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10.09.64.00.htm
| 10.09.64.00. Title 10 MARYLAND DEPARTMENT OF HEALTH Subtitle 09 MEDICAL CARE PROGRAMS Chapter 64 Maryland Medicaid Managed Care Program: MCO Application Authority: Health-General Article §15-102 and 15-103, Annotated Code of Maryland |
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10.09.64.01.htm
| 10.09.64.01. 01 Repealed.. |
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10.09.64.02.htm
| 10.09.64.02. 02 Application.. A. When applying for participation in the Maryland Medicaid Managed Care Program as an MCO, an applicant shall submit an application to the Secretary in the form that the Secretary requires.B. An applicant may omit from its application any information or documents that it has previously submitted to the Department, if:1) The information or documents are up to date; and. |
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10.09.64.03.htm
| 10.09.64.03. 03 Organization, Operations, and Financing.. Except as provided in Regulation .02B of this chapter, an MCO applicant shall include the following information or descriptions in its application:A. An indication whether the applicant is an operating HMO with a certificate of authority from the Maryland Insurance Administration;B. A written legal history of the applicant, specific as to dates and parties involved, that includes, but is not limited to:1) Predecessor corporations;. |
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10.09.64.04.htm
| 10.09.64.04. 04 Financial Solvency.. An applicant that is not a Maryland certified HMO shall include in its application the following information or descriptions:A. A table labeled "Insurance Coverage" specifying the applicant's coverage in insurance types including, but not limited to, reinsurance, risk of insolvency, medical malpractice, general liability, and fidelity bond, and detailing the:1) Carrier,. 2) Entity covered,. |
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10.09.64.05.htm
| 10.09.64.05. 05 Access and Capacity.. A. An MCO applicant shall include in its application the following information or descriptions:. 1) A map or maps showing the county or counties in which the applicant proposes to provide health care services, and the service area boundaries.2) The name and address of each of the applicant's service delivery sites, and, if applicable, the type of facility licensure of each site, grouped by county;3) If the applicant is an HMO, the applicant's tot |
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10.09.64.06.htm
| 10.09.64.06. 06 Access and Capacity: Benefits and Appointments.. An MCO applicant shall include in its application the following information or descriptions:. A. Written evidence of the applicant's preparedness to provide benefits equivalent to the benefit level mandated by the Maryland Medical Assistance Program as described in COMAR 10.09.67;B. A description of any benefits the applicant proposes to provide in addition to those required by the Maryland Medicaid Managed Care Program, including: |
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10.09.64.07.htm
| 10.09.64.07. 07 Access and Capacity: Contracts and Provider Applications.. An MCO applicant shall include in its application the following information or descriptions:. A. A description of the applicant's hiring and subcontracting policies, which shall correspond to the requirements of Insurance Article, §15-112, Annotated Code of Maryland;B. A blank copy of the provider application form;. C. Documentary assurances that the applicant and its health care providers furnish access on a nondi |
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10.09.64.08.htm
| 10.09.64.08. 08 National Committee on Quality Assurance (NCQA) Accreditation.. Effective July 1, 2012 an MCO applicant shall be NCQA accredited within 2 years of their effective date as an MCO. |
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10.09.64.09.htm
| 10.09.64.09. 09 Quality Assurance System ― General.. An applicant shall include in its application the following information or descriptions:. A. The applicant's proposed quality assurance plan, that contains, at a minimum, all elements specified by Health-General Article, §15-103(b)9)i) Annotated Code of Maryland;B. A description of any written procedures or protocols regarding physician and nursing care practice the applicant intends to use; |
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10.09.64.10.htm
| 10.09.64.10. 10 Special Needs Populations.. An MCO applicant shall include in its application the following information or descriptions:. A. A narrative description of the clinical expertise and experience of the MCO's network for special needs populations in a format specified by the Department;B. Written evidence of the applicant's ability to comply with specific quality access, data, and performance measurements to satisfy the general requirements for all special needs populations specifie |
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10.09.64.11.htm
| 10.09.64.11. 11 Management Information System and Data Reporting.. An MCO applicant shall include in its application the following information or descriptions:. A. A description of the applicant's management information system, including, but not limited to:. 1) Capacities, including:. a) The ability to generate and transmit electronic claims data consistent with the Medicaid Statistical Information System (MSIS) requirements or successor systems;b) The ability to collect |
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10.09.64.9999.htm
| 10.09.64.9999. Administrative History Effective date:. Regulations .01―11 adopted as an emergency provision effective November 8, 1996 (23:25 Md. R. 1730). Regulations .01―11 adopted effective March 10, 1997 (24:5 Md. R. 408). Regulation .01 repealed effective December 27, 2010 (37:26 Md. R. 1787). Regulation .02C repealed effective April 16, 2012 (39:7 Md. R. 492). Regulation .03F, G amended effective December 23, 2002 (29:25 Md. R. 1981). |
