Learn More
Log In
Sign Up
Md. Code Regs. 10.67.04 – Maryland Medicaid Managed Care Program: Managed Care Organizations | Midpage
Collections
Code of Maryland Regulations
Title 10
§ 67
Chapter 04
Md. Code Regs. 10.67.04
Maryland Medicaid Managed Care Program: Managed Care Organizations
Effective Apr 28, 2025
.01
Incorporation by Reference — Repealed
.02
Conditions for Participation.
.03
Quality Assessment and Improvement.
.03-1
HealthChoice Health Equity Incentive Program.
.03-2
HealthChoice Population Health Incentive Program (PHIP).
.04
Special Needs Populations.
.05
Special Needs Populations — Children with Special Health Care Needs.
.06
Special Needs Populations — Individuals with a Physical Disability.
.07
Special Needs Populations — Individuals with a Developmental Disability.
.08
Special Needs Populations — Pregnant and Postpartum Women.
.09
Special Needs Populations — Homeless Individuals.
.10
Special Needs Populations — Individuals with HIV/AIDS.
.11
Special Needs Populations — Individuals in Need of Substance Abuse Treatment — Repealed
.12
Consumer Advisory Board.
.13
Children in State-Supervised Care.
.14
Referral to Behavioral Health ASO.
.15
Data Collection and Reporting.
.16
Repealed.
.17
Subcontractual Relationships.
.18
Third-Party Liability.
.18-1
MCO Reimbursement — GME Exclusion.
.19
MCO Reimbursement.
.19-1
MCO-Specific Case Mix Adjustment for HIV and AIDS with Hepatitis C.
.19-2
MCO Supplemental Payment for Transitional Encounter Data Adjustment.
.19-3
MCO-Specific Case Mix Adjustment.
.19-4
MCO Medical Loss Ratio.
.20
MCO Payment for Self-Referred, Emergency, Physician, and Hospital Services.
.21
Payments to Federally Qualified Health Centers (FQHC).
.22
Stop Loss Program.
.23
Marketing.
.24
Repealed.
.25
Enrollee Outreach Plan.
.26
Time Period for Termination of Provider Agreement.
.27
Newborn Coordinator.