(a) If it is necessary to provide emergency services, authorization shall be presumed for utilizing the medical or surgical provider on call for unassigned patients or the appropriate specialist on call for the hospital on that date if:
(1) A telephone access system is not operational at the time of the call; or
(2) A member’s primary care provider or the specialist needed by a member cannot be determined within a reasonable time, as determined by the treating emergency physician but not to exceed 30 minutes after the initial documented call to the telephone access system.
(b) This section may not be construed to require a health maintenance organization to have contracted specialist providers at hospitals outside of the service area of the health maintenance organization.
Structure Maryland Statutes
Title 19 - Health Care Facilities
Subtitle 7 - Health Maintenance Organizations
Section 19-702 - Declaration of Intent and Policy
Section 19-703 - Scope of Subtitle
Section 19-704 - Corporate Practice of Medicine
Section 19-705 - Rules and Regulations
Section 19-705.1 - Standards of Quality of Care
Section 19-705.2 - Complaints of Members and Subscribers
Section 19-705.3 - Centers for Disease Control and Prevention's Guidelines on Universal Precautions
Section 19-705.4 - Limitations on Covered Services and Visits
Section 19-705.5 - Coverage for Inherited Metabolic Disease
Section 19-705.6 - Emergency Services
Section 19-705.7 - Toll-Free Telephone Access
Section 19-705.8 - Health Maintenance Organization Quality Assurance Unit
Section 19-706 - Regulation; Applicability of Other Laws
Section 19-706.1 - Rehabilitation or Liquidation of Health Maintenance Organizations
Section 19-707 - Authorization to Operate
Section 19-708 - Applications for Certificates to Operate
Section 19-710 - Basic Requirements to Operate as a Health Maintenance Organization
Section 19-710.1 - Payment to Health Care Provider Not Under Written Contract
Section 19-710.2 - Point-of-Service Option
Section 19-712 - Powers and Authority of Health Maintenance Organization
Section 19-712.2 - Notice to Pharmacies of Change in Pharmaceutical Benefits
Section 19-712.4 - Prohibited Referrals
Section 19-712.5 - Reimbursement for Hospital Emergency Facility and Provider
Section 19-712.6 - Continuing Care Facility
Section 19-712.7 - Reimbursement to Community Health Resources
Section 19-713 - Rates and Contracts
Section 19-713.1 - Contracts Between Health Maintenance Organization and Subscribers
Section 19-713.2 - Administrative Service Provider Contracts
Section 19-713.3 - Administrative Service Contracting Provider
Section 19-713.4 - Providing Pharmaceutical Services
Section 19-713.5 - Uniform Consultation Referral Form
Section 19-713.6 - Drug Therapy Management
Section 19-714 - Marketing Documents
Section 19-715 - Application or Offer of Enrollment
Section 19-716 - Availability of Information to Members and General Public
Section 19-717 - Annual Reports
Section 19-719 - Health Care Services; Examination
Section 19-720 - Health Services Cost Review Commission
Section 19-721 - Expiration of Certificate of Authority
Section 19-722 - Refusal to Renew Certificate; Remedies
Section 19-723 - Supervision of Health Maintenance Organizations
Section 19-724 - Solicitation of Members
Section 19-725 - Cancellation of Enrollment
Section 19-726 - Prohibited Use of Certain Terms
Section 19-727 - Applicability of Tax Laws
Section 19-728 - Responsibilities of Department and Commissioner
Section 19-729 - Prohibited Acts; Remedies
Section 19-730 - Penalties -- Violation of 19-729 of This Subtitle
Section 19-731 - Penalties -- Violation of 19-705 and 19-705.1 of This Subtitle
Section 19-735 - Foreign Health Maintenance Organization Transferring Domicile to This State