<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".03" citation="COMAR 10.09.57.03" title_num="10" subtitle_num="09" chapter_num="57" heading="Conditions of Participation.">
  <paragraph num="A.">
    <text>A PCP shall meet the general conditions for participation as set forth in COMAR 10.09.36.03.</text>
  </paragraph>
  <paragraph num="B.">
    <text>In addition, the PCP shall:</text>
    <paragraph num="(1)">
      <text>Ensure that all of its employees, subcontractors, and employees of its subcontractors are appropriately licensed in the jurisdiction in which they are practicing;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>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;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>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;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Allow each enrollee to choose his or her health professionals within the PCP to the extent possible and appropriate;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Comply with the requirements of Regulations .05 — .12 of this chapter;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Monitor the quality of the services its subcontractors render to its enrollees;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Be accessible 24 hours a day to enrollees unless the Program waives this requirement in the provider agreement;</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Agree to provide services to enrollees as promptly as appropriate;</text>
    </paragraph>
    <paragraph num="(9)">
      <text>Have a marketing plan which has been approved by the Department and conduct marketing activities in accordance with that plan; and</text>
    </paragraph>
    <paragraph num="(10)">
      <text>Meet all other applicable requirements of federal and State law.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>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.</text>
  </paragraph>
</regulation>