§ 19-712.5. Reimbursement for emergency services
West's Annotated Code of MarylandHealth--GeneralEffective: April 12, 2011
Effective: April 12, 2011
MD Code, Health - General, § 19-712.5
§ 19-712.5. Reimbursement for emergency services
(a) A health maintenance organization shall reimburse a hospital emergency facility and provider, less any applicable co-payments, for medically necessary services provided to a member or subscriber of the health maintenance organization if the health maintenance organization authorized, directed, referred, or otherwise allowed the member or subscriber to use the emergency facility and the medically necessary services are related to the condition for which the member was allowed to use the emergency facility.
(b) A health maintenance organization shall reimburse a hospital emergency facility and provider, less any applicable co-payments, for medically necessary services that relate to the condition presented and that are provided by the provider in the emergency facility to a member or subscriber of the health maintenance organization if the health maintenance organization fails to provide 24-hour access in accordance with the standards of quality of care required under § 19-705.1(b)(1)(ii) of this subtitle.
(c) A health maintenance organization shall reimburse a hospital emergency facility and provider, less any applicable co-payments, for medical screening, assessment, and stabilization services rendered to meet the requirements of the federal Emergency Medical Treatment and Active Labor Act.1
(d) Notwithstanding any other provision of this subtitle, a provider may not be required to obtain prior authorization or approval for payment from a health maintenance organization in order to obtain reimbursement under subsection (a), (b), or (c) of this section.
(e) Notwithstanding any other provision of this article, a hospital emergency facility or provider or a health maintenance organization that has reimbursed a provider may collect or attempt to collect payment from a member or subscriber for health care services provided for a medical condition that is determined not to be an emergency as defined in § 19-701(e) of this subtitle.
(f) If a health maintenance organization authorizes, directs, refers, or otherwise allows a member or subscriber to access a hospital emergency facility or other urgent care facility for a medical condition that requires emergency surgery, the health maintenance organization:
(2) May not impose on the member or subscriber any co-payment or other cost-sharing requirement for any follow-up care that exceeds what a member or subscriber is required to pay for services rendered by a physician, oral surgeon, periodontist, or podiatrist who is a member of the provider panel of the health maintenance organization.
Credits
Added by Acts 1996, c. 503, §§ 1, 2, 3, eff. July 1, 1996. Amended by Acts 1997, c. 107, § 1, eff. April 8, 1997; Acts 1998, c. 605, § 1, eff. July 1, 1998; Acts 1998, c. 606, § 1, eff. July 1, 1998; Acts 1999, c. 187, § 1, eff. July 1, 1999; Acts 1999, c. 188, § 1, eff. July 1, 1999; Acts 1999, c. 644, § 1, eff. Oct. 1, 1999; Acts 2003, c. 21, § 6, eff. April 8, 2003; Acts 2011, c. 65, § 5, eff. April 12, 2011.
Footnotes
Aug. 14, 1935, ch. 531, Title XVIII, 1867, as added Apr. 7, 1986, Pub.L. 99-272, Title IX, 9121(b), 100 Stat. 164.
MD Code, Health - General, § 19-712.5, MD HEALTH GEN § 19-712.5
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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