2013 Maryland Code
HEALTH - GENERAL
§ 15-102 - Indigent and medically indigent -- Preventive and home care services; educational opportunities

§15-102.

(a) Subject to the limitations of the State budget, the Department shall provide preventive and home care services for indigent and medically indigent individuals.

(b) (1) The Program shall promote educational opportunities for recipients on:

(i) Preventive health care;

(ii) Good health habits; and

(iii) The value of developing ongoing relationships with primary care and lower cost providers.

(2) In educating Program recipients in accordance with the provisions of paragraph (1) of this subsection, the Program shall work with appropriate groups to assist in the education of Program recipients.

§ 15-102 - 1. Indigent and medically indigent -- Comprehensive system of health care

(a) Legislative findings. -- The General Assembly finds that it is a goal of this State to promote the development of a health care system that provides adequate and appropriate health care services to indigent and medically indigent individuals.

(b) Establishment of programs within budget limits. -- The Department shall, to the extent permitted, subject to the limitations of the State budget:

(1) Provide a comprehensive system of quality health care services with an emphasis on prevention, education, individualized care, and appropriate case management;

(2) Develop a prenatal care program for Program recipients and encourage its utilization;

(3) Allocate State resources for the Program to provide a balanced system of health care services to the population served by the Program;

(4) Seek to coordinate the Program activities with other State programs and initiatives that are necessary to address the health care needs of the population served by the Program;

(5) Promote Program policies that facilitate access to and continuity of care by encouraging:

(i) Provider availability throughout the State;

(ii) Consumer education;

(iii) The development of ongoing relationships between Program recipients and primary health care providers; and

(iv) The regular review of the Program's regulations to determine whether the administrative requirements of those regulations are unnecessarily burdensome on Program providers;

(6) Strongly urge health care providers to participate in the Program and thereby address the needs of Program recipients;

(7) Require health care providers who participate in the Program to provide access to Program recipients on a nondiscriminatory basis in accordance with State and federal law;

(8) Seek to provide appropriate levels of reimbursement for providers to encourage greater participation by providers in the Program;

(9) Promote individual responsibility for maintaining good health habits;

(10) Encourage the Program and Maryland's health care regulatory system to work to cooperatively promote the development of an appropriate mix of health care providers, limit cost increases for the delivery of health care to Program recipients, and insure the delivery of quality health care to Program recipients;

(11) Encourage the development and utilization of cost-effective and preventive alternatives to the delivery of health care services to appropriate Program recipients in inpatient institutional settings;

(12) Encourage the appropriate executive agencies to coordinate the eligibility determination, policy, operations, and compliance components of the Program;

(13) Work with representatives of inpatient institutions, third party payors, and the appropriate State agencies to contain Program costs;

(14) Identify and seek to develop an optimal mix of State, federal, and privately financed health care services for Program recipients, within available resources through cooperative interagency efforts;

(15) Develop joint Legislative and Executive Branch strategies to persuade the federal government to reconsider those policies that discourage the delivery of cost-effective health care services to Program recipients;

(16) Evaluate departmental recommendations as to those persons whose financial need or health care needs are most acute;

(17) Establish mechanisms for aggressively pursuing recoveries against third parties permitted under current law and exploring additional methods for seeking to recover other moneys expended by the Program; and

(18) Take appropriate measures to assure the quality of health care services provided by managed care organizations.

(c) Statement. --

(1) The Department shall collaborate with the Office of the Comptroller or the Office of the State Treasurer to:

(i) Form a one-sentence statement advising that individuals who cannot afford health insurance may be eligible to enroll in a medical assistance program; and

(ii) Print the statement formed under item (i) of this paragraph:

1. On each State-issued tax refund check stub;

2. Once each pay quarter, on each State-issued employee paycheck stub; and

3. On each State-issued child support payment check stub.

(2) The statement shall include a telephone number or other contact information that an individual may use to receive more information on eligibility for medical assistance programs.

(3) The statement may be altered by the Department in collaboration with the Office of the Comptroller or the Office of the State Treasurer to:

(i) Provide the most current information;

(ii) Fit within the space constraints of the different types of checks listed in paragraph (1)(ii) of this subsection; or

(iii) Combine it with the statement required under § 15-304(c) of this title, if appropriate.

§ 15-102 - 2. Applicability of certain provisions -- Claims of subrogation

(a) Applicability of § 19-706.1 of this article. -- Except as otherwise provided in this section, the provisions of § 19-706.1 of this article (Rehabilitation and liquidation) shall apply to managed care organizations in the same manner they apply to health maintenance organizations.

(b) Assertion of claims. --

(1) A health care provider may not assert a claim of subrogation against an enrollee of a managed care organization or the State.

(2) Notwithstanding paragraph (1) of this subsection, a health care provider may assert any claim it may have against the receiver of the insolvent managed care organization.

§ 15-102 - 3. Applicability of certain provisions -- Examination of financial affairs and status.

(a) Applicability of § 15-112 of the Insurance Article. -- The provisions of § 15-112 of the Insurance Article (Provider panels) shall apply to managed care organizations in the same manner they apply to carriers.

(b) Applicability of § 15-1005 of the Insurance Article. -- 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) Applicability of §§ 4-311, 15-604, 15-605 and 15-1008 of the Insurance Article. -- The provisions of §§ 4-311, 15-604, 15-605, and 15-1008 of the Insurance Article shall apply to managed care organizations in the same manner they apply to carriers.

(d) Applicability of §§ 19-712, 19-713.2, and 19-713.3 of this article. --

(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.

(e) Applicability of § 15-112.1 of the Insurance Article. -- The provisions of § 15-112.1 of the Insurance Article apply to managed care organizations in the same manner they apply to carriers.

(f) Applicability of § 19-718 of this article; examination of financial affairs. -- 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.

§ 15-102 - 4. Surplus requirements

(a) In general; initial surplus. --

(1) Each managed care organization shall be actuarially sound.

(2) (i) Except as otherwise provided in this section, the surplus that a managed care organization is required to have shall be paid in full.

(ii) A managed care organization shall have an initial surplus that exceeds the liabilities of the managed care organization by at least $ 1,500,000.

(b) Adjustments to initial surplus requirements. --

(1) In consultation with the Secretary, the Insurance Commissioner may adjust the initial surplus requirement for a managed care organization that is not licensed as a health maintenance organization. In determining whether to make an adjustment under this paragraph, the Commissioner shall consider:

(i) The proposed capitation level that would be received by the managed care organization under a contract with the Department under this subtitle;

(ii) The proposed range of benefits to be provided under a contract with the Department under this subtitle;

(iii) The existence of any commitment by the Secretary to designate funds over and above the proposed capitation where the designated funds:

1. Are equivalent to the difference between the requirements of § 19-710 of this article and any lower requirements determined by the Commissioner under this subparagraph; and

2. Would be available in case of the impairment or insolvency of the managed care organization; and

(iv) The availability of the money held in trust by the Secretary to pay claims in case of impairment or insolvency of the managed care organization.

(2) Notwithstanding subsection (a)(2)(ii) of this section, a managed care organization shall have an initial surplus that exceeds liabilities by at least $ 1,250,000. If a managed care organization has an initial surplus that is at least $ 1,250,000 but less than $ 1,500,000, prior to approval, the Department shall designate funds under paragraph (1)(iii) of this subsection sufficient to provide an initial surplus of at least $ 1,500,000.

(c) Surplus compared to subscription charges earned; trust deposits. --

(1) (i) Each managed care organization shall maintain a surplus that exceeds the liabilities of the managed care organization in the amount that is at least equal to the greater of $ 750,000 or 5 percent of the subscription charges earned during the prior calendar year as recorded in the annual report filed by the managed care organization with the Commissioner.

(ii) No managed care organization shall be required to maintain a surplus in excess of a value of $ 3,000,000.

(2) (i) For the protection of the managed care organization's enrollees and creditors, the applicant shall deposit and maintain in trust with the State Treasurer $ 100,000 in cash or government securities of the type described in § 5-701(b) of the Insurance Article.

(ii) 1. The deposits shall be accepted and held in trust by the State Treasurer in accordance with the provisions of Title 5, Subtitle 7 of the Insurance Article.

2. For the purpose of applying this subparagraph, a managed care organization shall be treated as an insurer.

(d) Compliance with risk based capital standards. -- Each managed care organization shall comply with risk based capital standards in accordance with regulations adopted by the Insurance Commissioner under § 4-311 of the Insurance Article.

(e) Annual report. -- If there is money held in trust under this section, on or before June 1 of each year, the Secretary shall submit to the General Assembly, in accordance with § 2-1246 of the State Government Article, a report on:

(1) The number of managed care organizations for which the Secretary has designated money to be held in trust under this section; and

(2) The amount of money held in trust by the Secretary that has been paid out in cases of insolvency or impairment of managed care organizations.

§ 15-102 - 5. Mechanism to provide for equitable distribution of enrollees

(a) In general. -- Subject to § 15-103 (f) of this subtitle, a health maintenance organization that requires its panel providers to participate in a managed care organization shall establish a mechanism, subject to review by the Secretary, which provides for equitable distribution of enrollees and which ensures that a provider will not be assigned a disproportionate number of enrollees.

(b) Voluntary acceptance of additional enrollees. -- Nothing in this section may be interpreted as prohibiting a provider from voluntarily accepting additional enrollees.

§ 15-102 - 6. Applicability of other provisions; regulations

(a) Applicability of Title 7 of the Insurance Article. -- Subject to subsection (b) of this section, the provisions of Title 7 of the Insurance Article apply to managed care organizations.

(b) Consultation with Secretary. -- Before approving a transaction under § 7-306 of the Insurance Article, the Insurance Commissioner shall consult with the Secretary.

(c) Regulations. -- The Insurance Commissioner:

(1) Shall adopt regulations establishing a reporting materiality threshold; and

(2) May adopt regulations necessary to implement the provisions of this section.

(d) Transaction preempted by federal law. -- The provisions of this section may not apply to any transaction preempted by federal law.

§ 15-102 - 7. Applicability of certain premium tax provisions.

The premium tax imposed under § 6-102 of the Insurance Article applies to managed care organizations.

§ 15-102 - 8. Claims processing charge for Medicaid claims paid by Department to District of Columbia hospitals.

(a) In general. -- The Department may impose a claims processing charge on all Medicaid claims processed, approved, and paid by the Department to hospitals located in the District of Columbia for the provision of inpatient and outpatient hospital services.

(b) Amount. -- The amount to be paid under subsection (a) of this section may not exceed 6% of the amount of claims paid.

(c) Regulations. -- The Department shall adopt regulations to implement this section.