Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 5 › Subtitle 67 - MARYLAND HEALTHCHOICE PROGRAM › Chapter 10.67.03 - Maryland Medicaid Managed Care Program: MCO Application › Section 10.67.03.05 - Access and Capacity

Current through Register Vol. 51, No. 14, July 12, 2024
A. An MCO
				  applicant shall include in its application the following information or
				  descriptions:
(1) A map or maps showing the county or counties in
				  which the applicant proposes to provide health care services, and the service
				  area boundaries.
(2) The name and
				  address of each of the applicant's service delivery sites, and, if applicable,
				  the type of facility licensure of each site, grouped by county;
(3) If the applicant is an HMO, the
				  applicant's total prepaid enrollment or client population as of the date of
				  application, with a breakdown by payment source, including Medicare, Medicaid,
				  commercial group, commercial individual, and other enrollment;
(4) If the applicant is an HMO, the total of
				  the applicant's current unduplicated fee-for-service patient count, with a
				  breakdown by payment source, including Medicaid, Medicare, commercial group,
				  commercial individual, and other patients (including self-pay);
(5) The name and address of each of the
				  applicant's primary and specialty care providers, provided in a format
				  specified by the Department, for distribution to recipients in enrollment
				  packets;
(6) The following information, grouped by medical
				  specialty and county, regarding each individual practitioner, including primary
				  care providers and specialists, who will act as a health care provider for the
				  applicant:
(a) Name, address, and practice
				  location or locations, including a separate line for each location;
(b) State licensure number;
(c) Specialty, if applicable, indicating the
				  type of services to be provided on behalf of the applicant;
(d) Whether the provider will be a primary
				  care provider;
(e) A description of the practitioner's employment
				  relationship to the applicant, including but not limited to:
(i) A salaried employee;
(ii) A subcontractor;
(iii) An employee of a subcontractor;
				  or
(iv) Any other form of
				  contractual or employment relationship;
(f) Any
				  restrictions as to age of patients or numbers of enrollees the provider will
				  serve;
(7) The procedures for assuring proper credentialing
				  and recredentialing of providers;
(8) Documentation that the MCO applicant is
				  able to meet the access standards set forth in COMAR 10.67.66 in each service
				  area the MCO applicant plans to enter;
(9) Documentation of any reasons for which
				  they are unable to meet the access requirements of COMAR 10.67.66 in any
				  service area;
(10) For each primary care practice location, a
				  specification of:
(a) The name, address, and hours of operation;
				  and
(b) The staffing at each
				  location, expressed in full-time equivalencies and grouped by medical specialty
(i) General practice;
(ii) Family practice;
(iii) Internal medicine;
(iv) Pediatrics;
(v) Obstetrics and gynecology; and
(vi) Advanced practice nursing; and
(11) Written protocols detailing how the applicant
				  will provide 24-hour per day, 7-day per week coverage for emergency medical
				  situations, including compliance with MIEMSS protocols and the federal
				  Emergency Medical Treatment and Active Labor Act.