§ 19-705.1. Standards of quality of care
West's Annotated Code of MarylandHealth--GeneralEffective: March 27, 2019
Effective: March 27, 2019
MD Code, Health - General, § 19-705.1
§ 19-705.1. Standards of quality of care
(a) The Secretary shall adopt regulations that set out reasonable standards of quality of care that a health maintenance organization shall provide to its members.
(b)(1) The standards of quality of care shall include:
(vii) A requirement that a health maintenance organization print, in any directory of participating providers or hospitals, in a conspicuous manner, the address, telephone number, and facsimile number of the State agency that members, enrollees, and insureds may call to discuss quality of care issues, life and health insurance complaints, and assistance in resolving billing and payment disputes with the health plan or health care provider, as follows:
(c)(1) The health maintenance organization shall make available and encourage appropriate history and baseline examinations for each member within a reasonable time of enrollment set by it.
(d)(1) To implement these standards of quality of care, a health maintenance organization shall have a written plan that is updated and reviewed at least every 3 years.
(ii) The health maintenance organization shall place the following statement, in bold print, on every enrollment card or application: “If you have any questions concerning the benefits and services that are provided by or excluded under this agreement, please contact a membership services representative before signing this application or card”.
(e)(1) The health maintenance organization shall have an internal peer review system that will evaluate the utilizational services and the quality of health care provided to its members.
(f)(1) Except as provided in paragraph (5) of this subsection, the Department shall conduct an annual external review of the quality of the health services of the health maintenance organization in a manner that the Department considers to be appropriate.
Credits
Added by Acts 1986, c. 816, § 1, eff. July 1, 1986. Amended by Acts 1991, c. 121, § 1, eff. July 1, 1991; Acts 1993, c. 635, § 2, eff. Oct. 1, 1993; Acts 1994, c. 3, § 1, eff. Feb. 28, 1994; Acts 1994, c. 269, § 1, eff. Jan. 1, 1995; Acts 1995, c. 3, § 1, eff. March 7, 1995; Acts 1995, c. 499, § 3, eff. June 1, 1995; Acts 1996, c. 503, § 1, eff. July 1, 1996; Acts 1996, c. 529, § 1, eff. Oct. 1, 1996; Acts 1997, c. 363, § 1, eff. July 1, 1997; Acts 1998, c. 21, § 1, eff. April 14, 1998; Acts 1998, c. 116, § 1, eff. Oct. 1, 1998; Acts 1998, c. 126, § 1, eff. Oct. 1, 1998; Acts 1999, c. 127, § 2, eff. July 1, 2000; Acts 1999, c. 128, § 2, eff. July 1, 2000; Acts 2003, c. 261, § 1, eff. Oct. 1, 2003; Acts 2003, c. 461, § 1, eff. Oct. 1, 2003; Acts 2006, c. 232, § 1, eff. Oct. 1, 2006; Acts 2010, c. 77, § 1, eff. Oct. 1, 2010; Acts 2010, c. 78, § 1, eff. Oct. 1, 2010; Acts 2011, c. 65, § 1, eff. April 12, 2011; Acts 2015, c. 41, § 1, eff. Oct. 1, 2015; Acts 2016, c. 309, § 3, eff. Jan. 1, 2018; Acts 2019, c. 8, § 1, eff. March 27, 2019.
MD Code, Health - General, § 19-705.1, MD HEALTH GEN § 19-705.1
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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