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 10.09.57.10 - Financial Solvency

Universal Citation: MD Code Reg 10.09.57.10

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

A. The PCP shall include in its provider agreement a clause that the PCP will hold harmless both the Department and its enrollees from any liability for payment for the legal obligations of the PCP.

B. The PCP shall give the Department access to the PCP's financial records at reasonable intervals in order to monitor the PCP's financial solvency.

C. The PCP shall file annual audited financial statements with the Department. A PCP in operation for less than 1 year shall file an interim statement.

D. The provider agreement shall provide for the continuation of benefits to all enrollees for the duration of the contract period for which payment has been made.

E. The PCP shall have a financially sound operation as demonstrated by:

(1) A positive net worth; and

(2) Sufficient cash and adequate liquidity, as determined by the Department, to meet the PCP's obligations as they become due.

F. The PCP shall provide full and complete information 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 PCP has a 5 percent or more ownership interest.

G. PCPs that are at risk for services that the PCPs do not directly provide shall deposit an amount equal to the portion of 2 months' capitation payments relating to the services in a reserve account in trust. The agreement establishing the reserve account, which is subject to the Department's approval, may provide that the Department is the sole beneficiary of the trust, and that the trust funds may be disbursed only at the request of the Department to prevent or postpone the PCP's insolvency.

H. Minimum Insurance Coverage.

(1) The PCP shall provide written evidence to the Department on an annual basis that it has sufficient insurance issued by an insurer authorized by the Maryland Insurance Administrator to engage in the insurance business to protect its financial viability and its ability to carry out its contractual obligations.

(2) The coverage shall include at a minimum:
(a) Malpractice coverage for all professional and related employees of the provider as well as for the organization itself;

(b) Bonding of all employees and officers who have any responsibility for the accounting and financial management activities of the provider; and

(c) Workers' compensation, fire, theft, casualty, and other coverage as required by State and local laws.

I. PCPs which are governmental units or are funded by the Mental Hygiene Administration, the Alcohol and Drug Abuse Administration, or the Developmental Disabilities Administration of the Department and subject to the oversight of one of these agencies are exempt from the requirements of this regulation.

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