Article - Health - General
(a) In this title
the following words have the meanings indicated.
managed care organization” means a pre–paid dental plan
that receives fees to manage dental services.
services” means diagnostic, emergency, preventive, and therapeutic
services for oral diseases.
means a program recipient who is enrolled in a managed care organization.
eligibility” means a streamlined eligibility process, conducted
by the local health departments, for medical assistance for children
and pregnant women under which an eligibility determination is made
promptly, but not later than 10 working days after the date of application.
means a hospital or nursing facility including an intermediate care
facility, skilled nursing facility, comprehensive care facility, or
extended care facility.
(d) (1) “Historic
provider” means a health care provider, as defined in §
19–132 of this article, or a residential service agency licensed
under Title 19, Subtitle 4A of this article, that, on or before June
30, 1995, had a demonstrated history of providing services to program
recipients, as defined by the Department in regulations.
provider”, to the extent the provider meets the requirements
in paragraph (1) of this subsection, shall include:
(i) A federal or
State qualified community health center;
(ii) A provider
with a program for the training of health care professionals, including
an academic medical center;
(iii) A hospital
outpatient program, physician, or advanced practice nurse that is
a Maryland Access to Care (MAC) provider;
(iv) A local health
(v) A hospice,
as defined in Title 19, Subtitle 9 of this article;
(vi) A pharmacy;
(vii) Any other
historic provider designated in accordance with regulations adopted
by the Department.
foster care adolescent” means an individual:
(1) Who is under
26 years of age; and
(2) Who, on the
individual’s 18th birthday, was in foster care under the responsibility
of the State, any other state, or the District of Columbia.
care organization” means:
(1) A certified
health maintenance organization that is authorized to receive medical
assistance prepaid capitation payments; or
(2) A corporation
(i) Is a managed
care system that is authorized to receive medical assistance prepaid
(ii) Enrolls only
program recipients or individuals or families served under the Maryland
Children’s Health Program; and
(iii) Is subject
to the requirements of § 15–102.4 of this subtitle.
program” means a program that assists enrollees in resolving
disputes with managed care organizations in a timely manner and that
is responsible, at a minimum, for the following functions:
disputes between enrollees and managed care organizations referred
by the enrollee hotline;
(2) Reporting to
(i) The resolution
of all disputes;
(ii) A managed
care organization’s failure to meet the Department’s requirements;
(iii) Any other
information specified by the Department;
(3) Educating enrollees
(i) The services
provided by the enrollee’s managed care organization; and
(ii) The enrollee’s
rights and responsibilities in receiving services from the managed
care organization; and
on behalf of the enrollee before the managed care organization, including
assisting the enrollee in using the managed care organization’s
mental health services” means the clinical evaluation and assessment
of services needed by an individual and the provision of services
or referral for additional services as deemed medically appropriate
by a primary care provider.
means the Maryland Medical Assistance Program.
recipient” means an individual who receives benefits under the
mental health services” means any mental health services other
than primary mental health services.