<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".05" citation="COMAR 10.67.03.05" title_num="10" subtitle_num="67" chapter_num="03" heading="Access and Capacity.">
  <paragraph num="A.">
    <text>An MCO applicant shall include in its application the following information or descriptions:</text>
    <paragraph num="(1)">
      <text>A map or maps showing the county or counties in which the applicant proposes to provide health care services, and the service area boundaries.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The name and address of each of the applicant's service delivery sites, and, if applicable, the type of facility licensure of each site, grouped by county;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>If the applicant is an HMO, the applicant's total prepaid enrollment or client population as of the date of application, with a breakdown by payment source, including Medicare, Medicaid, commercial group, commercial individual, and other enrollment;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>If the applicant is an HMO, the total of the applicant's current unduplicated fee-for-service patient count, with a breakdown by payment source, including Medicaid, Medicare, commercial group, commercial individual, and other patients (including self-pay);</text>
    </paragraph>
    <paragraph num="(5)">
      <text>The name and address of each of the applicant's primary and specialty care providers, provided in a format specified by the Department, for distribution to recipients in enrollment packets;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>The following information, grouped by medical specialty and county, regarding each individual practitioner, including primary care providers and specialists, who will act as a health care provider for the applicant:</text>
      <paragraph num="(a)">
        <text>Name, address, and practice location or locations, including a separate line for each location;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>State licensure number;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Specialty, if applicable, indicating the type of services to be provided on behalf of the applicant;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Whether the provider will be a primary care provider;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>A description of the practitioner's employment relationship to the applicant, including, but not limited to:</text>
        <paragraph num="(i)">
          <text>A salaried employee;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>A subcontractor;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>An employee of a subcontractor; or</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Any other form of contractual or employment relationship;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(f)">
        <text>Any restrictions as to age of patients or numbers of enrollees the provider will serve;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(7)">
      <text>The procedures for assuring proper credentialing and recredentialing of providers;</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Documentation that the MCO applicant is able to meet the access standards set forth in COMAR 10.67.05 in each service area the MCO applicant plans to enter;</text>
    </paragraph>
    <paragraph num="(9)">
      <text>Documentation of any reasons for which they are unable to meet the access requirements of COMAR 10.67.05 in any service area;</text>
    </paragraph>
    <paragraph num="(10)">
      <text>For each primary care practice location, a specification of:</text>
      <paragraph num="(a)">
        <text>The name, address, and hours of operation; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The staffing at each location, expressed in full-time equivalencies and grouped by medical specialty; and</text>
      </paragraph>
    </paragraph>
    <paragraph num="(11)">
      <text>Written protocols detailing how the applicant will provide 24-hour per day, 7-day per week coverage for emergency medical situations, including compliance with MIEMSS protocols and the federal Emergency Medical Treatment and Active Labor Act.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>The service area in §A(1) of this regulation shall include at least two underserved counties as defined in §C of this regulation.</text>
  </paragraph>
  <paragraph num="C.">
    <text>An underserved county is a county in which less than three current MCOs are participating and accepting new enrollments.</text>
  </paragraph>
  <paragraph num="D.">
    <text>If there are no underserved counties, applications will not be accepted.</text>
  </paragraph>
</regulation>