1. A. A PCP shall meet the general conditions for participation as set forth in COMAR 10.09.36.03.

2. B. In addition, the PCP shall:

   1. (1) Ensure that all of its employees, subcontractors, and employees of its subcontractors are appropriately licensed in the jurisdiction in which they are practicing;
   2. (2) Enter into and maintain contractual arrangements necessary to meet the medical and health needs of enrollees for which it is receiving a capitation payment, except for emergency treatment and out-of-area referrals;
   3. (3) Accept all Medical Assistance recipients who qualify for the PCP's services who select the PCP and who reside in the PCP's designated geographic area;
   4. (4) Allow each enrollee to choose his or her health professionals within the PCP to the extent possible and appropriate;
   5. (5) Comply with the requirements of Regulations .05 — .12 of this chapter;
   6. (6) Monitor the quality of the services its subcontractors render to its enrollees;
   7. (7) Be accessible 24 hours a day to enrollees unless the Program waives this requirement in the provider agreement;
   8. (8) Agree to provide services to enrollees as promptly as appropriate;
   9. (9) Have a marketing plan which has been approved by the Department and conduct marketing activities in accordance with that plan; and
   10. (10) Meet all other applicable requirements of federal and State law.
3. C. In accordance with 42 CFR §434.26(b)(4), an applicant who does not come within one of the exceptions specified in 24 CFR §434.26(b) shall request from the Department a waiver of 42 CFR §434.26(a), which provides that Medicaid recipients and Medicare beneficiaries may constitute not more than 75 percent of the enrollees of a health maintenance organization or prepaid capitation plan. The Department shall pursue a waiver for good cause.

Authority: Health-General Article, §§2-104(b), 15-103, and 15-105, Annotated Code of Maryland

Effective date

Regulations .01 — .17 adopted as an emergency provision effective June 14, 1995 (22:14 Md. R. 1051); adopted permanently effective October 23, 1995 (22:21 Md. R. 1616)

Regulation .10I amended effective March 30, 2026 (53:6 Md. R. 291)