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§ 15-102.3. Application of provider participation standards, prompt payment, and financial affa...

West's Annotated Code of MarylandHealth--GeneralEffective: January 1, 2024

West's Annotated Code of Maryland
Health--General
Title 15. Assistance Programs (Refs & Annos)
Subtitle 1. Medical and Pharmacy Assistance Programs (Refs & Annos)
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
Insurance § 15-112
(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.
Insurance § 15-1005
(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.
Insurance §§ 4-311, 15-604, and 15-605
(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.
Health General §§ 19-712, 19-713.2, and 19-713.3
(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.
(2) The Insurance Commissioner shall consult with the Secretary before taking any action against a managed care organization under this subsection.
Insurance § 15-112.1
(e) The provisions of § 15-112.1 of the Insurance Article apply to managed care organizations in the same manner they apply to carriers.
Examination of financial affairs
(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.
Insurance § 15-1628.3
(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.
Insurance § 6-102.1 and managed care organizations
(h)(1) The provisions of § 6-102.1 of the Insurance Article apply to managed care organizations.
(2) For each calendar year that the Insurance Commissioner assesses a health insurance provider fee under § 6-102.1 of the Insurance Article, a managed care organization shall pay the fee on a quarterly basis in accordance with a schedule adopted by the Insurance Commissioner.
Insurance §§ 15-130 and 15-130.1
(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.
Insurance § 33-105
(j) The provisions of § 33-105(f) of the Insurance Article apply to managed care organizations.
Insurance § 15-1008
(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.
Insurance § 15-859
(l) Beginning July 1, 2025, the provisions of § 15-859 of the Insurance Article apply to managed care organizations in the same manner they apply to carriers.

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 May 9, 2024, from the 2024 Regular Session of the General Assembly. Some statute sections may be more current, see credits for details.
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