Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 1
Subtitle 07 - HOSPITALS
Chapter 10.07.11 - Health Maintenance Organizations
Section 10.07.11.08 - Policy Formulation

Universal Citation: MD Code Reg 10.07.11.08

Current through Register Vol. 51, No. 19, September 20, 2024

A. The HMO shall have written policies governing the provision of the HMO services according to stated objectives of the HMO. The policies shall be developed in consultation with the executive officer, representative professionals, including one or more physicians, nursing service personnel associated with the service, and one or more enrollee representative or representatives. Policies shall be approved by the governing authority and reviewed and revised annually as required. These approvals shall be affirmed in writing and dated by an authorized representative of the governing authority.

B. Patient Care Policies. The policies shall cover at least the following:

(1) Inpatient admission and discharge policies;

(2) Physician (Independent Practice Association) services, including medical staff organization;

(3) Provision of or arrangements for other services not directly provided by the HMO;

(4) Continuity and availability of care through an established referral mechanism and ongoing contract with other health services providers.

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