10.07.11.02

.02 Service Requirements.

A. The HMO shall provide the services required by the Maryland Health Maintenance Organization Act of 1975, Health-General Article, §19-701(d), Annotated Code of Maryland.

B. The HMO shall make available and encourage appropriate history and baseline examinations for each enrollee within a reasonable time of enrollment set by the HMO. Medical problems that are a potential hazard to the person's health shall be identified and a course of action to alleviate these problems outlined. Progress notes indicating success or failure of the course of action shall be recorded.

C. The HMO shall offer or arrange for preventive services that include health education and counseling, early disease detection, and immunization. The HMO shall develop or arrange for periodic health education on subjects which impact on the health status of the enrollee population and shall notify every enrollee in writing of the availability of these and other preventive services.

D. Services to prevent a disease shall be offered if all of the following conditions exist:

(1) The disease produces death or disability and exists in the enrolled population;

(2) The etiology of the disease is known or the disease can be detected at an early stage;

(3) Elimination of factors leading to the disease or immunization has been proven to prevent its occurrence, or early disease detection followed by behavior modification, environmental modification, or medical intervention has been proven to prevent death or disability.

E. An HMO shall offer services through a licensed health care practitioner who is not a physician if the:

(1) Services are within the scope of practice for both:

(a) A physician; and

(b) Another licensed health care practitioner; and

(2) HMO considers the offering of the practitioner's services appropriate.