Mid-Atlantic Health Law TOPICS

During its 2000 Session, the Maryland Gen­eral Assembly enacted a new "downstream risk" law that regulates health care providers who assume financial risk from HMOs.

As of June 1, 2000, contracting providers are required to register with the Maryland Insur­ance Administration (MIA) prior to entering into a new Administrative Service Provider Con­tract with an HMO. (An Administrative Service Provider Contract is one in which the provider, in return for a capitated payment, provides or arranges for the provision of certain medical services, and assumes the risk in some circumstances to pay other providers for such services.) If an Administrative Service Provider Contract was in effect prior to June 1, 2000, compliance with the new law is required no later than January 1, 2001.

To register, a contracting provider must submit a completed registration form along with a registration fee of $250 to the MIA. Registration is required even if the contracting provider is affiliated with an HMO and enters into an Administrative Service Provider Con­tract only with that HMO.

The registration form, which is attached to the Life and Health Bulletin 00-13, requires the applicant to provide various information, including a list of the Administrative Service Provider Contracts the provider has entered into with HMOs and managed care organiza­tions (including such details as the number of lives covered as of the date of the application and the approximate capitation and other pay­ments received by the contracting provider on an annual basis in regard to each contract).

Robin J. Siegel
(410) 576-4166 • rsiegel@gfrlaw.com