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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
10.09.64.01.htm 10.09.64.01. 01 Repealed..
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.
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,.
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,.
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
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:
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
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.
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;
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
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,. 2) Software,. 3) Characteristics, and. 4) Ability to interface with other systems;. B. A description of the applicant's operational procedures for generating service-specific encounter data;C. Evidence of the applic
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).
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