§ 19-713.2. Administrative service provider contract plans
West's Annotated Code of MarylandHealth--GeneralEffective: October 1, 2010
Effective: October 1, 2010
MD Code, Health - General, § 19-713.2
§ 19-713.2. Administrative service provider contract plans
(b) This section does not apply to a contract between a health maintenance organization and a contracting provider that is affiliated with the health maintenance organization through common ownership within an insurance holding company system, if the health maintenance organization:
(c) A health maintenance organization may not enter into an administrative service provider contract unless:
(d) The plan required under subsection (c) of this section shall:
(1) Require the contracting provider to provide the health maintenance organization with monthly reports, within 30 days of the end of the month reported, that identify payments made or owed to external providers in sufficient detail to determine if the payments are being made in compliance with law;
(3) Require the health maintenance organization to establish and maintain a segregated fund, in a form and an amount approved by the Commissioner, which may include withheld funds, escrow accounts, letters of credit, or similar arrangements, or require the availability of other resources that are sufficient to satisfy the contracting provider's obligations to external providers for services rendered to members of the health maintenance organization;
(4) Require the contracting provider to submit to the health maintenance organization information demonstrating that the fund established under item (3) of this subsection is sufficient to satisfy the contracting provider's obligations to external providers for services rendered to members of the health maintenance organization; and
(e) In determining the sufficiency of a segregated fund, the Commissioner may consider whether external providers are owned or controlled by the contracting provider.
(f) The segregated fund or other resources established as a result of an administrative service provider contract:
(g) The health maintenance organization and the contracting provider shall comply with the plan.
(h)(1) The health maintenance organization shall monitor the contracting provider to assure compliance with the plan, and the health maintenance organization shall notify the contracting provider whenever a failure to comply with the plan occurs.
(2) Upon the failure of the contracting provider to comply with the plan following notice of noncompliance, or upon termination of the administrative service provider contract for any reason, the health maintenance organization shall notify the Commissioner and shall assume the administration of any payments due from the contracting provider to external providers on behalf of the contracting provider, as required under § 19-712 of this subtitle.
(i) The health maintenance organization shall file with the Commissioner, the results of each quarterly review required under subsection (d)(5) of this section.
(j) The plan and all supporting documentation submitted in connection with the plan shall be treated as confidential and proprietary, and may not be disclosed except as otherwise required by law.
(k) A health maintenance organization and a contracting provider shall comply with the terms of an administrative service provider contract as required under this section and § 19-712 of this subtitle.
(l) If a contracting provider fails to comply with the plan or the administrative service provider contract, as required under subsections (g) and (k) of this section, the Commissioner may impose a fine not exceeding $125,000 or suspend or revoke the registration of the contracting provider under § 19-713.3 of this subtitle, or both.
Credits
Added by Acts 1991, c. 446, § 1, eff. July 1, 1991. Amended by Acts 1992, c. 22, § 1, eff. April 7, 1992; Acts 2000, c. 323, § 2, eff. June 1, 2000; Acts 2002, c. 19, § 1, eff. April 9, 2002; Acts 2010, c. 625, § 1, eff. Oct. 1, 2010; Acts 2010, c. 626, § 1, eff. Oct. 1, 2010.
MD Code, Health - General, § 19-713.2, MD HEALTH GEN § 19-713.2
Current through legislation effective through April 25, 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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