§ 15-102.3. Application of provider participation standards, prompt payment, and financial affa...
West's Annotated Code of MarylandHealth--GeneralEffective: January 1, 2024
Effective: January 1, 2024
MD Code, Health - General, § 15-102.3
§ 15-102.3. Application of provider participation standards, prompt payment, and financial affairs examination provisions
(a) The provisions of § 15-112(b)(1)(ii) and (2), (f) through (m), (r), (s), and (u) through (w) of the Insurance Article (Provider panels) shall apply to managed care organizations in the same manner they apply to carriers.
(b) The provisions of § 15-1005 of the Insurance Article shall apply to managed care organizations in the same manner they apply to health maintenance organizations.
(c) The provisions of §§ 4-311, 15-604, and 15-605 of the Insurance Article shall apply to managed care organizations in the same manner they apply to carriers.
(d)(1) The provisions of §§ 19-712(b), (c), and (d), 19-713.2, and 19-713. 3 of this article apply to managed care organizations in the same manner they apply to health maintenance organizations.
(e) The provisions of § 15-112.1 of the Insurance Article apply to managed care organizations in the same manner they apply to carriers.
(f) The Insurance Commissioner or an agent of the Commissioner shall examine the financial affairs and status of each managed care organization at least once every 5 years.
(g) The provisions of § 15-1628.3 of the Insurance Article apply to pharmacy benefits managers that contract with managed care organizations in the same manner as they apply to pharmacy benefits managers that contract with carriers.
(h)(1) The provisions of § 6-102.1 of the Insurance Article apply to managed care organizations.
(i) The provisions of §§ 15-130 and 15-130.1 of the Insurance Article apply to managed care organizations and pharmacy benefits managers that contract with managed care organizations.
(j) The provisions of § 33-105(f) of the Insurance Article apply to managed care organizations.
(k)(1) To the extent authorized under federal law and subject to paragraph (2) of this subsection, the provisions of § 15-1008(a), (b), (c)(1) and (2)(i), (d), (e), and (f) of the Insurance Article shall apply to managed care organizations in the same manner they apply to carriers.
(2) If a retroactive denial of reimbursement is the result of coordination of benefits, a written statement provided by a managed care organization to a health care provider in accordance with § 15-1008(c)(2)(i) of the Insurance Article shall include the name and address of the entity identified by the managed care organization as responsible for payment of the claim.
Credits
Added by Acts 1996, c. 352, § 1, eff. July 1, 1996. Amended by Acts 1997, c. 70, § 4, eff. Oct. 1, 1997; Acts 1999, c. 472, § 1, eff. Oct. 1, 1999; Acts 2000, c. 323, § 2, eff. June 1, 2000; Acts 2001, c. 29, § 1, eff. April 10, 2001; Acts 2007, c. 452, § 1, eff. July 1, 2007; Acts 2009, c. 90, § 1, eff. Oct. 1, 2009; Acts 2009, c. 91, § 1, eff. Oct. 1, 2009; Acts 2016, c. 309, § 1, eff. June 1, 2016; Acts 2019, c. 400, § 1, eff. May 13, 2019; Acts 2019, c. 597, § 1, eff. Oct. 1, 2019; Acts 2019, c. 598, § 1, eff. Oct. 1, 2019; Acts 2020, c. 525, § 1, eff. Jan. 1, 2021; Acts 2022, c. 231, § 1, eff. Oct. 1, 2022; Acts 2023, c. 108, § 1, eff. April 24, 2023; Acts 2023, c. 109, § 1, eff. April 24, 2023; Acts 2023, c. 322, § 1, eff. Jan. 1, 2024; Acts 2023, c. 323, § 1, eff. Jan. 1, 2024.
MD Code, Health - General, § 15-102.3, MD HEALTH GEN § 15-102.3
Current through legislation effective through April 9, 2023, from the 2024 Regular Session of the General Assembly. Some statute sections may be more current, see credits for details.
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