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Maryland Code, Health-General § 15-102.3

Current as of January 01, 2025 | Updated by Findlaw Staff

(a) The provisions of § 15-112(b)(1)(ii) and (2), (f) through (m), (r), (s), and (u) through (w) of the Insurance Article (Provider panels) shall apply to managed care organizations in the same manner they apply to carriers.

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

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

(f) 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.

(g) The provisions of § 15-1628.3 of the Insurance Article apply to pharmacy benefits managers that contract with managed care organizations in the same manner as they apply to pharmacy benefits managers that contract with carriers.

(h)(1) The provisions of § 6-102.1 of the Insurance Article apply to managed care organizations.

(2) For each calendar year that the Insurance Commissioner assesses a health insurance provider fee under § 6-102.1 of the Insurance Article, a managed care organization shall pay the fee on a quarterly basis in accordance with a schedule adopted by the Insurance Commissioner.

(i) The provisions of §§ 15-130 and 15-130.1 of the Insurance Article apply to managed care organizations and pharmacy benefits managers that contract with managed care organizations.

(j) The provisions of § 33-105(f) of the Insurance Article apply to managed care organizations.

(k)(1) To the extent authorized under federal law and subject to paragraph (2) of this subsection, the provisions of § 15-1008(a), (b), (c)(1) and (2)(i), (d), (e), and (f) of the Insurance Article shall apply to managed care organizations in the same manner they apply to carriers.

(2) If a retroactive denial of reimbursement is the result of coordination of benefits, a written statement provided by a managed care organization to a health care provider in accordance with § 15-1008(c)(2)(i) of the Insurance Article shall include the name and address of the entity identified by the managed care organization as responsible for payment of the claim.

(l) Beginning July 1, 2025, the provisions of § 15-859 of the Insurance Article apply to managed care organizations in the same manner they apply to carriers.

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Cite this article: FindLaw.com - Maryland Code, Health-General § 15-102.3 - last updated January 01, 2025 | https://codes.findlaw.com/md/health-general/md-code-health-gen-sect-15-102-3/

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