Mid-Atlantic Health Law TOPICS

The following is a sampling of health care/health insurance measures enacted by the Maryland General Assembly during its 1997 Session:

1. Maintenance Drug Prescriptions. Insurers that provide prescription drug coverage must allow an enrollee, other than a nursing home enrollee, to receive up to a 90-day supply of a maintenance drug at one time. Nevertheless, insurers may increase the co-payment applicable to such a prescription, provided that the insurer also proportionally increases the dispensing fee to the pharmacist. This law becomes effective on 10/1/97, but only for a trial period extending to 9/30/98.

2. Medical Records. A health care provider has 21 working days to comply with a request for a copy of a medical record from a person in interest. A provider may not refuse to disclose the records because the person in interest has refused to pay for the health care services rendered. In addition, State agencies have been added to the list of health care providers who are subject to penalties for the knowing and willful violation of laws relating to the confidentiality of medical records. Penalties for unauthorized disclosure or sale of medical records now range from $50,000 and/or 1 year imprisonment to $250,000 and/or 10 years imprisonment. These new provisions go into effect on 10/1/97.

3. Reimbursement of Service Providers. Providers now have 6 months from the date a covered service is rendered to submit a claim for insurance reimbursement. If additional information is requested to adjudicate a claim, an insurer must reimburse the provider within 30 days after receipt of the necessary documentation. An insurer failing to reimburse the provider within the time required is subject to an interest charge on the unpaid claim. This legislation becomes effective on 10/1/97.

4. HMOs - Access to Services. By 7/1/98, HMOs are required to provide enrollees and providers with a 24-hour toll free telephone access system to allow them to determine with one phone call, the enrollee's primary care provider as well as giving to the provider the names of three HMO contracted specialists with staff privileges at a particular hospital. By 7/1/97, HMO authorization for emergency services to be performed by the medical/surgical provider on call at a hospital is presumed acceptable, if the telephone access system is not operational or if a member's primary care provider or specialist cannot be determined within 30 minutes.

5. HMOs - Coinsurance Payments. HMOs are now included in the requirement that negotiated discounts be extended to enrollees who pay coinsurance based on a percentage of the fee for the services. A HMO may not charge or collect a coinsurance payment amount greater than the amount calculated using the negotiated alternative fee. This law is effective 10/1/97.

6. Maryland Health Care Foundation. A statewide, nonprofit foundation to solicit and receive public/private funds to support initiatives to expand the availability of health care services for uninsured Marylanders was established, effective 10/1/97.

7. Physician Assistants. Employers of a physician assistant must report the termination of the physician assistant to the Board of Physician Quality Assurance (BPQA), within 5 days of termination, if the cause of termination is related to a quality of care issue. In addition to other specific duties, physician assistants are now authorized to write medication orders in hospitals, prisons and public health clinics, according to written job descriptions approved by BPQA. The foregoing is effective on 10/1/97.