2016 Maryland Code
Health - General
Title 19 - Health Care Facilities
Subtitle 7 - Health Maintenance Organizations
§ 19-705.8. Health Maintenance Organization Quality Assurance Unit

(a) Definitions. --

(1) In this section the following words have the meanings indicated.

(2) "HMO Quality Assurance Unit" means the Health Maintenance Organization (HMO) Quality Assurance Unit in the Department.

(3) "Quality Assurance Medical Director" means the Medical Director of the HMO Quality Assurance Unit.

(b) Established. -- There is a Health Maintenance Organization (HMO) Quality Assurance Unit in the Department.

(c) Quality Assurance Medical Director. --

(1) The Secretary shall appoint the Quality Assurance Medical Director.

(2) The Quality Assurance Medical Director shall:

(i) Be a physician who is licensed in the State;

(ii) Be board certified in at least one specialty;

(iii) Have experience in primary care and administrative medicine; and

(iv) Have broad knowledge of health maintenance organizations and managed care organizations.

(3) The Quality Assurance Medical Director is entitled to the compensation provided in the State budget.

(4) Subject to the authority vested in the Secretary by law, the Quality Assurance Medical Director is in charge of and responsible for the clinical operations of the HMO Quality Assurance Unit.

(5) In accordance with the State budget the Secretary may employ staff for the HMO Quality Assurance Unit.

(d) Duties of Unit. -- The HMO Quality Assurance Unit shall:

(1) Enforce all requirements established under §§ 19-705 and 19-705.1 of this subtitle and the regulations adopted under these provisions regarding the quality of health care provided by a health maintenance organization; and

(2) Investigate quality of care complaints referred to the Secretary under § 19-705.2(b)(3) of this subtitle.

(e) Duties of Medical Director. -- The Quality Assurance Medical Director shall:

(1) Determine whether a health maintenance organization meets the requirements established under §§ 19-705 and 19-705.1 of this subtitle and the regulations adopted under these provisions regarding the quality of health care provided by a health maintenance organization; and

(2) Make recommendations to the Secretary for corrective action necessary to meet these requirements.

(f) Secretary authorized to issue orders. -- If the Secretary agrees with a determination made by the Quality Assurance Medical Director that a health maintenance organization does not meet the requirements established under §§ 19-705 and 19-705.1 of this subtitle or the regulations adopted under these provisions regarding the quality of health care provided by a health maintenance organization, the Secretary may issue an order under § 19-731 of this subtitle.