§ 19-706. Regulation; applicability of other laws[Amendment subject to abrogation; amended version follows this section]. (Abrogation of amendment effective June 30, 2015.)

   (a) Regulation. -- Each health maintenance organization that is issued a certificate of authority by the Commissioner shall be regulated under this subtitle.

(b) Nonprofit health service plans. --

   (1) Any health maintenance organization that is regulated by Title 14, Subtitle 1 of the Insurance Article is subject also to this subtitle.

   (2) This subsection applies to a corporation described in Title 14, Subtitle 1 of the Insurance Article, but only if it is a health maintenance organization.

(c) Inapplicability of certain insurance laws. -- Except as otherwise provided in this subtitle, a health maintenance organization is not subject to the insurance laws of this State.

(d) Impaired entities; regulation of insurance agents and brokers. --

   (1) The provisions of § 9-231 and Title 9, Subtitle 1 and Title 10, Subtitle 1 of the Insurance Article shall apply to health maintenance organizations.

   (2) The provisions of § 15-815 of the Insurance Article shall apply to health maintenance organizations.

(e) Medicare supplements. -- A health maintenance organization which enrolls members eligible for Medicare benefits under Title XVIII of the Social Security Act shall be subject to the requirements of Title 15, Subtitle 9 of the Insurance Article, to the extent any of the provisions of Title 15, Subtitle 9 of the Insurance Article are applicable to the Medicare eligible members.

(f) Issuance, suspension, or revocation of authority. -- Only the Commissioner may issue, suspend, or revoke a certificate of authority of a health maintenance organization.

(g) Unfair claim settlement practices. -- The provisions of § 27-504 and Title 27, Subtitle 3 of the Insurance Article shall apply to health maintenance organizations.

(h) Children's insurance coverage. -- The provisions of § 15-401, 15-402, 15-403, 15-403.1, and 15-405 of the Insurance Article shall apply to health maintenance organizations.

(i) Coverage information about breast implants; provider panels; compensation of health care practitioners; coverage for off-label use of drugs; inpatient hospitalization coverage for mothers and newborn children; cancer treatment hair loss. -- The provisions of § 12-203(g), 15-105, 15-112, 15-112.2, 15-113, 15-804, 15-812, 15-826, 15-828, and 15-836 of the Insurance Article shall apply to health maintenance organizations.

(j) Health insurance reform. -- The provisions of Title 15, Subtitle 12 of the Insurance Article shall apply to health maintenance organizations.

(k) Use of genetic tests. -- The provisions of § 27-909 of the Insurance Article shall apply to health maintenance organizations.

(l) Classification of obstetrician/gynecologist as primary care; annual visits; obstetric or gynecological care from nurse midwife, etc. --

   (1) A health maintenance organization shall:

      (i) Classify an obstetrician/gynecologist as a primary care physician; or

      (ii) If the obstetrician/gynecologist chooses not to be a primary care physician, permit a woman to receive gynecological care from an in-network obstetrician/gynecologist without requiring the woman to first visit a primary care provider, provided that:

         1. The care is medically necessary, including, but not limited to, care that is routine;

         2. Following each visit for gynecological care, the obstetrician/gynecologist communicates with the woman's primary care physician concerning any diagnosis or treatment rendered; and

         3. The obstetrician/gynecologist confers with the primary care physician before performing any diagnostic procedure that is not routine gynecological care rendered during an annual visit.

   (2) If a health maintenance organization classifies an obstetrician/gynecologist as a primary care physician as provided under paragraph (1) of this subsection, and a woman does not choose an obstetrician/gynecologist as her primary care provider, the health maintenance organization shall permit the woman to receive an annual visit to an in-network obstetrician/gynecologist for routine gynecological care without requiring the woman to first visit her primary care provider, whether or not the primary care provider is qualified to and regularly provides routine gynecological care.

   (3) (i) A health maintenance organization shall allow a woman to receive medically necessary, routine obstetric and gynecological care from an in-network, certified nurse midwife or any other in-network provider authorized under the Health Occupations Article to provide obstetric and gynecological services without first requiring the woman to visit a primary care provider.

      (ii) A certified nurse midwife or other nonphysician provider authorized under the Health Occupations Article to provide obstetric and gynecological services shall consult with an obstetrician/gynecologist with whom the certified nurse midwife or other provider has a collaborative agreement, in accordance with the collaborative agreement, regarding any care rendered under this paragraph.

(m) Communication of information by health care providers. -- The provisions of § 15-116 of the Insurance Article apply to health maintenance organizations.

(n) Disclosures required in enrollment sales materials. -- The provisions of § 15-121 of the Insurance Article shall apply to health maintenance organizations.

(o) Retroactive denial of reimbursements; preauthorized health care services. -- The provisions of § 15-1008 and 15-1009 of the Insurance Article apply to health maintenance organizations.

(p) Coverage of osteoporosis prevention and treatment. -- The provisions of § 15-823 of the Insurance Article shall apply to health maintenance organizations.

(q) Coverage for maintenance drugs. -- The provisions of § 15-824 of the Insurance Article shall apply to health maintenance organizations.

(r) Payments for blood products. -- The provisions of § 15-803 of the Insurance Article shall apply to health maintenance organizations.

(s) Interdepartmental Committee on Mandated Health Insurance Benefits; Maryland Health Insurance Portability and Accountability Act. -- The provisions of Title 15, Subtitles 13, 14, and 15 of the Insurance Article apply to health maintenance organizations.

(t) Emerging medical and surgical treatments. -- The provisions of § 15-123 of the Insurance Article shall apply to health maintenance organizations.

(u) Coverage for detection of prostate cancer. -- The provisions of § 15-825 of the Insurance Article shall apply to health maintenance organizations.

(v) Fraud prevention fee. -- The provisions of Title 6, Subtitle 2 and Title 27, Subtitle 8 of the Insurance Article shall apply to health maintenance organizations.

(w) Coinsurance payments for health care services. -- The provisions of § 15-118 of the Insurance Article shall apply to health maintenance organizations.

(x) Coverage for diabetes equipment, supplies and self-management training. -- The provisions of § 15-822 of the Insurance Article shall apply to health maintenance organizations.

(y) Complaint process for adverse decisions or grievances; medical directors. -- The provisions of Title 15, Subtitles 10A, 10B, 10C, and 10D of the Insurance Article shall apply to health maintenance organizations.

(z) Health care regulatory assessment. -- The provisions of § 2-112.2 of the Insurance Article shall apply to health maintenance organizations.

(aa) Patient costs for hospital, medical, surgical or pharmaceutical benefits; clinical trials. -- The provisions of § 15-827 of the Insurance Article shall apply to health maintenance organizations.

(bb) Cleft lip and/or cleft palate. -- The provisions of § 15-818 of the Insurance Article shall apply to health maintenance organizations.

(cc) Acquisition of nonprofit health entities. -- The provisions of Title 6.5 of the State Government Article shall apply to the acquisition of a health maintenance organization owned by a nonprofit entity.

(dd) Assignment, transfer or subcontracting health care providers' contracts. -- The provisions of § 15-125 of the Insurance Article apply to health maintenance organizations.

(ee) Insurance -- Regulation assessment; fees for certificates, licenses and services. -- The provisions of Title 2, Subtitle 5 and § 2-112 of the Insurance Article apply to health maintenance organizations.

(ff) Coverage for detection of chlamydia. -- The provisions of § 15-829 of the Insurance Article shall apply to health maintenance organizations.

(gg) Referrals to specialists; coverage of prescription drugs; coverage for mastectomies. -- The provisions of § 15-830, 15-831, and 15-832 of the Insurance Article shall apply to health maintenance organizations.

(hh) Expense-covered health insurance policies. -- The provisions of § 15-833 of the Insurance Article shall apply to health maintenance organizations.

(ii) Coverage for prostheses. -- The provisions of § 15-834 of the Insurance Article apply to health maintenance organizations.

(jj) Access to 911 emergency system. -- The provisions of § 15-126 of the Insurance Article apply to health maintenance organizations.

(kk) Provisions concerning uniform claims forms, prompt payment of claims. -- The provisions of § 15-1003, 15-1004, and 15-1005 of the Insurance Article apply to health maintenance organizations.

(ll) Provisions concerning notice of termination of coverage. -- The provisions of § 15-303(f) of the Insurance Article apply to health maintenance organizations.

(mm) Provisions concerning the distribution of information by carrier owning or contracting with managed behavioral care organizations. -- The provisions of § 15-127 of the Insurance Article shall apply to health maintenance organizations.

(nn) Provisions concerning habilitative services for children. -- The provisions of § 15-835 of the Insurance Article shall apply to health maintenance organizations.

(oo) Provisions concerning in vitro fertilization. -- The provisions of § 15-810 of the Insurance Article apply to health maintenance organizations.

(pp) Provisions concerning discrimination for specified diseases or diagnoses. -- The provisions of § 27-913 of the Insurance Article apply to health maintenance organizations.

(qq) Provisions concerning market conduct examinations. -- The provisions of § 2-205, 2-207, 2-208, and 2-209 of the Insurance Article apply to health maintenance organizations.

(rr) Provisions concerning § 15-837. -- The provisions of § 15-837 of the Insurance Article apply to health maintenance organizations.

(ss) Provisions concerning § 15-130. -- The provisions of § 15-130 of the Insurance Article apply to health maintenance organizations.

(tt) Provisions concerning § 15-838. -- The requirements of § 15-838 of the Insurance Article apply to health maintenance organizations.

(uu) Provisions concerning § 15-839. -- The provisions of § 15-839 of the Insurance Article apply to health maintenance organizations.

(vv) Provisions concerning § 15-1001. -- The provisions of § 15-1001 of the Insurance Article shall apply to health maintenance organizations.

(ww) Provisions concerning § 27-606. -- The provisions of § 27-606 of the Insurance Article apply to health maintenance organizations.

(xx) Provisions concerning Title 27, Subtitle 4. -- The requirements of Title 27, Subtitle 4 of the Insurance Article apply to health maintenance organizations.

(yy) Provisions concerning § 15-840. -- The provisions of § 15-840 of the Insurance Article apply to health maintenance organizations.

(zz) Provisions concerning § 15-416. -- The provisions of § 15-416 of the Insurance Article apply to health maintenance organizations.

(aaa) Provisions concerning § 27-501(h). -- The provisions of § 27-501(h) of the Insurance Article apply to health maintenance organizations.

(bbb) Provisions concerning § 27-209. -- The provisions of § 27-209 of the Insurance Article apply to health maintenance organizations.

(ccc) Provisions concerning § 15-713. -- The provisions of § 15-713 of the Insurance Article apply to health maintenance organizations.

(ddd) Provisions concerning § 27-221. -- The provisions of § 27-221 of the Insurance Article apply to health maintenance organizations.

(eee) Provisions concerning § 15-841. -- The provisions of § 15-841 of the Insurance Article apply to health maintenance organizations.

(fff) Provisions concerning § 15-131. -- The provisions of § 15-131 of the Insurance Article apply to health maintenance organizations.

(ggg) Provisions concerning § 15-417. -- The provisions of § 15-417 of the Insurance Article apply to health maintenance organizations.

(hhh) Provisions concerning § 27-222. -- The provisions of § 27-222 of the Insurance Article apply to health maintenance organizations.

(iii) Provisions concerning § 27-914. -- The provisions of § 27-914 of the Insurance Article apply to health maintenance organizations.

(jjj) Provisions concerning § 27-210. -- The provisions of § 27-210 of the Insurance Article apply to health maintenance organizations.

(kkk) Provisions concerning Title 14, Subtitle 6 of the Insurance Article. -- The provisions of Title 14, Subtitle 6 of the Insurance Article apply to health maintenance organizations.

(lll) Provisions concerning § 15-842. -- The provisions of § 15-842 of the Insurance Article apply to health maintenance organizations.

(mmm) Provisions concerning § 15-403.2 and 15-418. -- The provisions of § 15-403.2 and 15-418 of the Insurance Article apply to health maintenance organizations.

(nnn) Provisions concerning § 15-145. -- The provisions of § 15-145 of this article apply to health maintenance organizations.

(ooo) Provisions concerning § 2-115. -- The provisions of § 2-115 of the Insurance Article apply to health maintenance organizations.

(ppp) Provisions concerning Title 15, Subtitle 16 of the Insurance Article. -- The provisions of Title 15, Subtitle 16 of the Insurance Article apply to health maintenance organizations.

(qqq) Provisions concerning § 2-517 of the State Personnel and Pensions Article. -- The provisions of § 2-517 of the State Personnel and Pensions Article apply to health maintenance organizations.

(rrr) Provisions under § 15-843. -- The provisions of § 15-843 of the Insurance Article apply to health maintenance organizations.

(sss) Provisions of § 15-409.1. -- The provisions of § 15-409.1 of the Insurance Article apply to health maintenance organizations.

(ttt) Provisions of § 15-844. -- The provisions of § 15-844 of the Insurance Article apply to health maintenance organizations.

(uuu) Provisions concerning § 15-1106. -- The provisions of § 15-1106 of the Insurance Article apply to health maintenance organizations.

(vvv) Provisions concerning § 15-832.1. -- The provisions of § 15-832.1 of the Insurance Article apply to health maintenance organizations.

(www) Provisions concerning § 15-1105. -- The provisions of § 15-1105 of the Insurance Article apply to health maintenance organizations.

(xxx) Provisions concerning § 15-814. -- The provisions of § 15-814 of the Insurance Article apply to health maintenance organizations.

(yyy) Provisions concerning § 15-509. -- The provisions of § 15-509 of the Insurance Article apply to health maintenance organizations.

(zzz) Provisions concerning § 15-132. -- The provisions of § 15-132 of the Insurance Article apply to health maintenance organizations.

(aaaa) Provisions concerning Title 15, Subtitle 17 of the Insurance Article. -- The provisions of Title 15, Subtitle 17 of the Insurance Article apply to health maintenance organizations.

(bbbb) Provisions concerning § 15-134. -- The provisions of § 15-134 of the Insurance Article apply to health maintenance organizations.

(cccc) Provisions concerning § 5-608(t). -- The provisions of § 5-608(t) of the Insurance Article apply to health maintenance organizations.

(dddd) Provisions concerning § 15-135. -- The requirements of § 15-135 of the Insurance Article apply to health maintenance organizations.

(eeee) Provisions concerning Title 15, Subtitle 19 of the Insurance Article. -- The provisions of Title 15, Subtitle 19 of the Insurance Article apply to health maintenance organizations.

(ffff) Provisions concerning § 15-136. -- The provisions of § 15-136 of the Insurance Article apply to health maintenance organizations.

(gggg) Provisions concerning § 15-1314. -- The provisions of § 15-1314 of the Insurance Article apply to health maintenance organizations.

(hhhh) Provisions concerning Title 15, Subtitle 18 of the Insurance Article. -- The provisions of Title 15, Subtitle 18 of the Insurance Article apply to health maintenance organizations.

(iiii) Provisions concerning § 15-137.1. -- The provisions of § 15-137.1 of the Insurance Article apply to health maintenance organizations.

(jjjj) Provisions concerning § 15-845 of the Insurance Article. -- The provisions of § 15-845 of the Insurance Article apply to health maintenance organizations.

(kkkk) Provisions concerning § 15-138 of the Insurance Article. -- The provisions of § 15-138 of the Insurance Article apply to health maintenance organizations.

(llll) Provisions concerning § 15-846 of the Insurance Article. -- The provisions of § 15-846 of the Insurance Article apply to health maintenance organizations.

(mmmm) Provisions concerning § 15-139 of the Insurance Article. -- The provisions of § 15-139 of the Insurance Article apply to health maintenance organizations.

(nnnn) Provisions concerning § 15-135.1 of the Insurance Article. -- The provisions of § 15-135.1 of the Insurance Article apply to health maintenance organizations.

HISTORY: 2011, chs. 425, 426.