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<section article="ghg" article_name="Health - General" number="19-705.8" title_number="19" title_name="Health Care Facilities" subtitle_number="7" subtitle_name="Health Maintenance Organizations">
  <level label="a">
    <level label="1">
      <text>In this section the following words have the meanings indicated.</text>
    </level>
    <level label="2">
      <text>“HMO Quality Assurance Unit” means the Health Maintenance Organization (HMO) Quality Assurance Unit in the Department.</text>
    </level>
    <level label="3">
      <text>“Quality Assurance Medical Director” means the Medical Director of the HMO Quality Assurance Unit.</text>
    </level>
  </level>
  <level label="b">
    <text>There is a Health Maintenance Organization (HMO) Quality Assurance Unit in the Department.</text>
  </level>
  <level label="c">
    <level label="1">
      <text>The Secretary shall appoint the Quality Assurance Medical Director.</text>
    </level>
    <level label="2">
      <text>The Quality Assurance Medical Director shall:</text>
      <level label="i">
        <text>Be a physician who is licensed in the State;</text>
      </level>
      <level label="ii">
        <text>Be board certified in at least one specialty;</text>
      </level>
      <level label="iii">
        <text>Have experience in primary care and administrative medicine; and</text>
      </level>
      <level label="iv">
        <text>Have broad knowledge of health maintenance organizations and managed care organizations.</text>
      </level>
    </level>
    <level label="3">
      <text>The Quality Assurance Medical Director is entitled to the compensation provided in the State budget.</text>
    </level>
    <level label="4">
      <text>Subject to the authority vested in the Secretary by law, the Quality Assurance Medical Director is in charge of and responsible for the clinical operations of the HMO Quality Assurance Unit.</text>
    </level>
    <level label="5">
      <text>In accordance with the State budget the Secretary may employ staff for the HMO Quality Assurance Unit.</text>
    </level>
  </level>
  <level label="d">
    <text>The HMO Quality Assurance Unit shall:</text>
    <level label="1">
      <text>Enforce all requirements established under §§ 19-705 and 19-705.1 of this subtitle and the regulations adopted under these provisions regarding the quality of health care provided by a health maintenance organization; and</text>
    </level>
    <level label="2">
      <text>Investigate quality of care complaints referred to the Secretary under § 19-705.2(b)(3) of this subtitle.</text>
    </level>
  </level>
  <level label="e">
    <text>The Quality Assurance Medical Director shall:</text>
    <level label="1">
      <text>Determine whether a health maintenance organization meets the requirements established under §§ 19-705 and 19-705.1 of this subtitle and the regulations adopted under these provisions regarding the quality of health care provided by a health maintenance organization; and</text>
    </level>
    <level label="2">
      <text>Make recommendations to the Secretary for corrective action necessary to meet these requirements.</text>
    </level>
  </level>
  <level label="f">
    <text>If the Secretary agrees with a determination made by the Quality Assurance Medical Director that a health maintenance organization does not meet the requirements established under §§ 19-705 and 19-705.1 of this subtitle or the regulations adopted under these provisions regarding the quality of health care provided by a health maintenance organization, the Secretary may issue an order under § 19-731 of this subtitle.</text>
  </level>
</section>
