reglab/housing_qa huggingface dataset:
MD. Health - General Code Ann. §  19-712.6 (2021)
2021 Maryland Statutes|Health - General|Title 19 - Health Care Facilities|Subtitle 7 - Health Maintenance Organizations|Section 19-712.6 - Continuing Care Facility

    (a)    Whenever a subscriber or an enrollee of a health maintenance organization is a resident of a continuing care facility that is regulated under Title 10, Subtitle 4 of the Human Services Article and received health care services in an acute care health care facility, the resident’s primary care physician shall refer, if medically appropriate, the resident to the skilled nursing unit at the resident’s continuing care facility for the provision of health care services included in the resident’s health maintenance organization Medicare contract if:        (1)    The primary care physician and the resident or the designated representative of the resident do not choose an alternative course of treatment;        (2)    The continuing care facility becomes a contracting provider in accordance with the health maintenance organization’s standard terms and conditions for its participating providers and meets the credentialing criteria for becoming a participating provider;        (3)    The continuing care facility meets all the guidelines established by the Division of Licensing and Certification of the Department, including Medicare certification; and        (4)    The continuing care facility’s skilled nursing unit is certified as a Medicare skilled nursing facility.    (b)    (1)    The continuing care facility is not obligated to accept for the provision of health care services anyone other than a resident of the continuing care facility.        (2)    The health maintenance organization and the continuing care facility are not obligated to advertise in any manner that the continuing care facility is a participating provider with respect to coverage offered by the health maintenance organization for Medicare benefits or other treatment in the skilled nursing unit for anyone other than residents of the continuing care facility.
MD. Health - General Code Ann. §  19-712.7 (2021)
2021 Maryland Statutes|Health - General|Title 19 - Health Care Facilities|Subtitle 7 - Health Maintenance Organizations|Section 19-712.7 - Reimbursement to Community Health Resources

    To the extent required under federal law, a health maintenance organization shall reimburse a community health resource, as defined in § 19-2101 of this title, for covered services provided to a member or subscriber of the health maintenance organization.
MD. Health - General Code Ann. §  19-713.3 (2021)
2021 Maryland Statutes|Health - General|Title 19 - Health Care Facilities|Subtitle 7 - Health Maintenance Organizations|Section 19-713.3 - Administrative Service Contracting Provider

    (a)    (1)    In this section the following words have the meanings indicated.        (2)    “Administrative service provider contract” has the meaning stated in § 19-713.2 of this subtitle.        (3)    “Contracting provider” has the meaning stated in § 19-713.2 of this subtitle.    (b)    (1)    A person must register with the Commissioner before the person acts as a contracting provider in this State.        (2)    A health maintenance organization may not enter into an administrative service provider contract with a contracting provider that has not registered with the Commissioner.    (c)    (1)    An applicant for registration shall submit an application to the Commissioner in a form approved by the Commissioner and include any information required under subsection (e) of this section.        (2)    A registration under this section expires 2 years from the date the application is approved.    (d)    The Commissioner may charge a registration fee sufficient to cover the cost of implementing this section.    (e)    The Commissioner may adopt regulations to carry out the provisions of this section and § 19-713.2 of this subtitle.
MD. Health - General Code Ann. §  19-713.4 (2021)
2021 Maryland Statutes|Health - General|Title 19 - Health Care Facilities|Subtitle 7 - Health Maintenance Organizations|Section 19-713.4 - Providing Pharmaceutical Services

    (a)    In this section, “health maintenance organization” or “HMO” includes any agent of a health maintenance organization.    (b)    (1)    A health maintenance organization that issues a request for proposal, including changes in terms to an existing contract to provide pharmaceutical services, shall notify the Maryland Pharmacists Association of the request for proposal to provide pharmaceutical services within 10 days after issuing that request.        (2)    The Maryland Pharmacists Association may inform licensed pharmacists of the request.    (c)    A health maintenance organization may not charge a fee for processing or accepting an application to provide pharmaceutical services.    (d)    This section does not apply to a health maintenance organization if the health maintenance organization provides pharmaceutical services from a pharmacy that is:        (1)    Located on the site of the health maintenance organization; and        (2)    Wholly owned and operated by the health maintenance organization.
MD. Health - General Code Ann. §  19-713.5 (2021)
2021 Maryland Statutes|Health - General|Title 19 - Health Care Facilities|Subtitle 7 - Health Maintenance Organizations|Section 19-713.5 - Uniform Consultation Referral Form

    (a)    If a health maintenance organization requires its subscribers to have a referral to receive consultation services in writing, the health maintenance organization shall use the uniform consultation referral form adopted by the Commissioner under § 15-120 of the Insurance Article as the sole instrument for referrals for consultation services.    (b)    A health maintenance organization may not impose as a condition of coverage any requirement to:        (1)    Modify the uniform consultation referral form; or        (2)    Submit additional consultation referral forms.    (c)    The uniform consultation referral form shall be properly completed by the health care provider referring the subscriber for consultation services.
MD. Health - General Code Ann. §  19-714 (2021)
2021 Maryland Statutes|Health - General|Title 19 - Health Care Facilities|Subtitle 7 - Health Maintenance Organizations|Section 19-714 - Marketing Documents

    Each marketing document that sets forth the health care services of a health maintenance organization shall describe fully and clearly:         (1)    The health care services under each benefit package and every other benefit to which a member is entitled;        (2)    Where and how services may be obtained;        (3)    Each exclusion or limitation on any service or other benefit that it provides;        (4)    Each deductible feature;        (5)    Each copayment provision; and        (6)    All information required by § 15-1206 of the Insurance Article.
MD. Health - General Code Ann. §  19-715 (2021)
2021 Maryland Statutes|Health - General|Title 19 - Health Care Facilities|Subtitle 7 - Health Maintenance Organizations|Section 19-715 - Application or Offer of Enrollment

    Each health maintenance organization application or offer of enrollment shall contain or be accompanied by, and each form of health maintenance organization subscriber contract shall contain, a full and clear statement of:         (1)    The items specified in § 19-714 of this subtitle;        (2)    The rate of periodic payment;        (3)    When the coverage is effective and what restrictions, if any, apply to preexisting conditions;        (4)    All standards for cancellation of enrollment or denial of reenrollment; and        (5)    Service priorities, if any, in epidemic or other emergency or catastrophic conditions that may cause an unusually high demand for medical services.
MD. Health - General Code Ann. §  19-716 (2021)
2021 Maryland Statutes|Health - General|Title 19 - Health Care Facilities|Subtitle 7 - Health Maintenance Organizations|Section 19-716 - Availability of Information to Members and General Public

    Annually, each health maintenance organization shall provide to its members and make available to the general public, in clear, readable, and concise form:         (1)    A summary of the most recent financial report that the health maintenance organization submits to the Commissioner under § 19-717 of this subtitle;        (2)    A description of the benefit packages available and the nongroup rates required by the Commissioner;        (3)    A description of the accessibility and availability of services, including where and how to obtain them;        (4)    A statement of the potential responsibility of a member for payment for services the member seeks to obtain from a provider, including a physician or hospital, that does not have a written contract with the health maintenance organization;        (5)    A description of procedures to be followed for emergency services, including:            (i)    The appropriate use of hospital emergency facilities;            (ii)    The appropriate use, location, and hours of operation of any urgent care facilities operated by the health maintenance organization; and            (iii)    The potential responsibility of subscribers and enrollees for payment for emergency services or nonemergency services rendered in a hospital emergency facility;        (6)    A statement that shows, by category, the percentage of members assisted by public funds;        (7)    The information required to be disclosed by § 15-1206 of the Insurance Article; and        (8)    Any other information that the Commissioner or the Department requires by rule or regulation.
MD. Health - General Code Ann. §  19-717 (2021)
2021 Maryland Statutes|Health - General|Title 19 - Health Care Facilities|Subtitle 7 - Health Maintenance Organizations|Section 19-717 - Annual Reports

    (a)    Except as provided in subsections (b) and (c) of this section and unless, for good cause shown, the Commissioner extends the time for a reasonable period:        (1)    On or before March 1 of each year, each health maintenance organization shall file with the Commissioner a report that shows the financial condition of the health maintenance organization on the last day of the preceding calendar year and any other information that the Commissioner requires by rule or regulation; and        (2)    On or before June 1 of each year, each health maintenance organization shall file with the Commissioner an audited financial report for the preceding calendar year.    (b)    A health maintenance organization that has a fiscal year other than the calendar year may request permission to file both the annual report required under subsection (a)(1) of this section and the audited financial report required under subsection (a)(2) of this section at the end of its fiscal year rather than the preceding calendar year. If the Commissioner grants this permission, the health maintenance organization shall file the annual report with the Commissioner within 60 days after the end of its fiscal year, and the health maintenance organization shall file the audited financial report with the Commissioner within 150 days after the end of its fiscal year.    (c)    With 90 days’ advance notice, the Commissioner may require a health maintenance organization to file an audited financial report earlier than the date specified in subsection (a) of this section.    (d)    The annual report shall:        (1)    Be on the forms that the Commissioner requires; and        (2)    Include a description of any changes in the information submitted under § 19–708 of this subtitle.    (e)    The audited financial report shall:        (1)    Be on the forms that the Commissioner requires; and        (2)    Be certified by an audit of a certified public accounting firm.    (f)    Each financial report filed under this section is a public record.
MD. Health - General Code Ann. §  19-719 (2021)
2021 Maryland Statutes|Health - General|Title 19 - Health Care Facilities|Subtitle 7 - Health Maintenance Organizations|Section 19-719 - Health Care Services; Examination

    Under rules, regulations, and procedures that the Secretary approves and using methods that keep the identity of patients as confidential as possible, assure objective evaluation, and are consistent with § 19-710 of this subtitle, the Department may do periodic examinations to:         (1)    Determine the quality of health care services being provided by health maintenance organizations; and        (2)    Develop statistical information.
MD. Health - General Code Ann. §  19-720 (2021)
2021 Maryland Statutes|Health - General|Title 19 - Health Care Facilities|Subtitle 7 - Health Maintenance Organizations|Section 19-720 - Health Services Cost Review Commission

    (a)    The State Health Services Cost Review Commission promptly shall give the Commissioner and the Secretary any financial information that the Commission acquires about each facility that is:        (1)    Under the jurisdiction of the Commission; and        (2)    Subject to this subtitle.    (b)    If requested by the Commissioner or the Secretary, the State Health Services Cost Review Commission shall provide any other information that the Commission is authorized to acquire about health maintenance organizations regulated under this subtitle.
MD. Health - General Code Ann. §  19-721 (2021)
2021 Maryland Statutes|Health - General|Title 19 - Health Care Facilities|Subtitle 7 - Health Maintenance Organizations|Section 19-721 - Expiration of Certificate of Authority

    (a)    Unless previously suspended or revoked, each original and renewal certificate of authority issued under this subtitle to a health maintenance organization expires at midnight on the November 30 after its effective date.    (b)    On payment of an annual renewal fee of $25 by the health maintenance organization before the expiration date of its certificate of authority, its certificate remains in effect until a new certificate of authority is issued or specifically refused.
MD. Health - General Code Ann. §  19-722 (2021)
2021 Maryland Statutes|Health - General|Title 19 - Health Care Facilities|Subtitle 7 - Health Maintenance Organizations|Section 19-722 - Refusal to Renew Certificate; Remedies

    (a)    The Commissioner may refuse to renew a certificate of authority for any reason for which the Commissioner may:        (1)    Refuse to issue an original certificate; or        (2)    Suspend or revoke an existing certificate.    (b)    If the Commissioner refuses to renew a certificate of authority, the applicant has the same administrative and legal remedies as those provided under this subtitle for the suspension or revocation of a certificate of authority.
MD. Health - General Code Ann. §  19-723 (2021)
2021 Maryland Statutes|Health - General|Title 19 - Health Care Facilities|Subtitle 7 - Health Maintenance Organizations|Section 19-723 - Supervision of Health Maintenance Organizations

    (a)    At all times, each health maintenance organization is subject to the supervision of the Commissioner and the Department as provided in this subtitle.    (b)    Any health maintenance organization that contracts with the Department and is subject to this subtitle shall act in concert with the Department or with the written consent of the Department concerning all information that the Commissioner requires.
MD. Health - General Code Ann. §  19-724 (2021)
2021 Maryland Statutes|Health - General|Title 19 - Health Care Facilities|Subtitle 7 - Health Maintenance Organizations|Section 19-724 - Solicitation of Members

    (a)    Except as provided in subsection (b) of this section, a health maintenance organization may solicit members through advertising its services, charges, or nonprofessional aspects of its operation.    (b)    A health maintenance organization may not use any advertising that makes any qualitative judgment about any person who provides services for a health maintenance organization.
MD. Health - General Code Ann. §  19-725 (2021)
2021 Maryland Statutes|Health - General|Title 19 - Health Care Facilities|Subtitle 7 - Health Maintenance Organizations|Section 19-725 - Cancellation of Enrollment

    (a)    A health maintenance organization may not cancel the enrollment of a member or refuse to transfer a member from a group to an individual basis because of age, sex, race, or health status.    (b)    A health maintenance organization may cancel a contract with a member who violates any published policy of the health maintenance organization that has been approved by the Commissioner and the Department under their joint internal procedures.
MD. Health - General Code Ann. §  19-726 (2021)
2021 Maryland Statutes|Health - General|Title 19 - Health Care Facilities|Subtitle 7 - Health Maintenance Organizations|Section 19-726 - Prohibited Use of Certain Terms

    (a)    (1)    A health maintenance organization may not include in its name:            (i)    The words “insurer”, “casualty”, “surety”, or “health and accident”; or            (ii)    Any other words generally regarded as descriptive of the insurance industry.        (2)    This subsection does not apply to an insurer or health service corporation that is licensed and regulated under the laws of this State, except as to its health maintenance organization activities that are authorized and regulated under this subtitle.    (b)    Except as authorized by the Commissioner under this subtitle, a person other than a health maintenance organization regulated under this subtitle may not designate its services, operations, or functions as a “health maintenance organization” or use any other title or designation if the arrangement of services, operations, or functions substantially fall under the definition of a health maintenance organization in § 19-701 of this subtitle.
MD. Health - General Code Ann. §  19-727 (2021)
2021 Maryland Statutes|Health - General|Title 19 - Health Care Facilities|Subtitle 7 - Health Maintenance Organizations|Section 19-727 - Applicability of Tax Laws

    (a)    Except as provided in subsection (b) of this section, a health maintenance organization is not exempted from any State, county, or local taxes solely because of this subtitle.    (b)    (1)    A nonprofit health maintenance organization that is exempt from taxation under § 501(c)(3) of the Internal Revenue Code is not subject to the insurance premium tax under Title 6, Subtitle 1 of the Insurance Article.        (2)    Premiums received by an insurer under policies that provide health maintenance organization benefits are not subject to the premium tax imposed under Title 6, Subtitle 1 of the Insurance Article to the extent:            (i)    Of the amounts actually paid by the insurer to a nonprofit health maintenance organization that operates only as a health maintenance organization; or            (ii)    The premiums have been paid by that nonprofit health maintenance organization.
MD. Health - General Code Ann. §  19-728 (2021)
2021 Maryland Statutes|Health - General|Title 19 - Health Care Facilities|Subtitle 7 - Health Maintenance Organizations|Section 19-728 - Responsibilities of Department and Commissioner

    (a)    The Commissioner is responsible for:        (1)    Determining whether each health maintenance organization is or will be able to provide a fiscally sound operation and adequate provision against risk of insolvency and may adopt reasonable rules and regulations designed to achieve this goal; and        (2)    Actuarial and financial evaluations and determinations of each health maintenance organization.    (b)    (1)    If the Commissioner determines that a health maintenance organization is not operating in a fiscally sound manner, the Commissioner shall notify the Department of the determination.        (2)    After notifying the Department in accordance with the provisions of paragraph (1) of this subsection, the Commissioner shall monitor the health maintenance organization on a continuous basis until the Commissioner determines that the health maintenance organization is operating in a fiscally sound manner.
MD. Health - General Code Ann. §  19-729 (2021)
2021 Maryland Statutes|Health - General|Title 19 - Health Care Facilities|Subtitle 7 - Health Maintenance Organizations|Section 19-729 - Prohibited Acts; Remedies

    (a)    A health maintenance organization may not:        (1)    Violate any provision of this subtitle or any rule or regulation adopted under it;        (2)    Fail to fulfill its obligations to provide the health care services specified in its contracts with subscribers;        (3)    Make any false statement with respect to any report or statement required by this subtitle or by the Commissioner under this subtitle;        (4)    Advertise, merchandise, or attempt to merchandise its services in a way that misrepresents its services or capacity for service;        (5)    Engage in a deceptive, misleading, unfair, or unauthorized practice as to advertising or merchandising;        (6)    Prevent or attempt to prevent the Commissioner or the Department from performing any duty imposed by this subtitle;        (7)    Fraudulently obtain or fraudulently attempt to obtain any benefit under this subtitle;        (8)    Fail to fulfill the basic requirements to operate as a health maintenance organization as provided in § 19-710 of this subtitle;        (9)    Violate any applicable provision of Title 15, Subtitle 12 of the Insurance Article;        (10)    Fail to provide services to a member in a timely manner as provided in § 19-705.1(b)(1) of this subtitle;        (11)    Fail to comply with the provisions of Title 15, Subtitle 10A, 10B, 10C, or 10D or § 2-112.2 of the Insurance Article; or        (12)    Violate any provision of § 19-712.5 of this subtitle.    (b)    If any health maintenance organization violates this section, the Commissioner may pursue any one or more of the courses of action described in § 19-730 of this subtitle.
MD. Health - General Code Ann. §  19-730 (2021)
2021 Maryland Statutes|Health - General|Title 19 - Health Care Facilities|Subtitle 7 - Health Maintenance Organizations|Section 19-730 - Penalties -- Violation of 19-729 of This Subtitle

    (a)    If any person violates any provision of § 19-729 of this subtitle, the Commissioner may:        (1)    Issue an administrative order that requires the health maintenance organization to:            (i)    Cease inappropriate conduct or practices by it or any of the personnel employed or associated with it;            (ii)    Fulfill its contractual obligations;            (iii)    Provide a service that has been denied improperly;            (iv)    Take appropriate steps to restore its ability to provide a service that is provided under a contract;            (v)    Cease the enrollment of any additional enrollees except newborn children or other newly acquired dependents of existing enrollees; or            (vi)    Cease any advertising or solicitation;        (2)    In addition to suspending or revoking a certificate of authority:            (i)    Impose a penalty of not less than $100, but not more than $125,000 for each violation; and            (ii)    Order the health maintenance organization to pay restitution to any person who has suffered financial injury because of the violation;        (3)    Suspend, revoke, or refuse to renew the certificate of authority to do business as a health maintenance organization;        (4)    Suspend, revoke, or refuse to renew the certificate of a medical director of a health maintenance organization; or        (5)    Apply to any court for legal or equitable relief considered appropriate by the Commissioner or the Department, in accordance with the joint internal procedures.    (b)    If the Commissioner issues an order or imposes any penalty under this section, the Commissioner immediately shall provide written notice of the order or penalty to the Secretary.