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ROBERT L. EHRLICH, JR., Governor S.B. 707
Robert L. Ehrlich, Jr.
Governor
Senate Bill No. 707
AN ACT concerning
Medicaid Quality Improvement Act of 2005
Managed Care Organizations Adjustment to Capitation Payments----
Quality Improvement Incentive
Maryland Medical Assistance Program - Medical Loss Ratio and Quality of
Care
FOR the purpose of authorizing the Secretary of Health and Mental Hygiene, in
consultation with the Maryland Insurance Commissioner, to adjust capitation
payments for a managed care organization based on a certain loss ratio of the
managed care organization; authorizing a managed care organization or a
certified health maintenance organization to appeal a certain decision of the
Secretary of Health and Mental Hygiene under certain circumstances;
authorizing a managed care organization to take a certain appeal under the
Administrative Procedure Act under certain circumstances; requiring the
Secretary to adopt certain regulations prior to making a certain adjustment to
capitation payments; establishing requiring the Secretary, in consultation with
the Maryland Insurance Commissioner, to adopt regulations that establish a
certain definition and certain procedures, standards, and limits data collection
and reporting requirements for the adjustment of capitation payments;
authorizing the Secretary, in consultation with the Commissioner, to adjust
capitation payments based on a certain quality performance initiative adopted
by the Secretary; establishing certain standards and procedures relating to the
quality performance initiative; requiring the Secretary to adopt certain
regulations on or before a certain date; providing that this Act may not be
implemented until the Secretary adopts certain regulations; 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
adjustments to capitation payments to managed care organizations and quality
of care the Maryland Medical Assistance Program, medical loss ratio, and
Quality of care.
BY repealing and reenacting, with amendments,
Article — Insurance
Section 15-605(c)
Annotated Code of Maryland
(2002 Replacement Volume and 2004 Supplement)
BY adding to
Article—Insurance
Section 15-605.1
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