reglab/statecodes huggingface dataset:
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
(p)    The provisions of Title 33 of the Insurance Article apply to health maintenance organizations.
2023 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.
2023 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.
2023 Maryland Statutes › Health - General › Title 19 - Health Care Facilities › Subtitle 7 - Health Maintenance Organizations › Section 19-710.2 - Point-of-Service Option

(a)    (1)    In this section the following words have the meanings indicated.
(2)    “Carrier” means:
(i)    An insurer;
(ii)    A nonprofit health service plan;
(iii)    A health maintenance organization;
(iv)    A dental plan organization; or
(v)    Any other person or organization that provides health benefit plans subject to State regulation.
(3)    “Point-of-service option” means a health benefit plan that permits a member or subscriber of a health maintenance organization to receive any health care service outside the provider panel of the health maintenance organization that is covered under the member’s or subscriber’s contract with the health maintenance organization.
(4)    “Provider panel” means those providers with which a health maintenance organization contracts to provide services to the health maintenance organization’s members or subscribers under the health maintenance organization’s health benefit plan.
(b)    (1)    If an employer, association, or other private group arrangement offers health benefit plan coverage to employees or individuals only through a health maintenance organization, the health maintenance organization with which the employer, association, or other private group arrangement is contracting for the coverage shall offer, or contract with another carrier to offer, a point-of-service option to the employer, association, or other private group arrangement in conjunction with the health maintenance organization as an additional benefit for an employee or individual, at the employee’s or individual’s option, to accept or reject.
(2)    When a health maintenance organization is the sole delivery system offered to employees by an employer, the health maintenance organization:
(i)    Shall offer the employer a point-of-service option for the individual employee to accept or reject;
(ii)    May not impose a minimum participation level on the point-of-service option; and
(iii)    As part of the group enrollment application, shall provide to each employer a disclosure statement for each point-of-service option offered that conforms to regulations, for the point-of-service option required under paragraph (1) of this subsection, adopted by:
1.    The Maryland Health Care Commission for the small group market; and
2.    The Maryland Insurance Administration for the non-small group market.
(c)    (1)    An employer, association, or other private group arrangement may require an employee or individual that accepts the additional coverage under a point-of-service option under subsection (b) of this section to be responsible for the payment of a premium over the amount of the premium for the coverage offered by the health maintenance organization.
(2)    A carrier may impose different cost-sharing provisions for the point-of-service option based on whether the service is provided through the provider panel of the health maintenance organization or outside the provider panel of the health maintenance organization.
2023 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.
2023 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.
2023 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.
2023 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.
2023 Maryland Statutes › Health - General › Title 19 - Health Care Facilities › Subtitle 7 - Health Maintenance Organizations › Section 19-712.5 - Reimbursement for Hospital Emergency Facility and Provider

(a)    A health maintenance organization shall reimburse a hospital emergency facility and provider, less any applicable co–payments, for medically necessary services provided to a member or subscriber of the health maintenance organization if the health maintenance organization authorized, directed, referred, or otherwise allowed the member or subscriber to use the emergency facility and the medically necessary services are related to the condition for which the member was allowed to use the emergency facility.
(b)    A health maintenance organization shall reimburse a hospital emergency facility and provider, less any applicable co–payments, for medically necessary services that relate to the condition presented and that are provided by the provider in the emergency facility to a member or subscriber of the health maintenance organization if the health maintenance organization fails to provide 24–hour access in accordance with the standards of quality of care required under § 19–705.1(b)(1)(ii) of this subtitle.
(c)    A health maintenance organization shall reimburse a hospital emergency facility and provider, less any applicable co–payments, for medical screening, assessment, and stabilization services rendered to meet the requirements of the federal Emergency Medical Treatment and Active Labor Act.
(d)    Notwithstanding any other provision of this subtitle, a provider may not be required to obtain prior authorization or approval for payment from a health maintenance organization in order to obtain reimbursement under subsection (a), (b), or (c) of this section.
(e)    Notwithstanding any other provision of this article, a hospital emergency facility or provider or a health maintenance organization that has reimbursed a provider may collect or attempt to collect payment from a member or subscriber for health care services provided for a medical condition that is determined not to be an emergency as defined in § 19–701(e) of this subtitle.
(f)    If a health maintenance organization authorizes, directs, refers, or otherwise allows a member or subscriber to access a hospital emergency facility or other urgent care facility for a medical condition that requires emergency surgery, the health maintenance organization:
(1)    Shall reimburse the physician, oral surgeon, periodontist, or podiatrist, who performed the surgical procedure, for follow–up care that is:
(i)    Medically necessary;
(ii)    Directly related to the condition for which the surgical procedure was performed; and
(iii)    Provided in consultation with the member’s or subscriber’s primary care physician; and
(2)    May not impose on the member or subscriber any co–payment or other cost–sharing requirement for any follow–up care that exceeds what a member or subscriber is required to pay for services rendered by a physician, oral surgeon, periodontist, or podiatrist who is a member of the provider panel of the health maintenance organization.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.