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Code of Maryland Regulations

Chapter 04

Md. Code Regs. 10.67.04

Maryland Medicaid Managed Care Program: Managed Care Organizations

Effective Apr 28, 2025

.01Incorporation by Reference — Repealed .02Conditions for Participation..03Quality Assessment and Improvement..03-1HealthChoice Health Equity Incentive Program..03-2HealthChoice Population Health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— Individuals with HIV/AIDS..11Special Needs Populations — Individuals in Need of Substance Abuse Treatment — Repealed .12Consumer Advisory Board..13Children in State-Supervised Care..14Referral to Behavioral Health ASO..15Data Collection and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