Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 2
Subtitle 09 - MEDICAL CARE PROGRAMS
Chapter 10.09.57 - Partially Capitated Programs
Section 10.09.57.02 - Application for Qualification as a Partially Capitated Provider
Universal Citation: MD Code Reg 10.09.57.02
Current through Register Vol. 51, No. 19, September 20, 2024
A. An applicant shall demonstrate to the satisfaction of the Department that it has the managerial, financial, clinical, and administrative capability to carry out the duties required by these regulations.
B. An applicant shall submit the following documents to the Department along with a completed application form:
(1) A narrative of the applicant's overall
plan for providing and arranging for the provision of high quality services to
enrollees efficiently, effectively, and economically;
(2) A description of the organization and
staff responsible for delivering health care and a copy of the applicant's
organizational documents;
(3) An
annualized pro forma budget and financial plan for the operation of the
organization or, at the Department's option, of the appropriate unit within the
organization responsible for the operation for delivery of services pursuant to
this regulation for the first 3 years of its anticipated operations which
demonstrates its financial viability based on reasonable assumptions;
(4) An annualized cash flow chart;
(5) A statement of policy and procedures for
accounting, methods of reimbursing subcontractors, and payment of emergency and
out-of-area claims;
(6) Balance
sheets;
(7) Any other financial
information the Program requires;
(8) Full and complete information at all
times as to the identity of each person or corporation with an ownership or
control interest in the PCP and of any subcontractor in which the applicant has
a 5 percent or more ownership interest;
(9) A detailed description of the applicant's
quality assurance plan which demonstrates compliance with Regulation .07 of
this chapter;
(10) A description of
a system for the receipt and prompt adjudication of complaints and grievances
by enrollees which complies with Regulation .12 of this chapter;
(11) A description of the process by which
data about services provided will be collected;
(12) Copies of all of the applicant's
contracts with subcontractors;
(13)
A description of the boundaries of the geographic area or area the applicant
wishes to serve; and
(14) A copy of
the applicant's marketing plan.
C. If the applicant will be at risk for services it will not directly provide, the applicant shall identify and document a source of funds which will comprise the reserve account required by Regulation .10 of this chapter.
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