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ROBERT L. EHRLICH, JR., Governor
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Ch. 193
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certain regulations prior to making a certain adjustment to capitation
payments; requiring the Secretary, in consultation with the Maryland Insurance
Commissioner, to adopt regulations that establish a certain definition and
certain procedures, standards, and data collection and reporting requirements
for the adjustment of capitation payments; authorizing the Secretary to modify,
enhance, or replace the Value Based Purchasing Initiative in effect on a certain
date, subject to certain conditions; and generally relating to the Maryland
Medical Assistance Program, medical loss ratio, and quality of care.
BY repealing and reenacting, without amendments,
Article - Insurance
Section 15-605(c)(5), (c)(6), and (c)(7)
Annotated Code of Maryland
(2002 Replacement Volume and 2004 Supplement)
BY adding to
Article - Insurance
Section 15-605(c)(8)
Annotated Code of Maryland
(2002 Replacement Volume and 2004 Supplement)
BY repealing and reenacting, without amendments,
Article - Health - General
Section 2-207
Annotated Code of Maryland
(2000 Replacement Volume and 2004 Supplement)
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF
MARYLAND, That the Laws of Maryland read as follows:
Article - Insurance
15-605.
(c) (5) The Secretary of Health and Mental Hygiene, in consultation with
the Commissioner and in accordance with their memorandum of understanding, may
adjust capitation payments for a managed care organization or for the Maryland
Medical Assistance Program of a managed care organization that is a certified health
maintenance organization:
(i) if the loss ratio is less than 80% during calendar year 1997; and
(ii) during each subsequent calendar year if the loss ratio is less
than 85%.
(6) A loss ratio reported under paragraph (5) of this subsection shall be
calculated separately and may not be part of another loss ratio reported under this
section.
- 1145 -
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