Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.08 - Evaluation of Quality and Performance of Health Benefit Plans › Section 10.25.08.03 - Health Benefit Plan Quality and Performance Evaluation System - Implementation

Current through Register Vol. 51, No. 14, July 12, 2024
Carrier Participation.
(1) Each carrier may participate in the
				  health benefit plan quality and performance evaluation system.
(2) Each carrier that meets the criteria of
				  Regulation .01B of this chapter is required to participate.
(3) A carrier that chooses not to participate
				  in the health benefit plan quality and performance evaluation system must
				  present clear evidence to the Commission that shows that the carrier has no
				  more than $1,000,000 in annual premium volume by category of health benefit
				  plan and no more than 65 percent of its Maryland enrollees covered through the
				  Medicaid and Medicare programs.
Performance Measures. The Commission shall choose
					 performance measures that are important, feasible, scientifically sound, and
					 actionable, including performance measures that:
(1) Are related to the quality and
				  performance of medical services provided by a health benefit plan;
(2) Allow for comparisons among health
				  benefit plans;
(3) Can be of
				  interest to purchasers, consumers, providers, carriers, or health
				  officials;
(4) Can be used to
				  affect changes in performance; and
(5) Can be validated through an audit
				  conducted by an independent party for validity, reliability, and comparability.
Notice by the Commission.
(1) Beginning in November 2011, and each
				  November thereafter, the Commission shall provide a dated notice posted on the
				  Commission's website and a written notice to each carrier required to report
				  under Regulation .01A. of this chapter regarding the following:
(a) The required categories of health benefit
				  plans for which HEDIS and other performance measures must be submitted for the
				  upcoming measurement year;
(b) The
				  selected HEDIS and other performance measures for each category of health
				  benefit plan to be included in the reporting period; and
(c) Quality and performance measures that
				  will be subject to audit.
(2) Beginning in December 2011, and each
				  December thereafter, the Commission shall provide a dated notice posted on the
				  Commission's website and a written notice to each carrier required to report
				  under Regulation .01A of this chapter regarding the following:
(a) The required categories of health benefit
				  plans for which HEDIS and other performance measures must be submitted for the
				  upcoming measurement year;
(b) The
				  selected HEDIS and other performance measures for each category of health
				  benefit plan to be included in the reporting period;
(c) Quality and performance measures that
				  will be subject to audit; and
(d)
				  The HEDIS and other performance measures anticipated to be required in the
				  measurement year occurring after the current measurement year.
Performance Measures Collection.
(1) Beginning in January of each reporting
				  period, a carrier that is required to participate or elects to participate in
				  the health benefit plan quality and performance evaluation system shall collect
				  all required performance measures as follows:
(a) Collecting HEDIS measures, a carrier
				  shall follow the specifications contained in the latest version or technical
				  update of HEDIS applicable to the measurement year;
(b) Collecting other performance measures, a
				  carrier shall follow specifications published by a nationally recognized
				  organization involved in quality and performance measurement, and in accordance
				  with the notice provided by the Commission in November for the measurement
				  year; and
(c) A carrier shall use
				  the specifications, templates, and other documents provided by the Commission,
				  which shall be consistent with those published by the National Committee for
				  Quality Assurance for HEDIS measures and, for non-HEDIS performance measures,
				  required by the Commission, consistent with specifications, templates, or
				  documents published by nationally recognized organizations involved in quality
				  of care and performance measurement.
(2) A carrier is not required to submit HEDIS
				  or other performance measures regarding proprietary information contained in
				  descriptive information on health plan management and activities.
(3) The Commission shall provide technical
				  assistance and auditing services to a carrier required to report the HEDIS and
				  other performance measures.
Commission Publication of Health Benefit Plan Quality and
					 Performance Evaluation Reports. On or before November 1 of each year, the
					 Commission shall publish on its website one or more reports for use by
					 consumers and purchasers who make health benefit plan enrollment and
					 contracting decisions. The reports shall:
(1) Compare quality and performance
				  evaluation results of each health benefit plan on the various HEDIS and other
				  performance measures required by the Commission; and
(2) Include information on valid and reliable
				  HEDIS and other performance measures that are comparable on a health benefit
				  plan level, as determined by the Commission.