with the complaint previously attempted to have the complaint resolved; and            (ii)    A determination as to whether a complaint should be sent to the member’s or subscriber’s health maintenance organization for resolution prior to investigation under the provisions of this section; and        (3)    A procedure for the referral of quality of care complaints to the Secretary for an appropriate investigation.    (c)    If a determination is made to investigate a complaint under the provisions of this section prior to the member or subscriber attempting to otherwise resolve the complaint, the reasons for that determination shall be documented.    (d)    Notice of the complaint system established under the provisions of this section shall be included in all contracts between a health maintenance organization and a member or subscriber of a health maintenance organization.    (e)    For quality of care complaints referred to the Secretary for investigation under subsection (b)(3) of this section, the Secretary shall report to the Commissioner in a timely manner on the results and findings of each investigation.
MD. Health - General Code Ann. §  19-705.3 (2021)
2021 Maryland Statutes|Health - General|Title 19 - Health Care Facilities|Subtitle 7 - Health Maintenance Organizations|Section 19-705.3 - Centers for Disease Control and Prevention's Guidelines on Universal Precautions

    (a)    In this section, “health maintenance organization” means a health maintenance organization where health care services are delivered by health care providers to subscribers at a central facility or centralized system of facilities operated by the health maintenance organization.    (b)    The Department shall adopt regulations to require health maintenance organizations to:        (1)    Adopt, implement, and enforce a policy that requires, except in an emergency life–threatening situation where it is not feasible or practicable, all employees and medical staff involved in patient care services to comply with the Centers for Disease Control and Prevention’s guidelines on universal precautions; and        (2)    Display the notice developed under § 1–207 of the Health Occupations Article at the entrance to the health maintenance organization.    (c)    If the health maintenance organization fails to comply with the requirements of this section the Secretary may impose a penalty of up to $500 per day per violation for each day a violation continues.
MD. Health - General Code Ann. §  19-705.4 (2021)
2021 Maryland Statutes|Health - General|Title 19 - Health Care Facilities|Subtitle 7 - Health Maintenance Organizations|Section 19-705.4 - Limitations on Covered Services and Visits

    (a)    Any limitation imposed by a health maintenance organization on the receipt of covered services provided to a member or subscriber by a physical therapist licensed under Title 13 of the Health Occupations Article may only be imposed per incident or per injury within a contract period.    (b)    This subsection may not be construed to prohibit a health maintenance organization from imposing any limitations on the number of visits permitted for a member or subscriber.
MD. Health - General Code Ann. §  19-705.5 (2021)
2021 Maryland Statutes|Health - General|Title 19 - Health Care Facilities|Subtitle 7 - Health Maintenance Organizations|Section 19-705.5 - Coverage for Inherited Metabolic Disease

    (a)    (1)    In this section the following words have the meanings indicated.        (2)    (i)    “Inherited metabolic disease” means a disease caused by an inherited abnormality of body chemistry.            (ii)    “Inherited metabolic disease” includes a disease for which the State screens newborn babies.        (3)    (i)    “Low protein modified food product” means a food product that is:                1.    Specially formulated to have less than 1 gram of protein per serving; and                2.    Intended to be used under the direction of a physician for the dietary treatment of an inherited metabolic disease.            (ii)    “Low protein modified food product” does not include a natural food that is naturally low in protein.        (4)    “Medical food” means a food that is:            (i)    Intended for the dietary treatment of a disease or condition for which nutritional requirements are established by medical evaluation; and            (ii)    Formulated to be consumed or administered enterally under the direction of a physician.    (b)    A health maintenance organization shall include as part of its benefit package of health care services to be provided to members and subscribers coverage for medical foods and low protein modified food products for the treatment of inherited metabolic diseases if the medical foods and low protein modified food products are:        (1)    Prescribed as medically necessary for the therapeutic treatment of inherited metabolic diseases; and        (2)    Administered under the direction of a physician.
MD. Health - General Code Ann. §  19-705.6 (2021)
2021 Maryland Statutes|Health - General|Title 19 - Health Care Facilities|Subtitle 7 - Health Maintenance Organizations|Section 19-705.6 - Emergency Services

    (a)    If it is necessary to provide emergency services, authorization shall be presumed for utilizing the medical or surgical provider on call for unassigned patients or the appropriate specialist on call for the hospital on that date if:        (1)    A telephone access system is not operational at the time of the call; or        (2)    A member’s primary care provider or the specialist needed by a member cannot be determined within a reasonable time, as determined by the treating emergency physician but not to exceed 30 minutes after the initial documented call to the telephone access system.    (b)    This section may not be construed to require a health maintenance organization to have contracted specialist providers at hospitals outside of the service area of the health maintenance organization.
MD. Health - General Code Ann. §  19-705.7 (2021)
2021 Maryland Statutes|Health - General|Title 19 - Health Care Facilities|Subtitle 7 - Health Maintenance Organizations|Section 19-705.7 - Toll-Free Telephone Access

    The 24-hour toll free telephone access system provided by each health maintenance organization shall:         (1)    Enable members and providers to determine, with one telephone call, the primary care provider assigned to a member; and        (2)    Enable providers to determine, with one telephone call, the names of three contracted specialist providers for the health maintenance organization who also have staff privileges at a particular hospital in the State.
MD. Health - General Code Ann. §  19-705.8 (2021)
2021 Maryland Statutes|Health - General|Title 19 - Health Care Facilities|Subtitle 7 - Health Maintenance Organizations|Section 19-705.8 - Health Maintenance Organization Quality Assurance Unit

    (a)    (1)    In this section the following words have the meanings indicated.        (2)    “HMO Quality Assurance Unit” means the Health Maintenance Organization (HMO) Quality Assurance Unit in the Department.        (3)    “Quality Assurance Medical Director” means the Medical Director of the HMO Quality Assurance Unit.    (b)    There is a Health Maintenance Organization (HMO) Quality Assurance Unit in the Department.    (c)    (1)    The Secretary shall appoint the Quality Assurance Medical Director.        (2)    The Quality Assurance Medical Director shall:            (i)    Be a physician who is licensed in the State;            (ii)    Be board certified in at least one specialty;            (iii)    Have experience in primary care and administrative medicine; and            (iv)    Have broad knowledge of health maintenance organizations and managed care organizations.        (3)    The Quality Assurance Medical Director is entitled to the compensation provided in the State budget.        (4)    Subject to the authority vested in the Secretary by law, the Quality Assurance Medical Director is in charge of and responsible for the clinical operations of the HMO Quality Assurance Unit.        (5)    In accordance with the State budget the Secretary may employ staff for the HMO Quality Assurance Unit.    (d)    The HMO Quality Assurance Unit shall:        (1)    Enforce all requirements established under §§ 19-705 and 19-705.1 of this subtitle and the regulations adopted under these provisions regarding the quality of health care provided by a health maintenance organization; and        (2)    Investigate quality of care complaints referred to the Secretary under § 19-705.2(b)(3) of this subtitle.    (e)    The Quality Assurance Medical Director shall:        (1)    Determine whether a health maintenance organization meets the requirements established under §§ 19-705 and 19-705.1 of this subtitle and the regulations adopted under these provisions regarding the quality of health care provided by a health maintenance organization; and        (2)    Make recommendations to the Secretary for corrective action necessary to meet these requirements.    (f)    If the Secretary agrees with a determination made by the Quality Assurance Medical Director that a health maintenance organization does not meet the requirements established under §§ 19-705 and 19-705.1 of this subtitle or the regulations adopted under these provisions regarding the quality of health care provided by a health maintenance organization, the Secretary may issue an order under § 19-731 of this subtitle.
MD. Health - General Code Ann. §  19-706 (2021)
2021 Maryland Statutes|Health - General|Title 19 - Health Care Facilities|Subtitle 7 - Health Maintenance Organizations|Section 19-706 - Regulation; Applicability of Other Laws

    (a)    Each health maintenance organization that is issued a certificate of authority by the Commissioner shall be regulated under this subtitle.    (b)    (1)    Any health maintenance organization that is regulated by Title 14, Subtitle 1 of the Insurance Article is subject also to this subtitle.        (2)    This subsection applies to a corporation described in Title 14, Subtitle 1 of the Insurance Article, but only if it is a health maintenance organization.    (c)    Except as otherwise provided in this subtitle or expressly provided in the Insurance Article, a health maintenance organization is not subject to the insurance laws of this State.    (d)    Only the Commissioner may issue, suspend, or revoke a certificate of authority of a health maintenance organization.    (e)    The provisions of Title 27, Subtitle 8 of the Insurance Article shall apply to health maintenance organizations.    (f)    The provisions of Title 15, Subtitle 10B of the Insurance Article shall apply to health maintenance organizations.    (g)    The provisions of Title 6.5 of the State Government Article shall apply to the acquisition of a health maintenance organization owned by a nonprofit entity.    (h)    The provisions of § 27–210 of the Insurance Article apply to health maintenance organizations.    (i)    The provisions of § 15–145 of this article apply to health maintenance organizations.    (j)    The provisions of Title 15, Subtitle 16 of the Insurance Article apply to health maintenance organizations.    (k)    The provisions of § 2–517 of the State Personnel and Pensions Article apply to health maintenance organizations.    (l)    The provisions of § 15–134 of the Insurance Article apply to health maintenance organizations.    (m)    The provisions of § 4–406 of the Insurance Article apply to health maintenance organizations.    (n)    The provisions of Title 4, Subtitle 5 of the Insurance Article apply to health maintenance organizations.    (o)    The provisions of Title 9, Subtitle 4 of the Insurance Article apply to health maintenance organizations.
MD. Health - General Code Ann. §  19-707 (2021)
2021 Maryland Statutes|Health - General|Title 19 - Health Care Facilities|Subtitle 7 - Health Maintenance Organizations|Section 19-707 - Authorization to Operate

    (a)    A health maintenance organization shall obtain from the Commissioner a certificate of authority to operate as a health maintenance organization before it may issue any contract or certificate to a member, provide any health care services to a member, or otherwise operate in this State.    (b)    Except as permitted by the Commissioner and subject to the rules and regulations adopted under this subtitle, a health maintenance organization that does not have a certificate of authority may not contact potential members to discuss the health care services the health maintenance organization proposes to offer if a certificate of authority is granted.
MD. Health - General Code Ann. §  19-709 (2021)
2021 Maryland Statutes|Health - General|Title 19 - Health Care Facilities|Subtitle 7 - Health Maintenance Organizations|Section 19-709 - Initial Fees

    (a)    When a health maintenance organization files its initial application for a certificate of authority to operate, it shall pay to the Commissioner a fee of $300.    (b)    In addition to the fee required under subsection (a) of this section, each health maintenance organization shall pay a reasonable sum that the Commissioner finds to be the cost of the investigations made by the Commissioner and the Department as required under this subtitle.
MD. Health - General Code Ann. §  19-711 (2021)
2021 Maryland Statutes|Health - General|Title 19 - Health Care Facilities|Subtitle 7 - Health Maintenance Organizations|Section 19-711 - Issuance of Certificate of Authority; Merger, Consolidation, etc., With Domestic Health Maintenance Organization

    (a)    Within 90 days after the filing of an application for a certificate of authority to operate as a health maintenance organization, the Commissioner shall issue the certificate of authority to the applicant if:        (1)    The application conforms with § 19-708 of this subtitle;        (2)    The applicant has paid the fees required by § 19-709 of this subtitle;        (3)    The Department has advised in writing that the health maintenance organization’s proposed health-related services, operations, and functions that fall under the regulatory jurisdiction of the Department appear to meet its requirements or are approved by the Department; and        (4)    The Commissioner is satisfied that the requirements of § 19-710 of this subtitle are met.    (b)    (1)    Subject to paragraph (2) of this subsection, the provisions of Title 7 of the Insurance Article apply to health maintenance organizations.        (2)    Before approving a transaction under § 7-306 of the Insurance Article, the Insurance Commissioner shall consult with the Secretary.    (c)    Subsection (b) of this section may not apply to any transaction preempted by federal law.
MD. Health - General Code Ann. §  19-711.3 (2021)
2021 Maryland Statutes|Health - General|Title 19 - Health Care Facilities|Subtitle 7 - Health Maintenance Organizations|Section 19-711.3 - Merger, Consolidation, or Acquisition of Health Maintenance Organization; Financing Money

    In any case where a health maintenance organization is being merged or consolidated with or acquired by another person, any current financing money provided by the health maintenance organization to a hospital, in accordance with regulations adopted by the Health Services Cost Review Commission, in return for a discount in rates charged by the hospital shall be deemed to be security for the amount of outstanding charges owed by the health maintenance organization to the hospital for bills or claims for services provided by the hospital prior to the merger, consolidation, or acquisition.
MD. Health - General Code Ann. §  19-712.2 (2021)
2021 Maryland Statutes|Health - General|Title 19 - Health Care Facilities|Subtitle 7 - Health Maintenance Organizations|Section 19-712.2 - Notice to Pharmacies of Change in Pharmaceutical Benefits

    (a)    A health maintenance organization that provides pharmaceutical benefits shall notify all pharmacies under contract with the health maintenance organization in writing of changes in the pharmaceutical benefit program rules or requirements at least 30 days before the change is effective.    (b)    Changes that require 30 days’ advance written notice under subsection (a) of this section are:        (1)    Exclusion of coverage for classes of drugs as specified by contract;        (2)    Changes in prior or preauthorization procedures; and        (3)    Selection of new prescription claims processors.    (c)    A health maintenance organization that fails to provide advance notice as required under subsection (a) of this section shall honor and pay in full any claim under the program rules or requirements that existed before the change for 30 days after the postmarked date of the notice.
MD. Health - General Code Ann. §  19-712.4 (2021)
2021 Maryland Statutes|Health - General|Title 19 - Health Care Facilities|Subtitle 7 - Health Maintenance Organizations|Section 19-712.4 - Prohibited Referrals

    (a)    In this section the terms “health care practitioner”, “health care entity”, and “health care service” have the same meanings as provided in § 1–301 of the Health Occupations Article.    (b)    A health maintenance organization may seek repayment from a health care practitioner of any money paid for any claim, bill, or other demand or request for payment for the health care services that were determined by the appropriate regulatory licensing board to be furnished as a result of a referral prohibited by § 1–302 of the Health Occupations Article.    (c)    Every contract between a health maintenance organization and its subscribers or a group of subscribers for the provision of health care services shall include a provision excluding payment of any claim, bill, or other demand or request for payment for health care services determined to be furnished as a result of a referral prohibited by § 1–302 of the Health Occupations Article.    (d)    A health maintenance organization subject to the provisions of this section shall report to the Commissioner and the appropriate regulatory board any pattern of claims, bills or other demands or requests for payment submitted for a health care service provided as a result of a referral prohibited by § 1–302 of the Health Occupations Article within 30 days after that health maintenance organization has knowledge of that pattern.    (e)    (1)    Notwithstanding the provisions of this section, a health maintenance organization reimbursing for health care services is not required to audit or investigate any claim, bill, or other demand or request for payment for the purpose of determining whether those services were the result of a prohibited referral.        (2)    Any audit or investigation of any claim, bill, or other demand or request for payment for the purpose of determining whether those services were the result of the prohibited referral are not grounds to delay payment or waive the provisions of § 15–1005 of the Insurance Article.    (f)    For any claim, bill, or request for payment that is paid and is subsequently determined to be the result of a prohibited referral, a health maintenance organization may seek a refund of that payment in accordance with the provisions of § 1–305 of the Health Occupations Article.