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10.09.66.00.htm 10.09.66.00. Title 10 MARYLAND DEPARTMENT OF HEALTH Subtitle 09 MEDICAL CARE PROGRAMS Chapter 66 Maryland Medicaid Managed Care Program: Access Authority: Health-General Article, §15-102.1(b)10) and 15-103(b) Annotated Code of Maryland
10.09.66.01.htm 10.09.66.01. 01 Access Standards: Addressing Enrollees' Individualized Needs.. A. An MCO shall provide access to health care services and information in a manner that addresses the individualized needs of its enrollees, regardless of gender, sexual orientation, or gender identity, including, but not limited to, the delivery of services and information to enrollees:1) In a culturally sensitive manner;. 2) At an appropriate reading comprehension level;.
10.09.66.02.htm 10.09.66.02. 02 Access Standards: Enrollee Handbook and Provider Directory.. A. An MCO shall inform and educate its enrollees about the:. 1) MCO;. 2) Availability of health care services and how to access them; and. 3) Enrollee's rights and responsibilities in the MCO, and that the exercise of those rights does not adversely affect the way the MCO, its providers, or the Department treats the enrollee.B. An MCO shall, at the time of enrollment, and anytime upon request, furni
10.09.66.03.htm 10.09.66.03. 03 Access Standards: Outreach.. A. An MCO is responsible for delivering needed health care services even when the enrollee is difficult to reach or misses appointments.B. The assistance of local health departments in contacting and bringing into care enrollees who are difficult to reach or miss appointments is available for the specific categories of enrollees identified in this regulation, but only after the MCO has made documented attempts to contact and bring i
10.09.66.04.htm 10.09.66.04. 04 Access Standards: Information for Providers.. A. An MCO shall develop and make available either electronically or by hard copy to all of its PCP and specialty care providers a Medicaid requirements manual, including periodic updates as appropriate, and shall:1) Before distribution, file a copy of its manual with the Department for review;. 2) Include in its manual the information necessary to facilitate the providers' full compliance with federal and State Medica
10.09.66.05.htm 10.09.66.05. 05 Access Standards: PCPs and MCO's Provider Network.. A. Primary Care Provider (PCP). 1) An MCO shall assign each enrollee to a primary care provider who is:. a) Chosen by the enrollee from the MCO's panel of qualified providers; or. b) Chosen by the MCO from its panel of qualified providers if the enrollee has failed to choose a PCP.2) An enrollee may request a change of PCP at any time if the PCP is within the recipient's current MCO's panel of providers.3) With respect to enroll
10.09.66.05-1.htm 10.09.66.05-1. 05-1 Access Standards: Specialty Provider Network.. A. Standards and Regions.. 1) The Department shall review an MCO's specialty provider network for MCO's overall network and for each region as defined in §A(4) of this regulation.2) Overall Network Standard.. a) An MCO shall contract with at least one provider in each of the 14 major specialty areas specified in §A(2)b) of this regulation.b) The 14 major specialties are:. i) Allergy;. ii) Cardiology;. iii) Dermatology;.
10.09.66.06.htm 10.09.66.06. 06 Geographical Access.. A. An MCO shall develop and maintain a provider network that ensures that enrollees have access to the sites at which they receive the following services:1) Primary care;. 2) Pharmacy;. 3) OB/GYN; and. 4) Diagnostic laboratory and X-ray.. B. Except as provided in §C of this regulation, to meet the geographical access standard established by this regulation, an MCO shall provide the services listed in §A(1)4) of this regulation:
10.09.66.07.htm 10.09.66.07. 07 Access Standards: Clinical and Pharmacy Access.. A. Appointments.. 1) New Enrollees: Initial Appointment.. a) On its receipt and review of the health service needs information of a new enrollee, an MCO shall take appropriate action to ensure that the new enrollee who needs special or immediate health care services, as identified by the health service needs information, receives them in a timely manner.b) Unless the new enrollee is assigned to a PCP who was the enrollee’s esta
10.09.66.08.htm 10.09.66.08. 08 Emergency Services Access.. A. An MCO shall develop and maintain policies and procedures for the adequate provision of emergency services for all its enrollees, including:1) Instituting and monitoring a system for responding to enrollees' emergency medical conditions, with provisions for immediate attention to and appropriate disposition of emergency calls; and2) Informing and educating its enrollees in the procedures to be followed in the event of an emergen
10.09.66.09.htm 10.09.66.09. 09 Access: Hospitals.. If an MCO’s service area includes a county that is designated as a medically underserved area and there is only one hospital in the county, the MCO shall include the hospital in its network.
10.09.66.9999.htm 10.09.66.9999. Administrative History Effective date:. Regulations .01―08 adopted as an emergency provision effective November 8, 1996 (23:25 Md. R. 1730). Regulations .01―08 adopted effective March 10, 1997 (24:5 Md. R. 408). Regulation .01A amended as an emergency provision effective November 1, 2008 (35:24 Md. R. 2069) amended permanently effective February 23, 2009 (36:4 Md. R. 353) November 7, 2016 (43:22 Md. R. 1221)Regulation .01B amended effective June 30, 2008 (35:13 Md. R. 1180).
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