Sec. 10.67.03.07. Access and Capacity: Contracts and Provider Applications

An MCO applicant shall include in its application the following information or descriptions:

A. A description of the applicant's hiring and subcontracting policies, which shall correspond to the requirements of Insurance Article, §15-112, Annotated Code of Maryland;

B. A blank copy of the provider application form;

C. Documentary assurances that the applicant and its health care providers furnish access on a nondiscriminatory basis, in accordance with State and federal law, to all of their enrollees regardless of gender, race, age, religion, national origin, physical or mental disability, or type of illness or condition;

D. If the applicant is an HMO that will require its panel providers to participate in the MCO, documentation of the mechanism the MCO will use to make an equitable distribution of enrollees among its panel providers so that no provider is assigned a disproportionate number of enrollees;

E. Written evidence of the applicant's organizational capacity to provide special programs adequate to meet the individual needs of all enrollees, including:

(1) Outreach;

(2) Case management;

(3) Home visiting;

(4) Disease management;

(5) Prevention and wellness education; and

(6) All Medicaid-covered services required to comply with State statutes and regulations mandating health and behavioral health services for children in State-supervised care;

F. A written explanation of the applicant's plan for ensuring that each primary and specialty care provider receives a copy of the MCO's Medicaid requirements manual, and any other information necessary to facilitate full compliance with all federal and State Medicaid requirements within 2 weeks after the provider has entered into a contract or has begun employment with the MCO, and updated as necessary thereafter; and

G. A description of the applicant's plan to accommodate the cultural and ethnic diversity of the populations to be served.