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31.10.22.00.htm 31.10.22.00. Title 31 MARYLAND INSURANCE ADMINISTRATION Subtitle 10 HEALTH INSURANCE ― GENERAL Chapter 22 Provider-Sponsored Organizations Authority: Health-General Article, Title 19, Subtitle 7A, Annotated Code of Maryland
31.10.22.01.htm 31.10.22.01. 01 Scope.. The scope of this chapter is the scope of Health-General Article, Title 19, Subtitle 7A, Annotated Code of Maryland, as it relates to the Insurance Commissioner.
31.10.22.02.htm 31.10.22.02. 02 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) "Commissioner" means the Maryland Insurance Commissioner.. 2) "Contract" means the contractual agreement for the provision of health care services on a prepaid, capitated basis entered into between a provider-sponsored organization and the Health Care Finance Administration to provide health care benefits to medicare program beneficiaries.
31.10.22.03.htm 31.10.22.03. 03 Certificate of Authority Required.. Before a person may operate as a provider-sponsored organization under the federal Medicare+Choice Program, the person shall obtain a certificate of authority from the Commissioner.
31.10.22.04.htm 31.10.22.04. 04 Application for Certificate of Authority.. A. Submission of Application. An applicant shall submit an application for a certificate of authority to the Commissioner at least 90 days before the date that the applicant proposes to engage in business in the State.B. Provision of Application Form. The Commissioner shall provide an application form to an applicant on request.C. Filing of Information. Each applicant seeking a certificate of authority to transact business in
31.10.22.05.htm 31.10.22.05. 05 Net Worth Requirements.. A. Initial Net Worth. An applicant may not obtain a certificate of authority unless the applicant has an initial net worth of at least:1) $1,500,000; or. 2) $1,000,000, based on evidence from the applicant's financial plan, as required by 42 CFR §422.384, demonstrating to the Commissioner's satisfaction that the applicant has available to it an administrative infrastructure that the Commissioner considers appropriate to reduce, control, or eliminate
31.10.22.06.htm 31.10.22.06. 06 Determination of Financial Condition.. A. Additional Assets. In any determination of the financial condition of an applicant or provider-sponsored organization, in addition to the assets under Regulation .05 of this chapter, the following assets are allowed:1) Cash in the possession of the applicant or provider-sponsored organization or in transit under its control, and the balance of any deposit of the applicant or provider-sponsored organization in a solvent bank or trust comp
31.10.22.07.htm 31.10.22.07. 07 Deposit of Securities.. A. Deposit Required. The Commissioner may not issue or renew a certificate of authority for a provider-sponsored organization unless it has deposited and maintains in trust with the State Treasurer, for the protection of its members or its members and creditors, cash or government securities of the type described in Health-General Article, §19-710, Annotated Code of Maryland, in the market value amount of $100,000.B. Assets.. 1) For purposes of determ
31.10.22.08.htm 31.10.22.08. 08 Term and Renewal of Certificate of Authority.. A. Expiration. Unless previously suspended or revoked, each original and renewal certificate of authority issued to a provider-sponsored organization expires at midnight on the November 30 after its effective date in accordance with Health-General Article, §19-721(a) Annotated Code of Maryland.B. Renewal. On payment of an annual renewal fee of $25 by the provider-sponsored organization before the expiration date of i
31.10.22.09.htm 31.10.22.09. 09 Disciplinary Action.. If a provider-sponsored organization violates any provision of Health-General Article, §19-729, Annotated Code of Maryland, the Commissioner may take any action against the provider-sponsored organization that is authorized pursuant to Health-General Article, §19-730, Annotated Code of Maryland.
31.10.22.10.htm 31.10.22.10. 10 Change of Name.. A provider-sponsored organization may not:. A. Use a name that has not been approved by the Commissioner; or. B. Change its name without the prior approval of the Commissioner..
31.10.22.11.htm 31.10.22.11. 11 Termination of Services.. A. Notice of Intent to Terminate. When a provider-sponsored organization desires to cease offering a service under the contract, the provider-sponsored organization shall provide written notice of the intent to terminate to the Commissioner at least 30 days before ceasing to offer the service.B. Permissible Reasons for Cancellation or Nonrenewal of Enrollment. A provider-sponsored organization may cancel or nonrenew enrollment in the provid
31.10.22.12.htm 31.10.22.12. 12 Annual Report.. A. Required. Each licensed provider-sponsored organization shall file with the Commissioner a report, certified by at least two principal officers, showing its financial condition on the last day of the preceding calendar year.B. Form. The report shall be on the form adopted by the Commissioner.. C. Filing Deadline. Unless the time is extended for good cause, a provider-sponsored organization shall file its annual report with the Commissioner o
31.10.22.13.htm 31.10.22.13. 13 Fiscal Examination.. A. Frequency of Examination. The Commissioner may examine the operation of a provider-sponsored organization as often as the Commissioner deems necessary for the protection of the interest of the people of Maryland, but the examinations may not be less frequent than once every 5 years.B. Cost of Examination.. 1) The Commissioner shall assess the provider-sponsored organization being examined for the cost of the examination.
31.10.22.14.htm 31.10.22.14. 14 General Operations of a Provider-Sponsored Organization.. A. Effective Date of Contract. A provider-sponsored organization shall inform the Commissioner of the effective date of its contract.B. Review of Agreements by Commissioner. All signed written agreements, including those defining physicians' services, shall be on file and available for review by the Commissioner at all times in the provider-sponsored organization's central office.
31.10.22.15.htm 31.10.22.15. 15 Insurance ― Catastrophic or Back-Up Coverage.. A. Insurance Coverage Required. Unless the Commissioner grants an exemption from the requirements of this section, a provider-sponsored organization shall secure insurance coverage to provide:1) Payments or services required to be made or furnished under the health care contract to those enrollees who are injured or become ill outside the geographic limits served by the provider-sponsored organization; and2) Reinsurance protection
31.10.22.9999.htm 31.10.22.9999. Administrative History Effective date:. Regulations .01―15 adopted as an emergency provision effective June 29, 1999 (26:15 Md. R. 1146) emergency status extended at 27:3 Md. R. 326; emergency status expired April 17, 2000; adopted permanently effective May 15, 2000 (27:9 Md. R. 860)
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