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S.B. 707
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VETOES
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3. ARE DEVELOPED IN CONSULTATION WITH EXPERTS IN
THE FIELD OF HEALTH CARE QUALITY FOR THOSE POPULATIONS SERVED BY
MANAGED CARE ORGANIZATIONS;
4. ARE BASED ON ABSOLUTE RATHER THAN RELATIVE
PERFORMANCE BY MANAGED CARE ORGANIZATIONS; AND
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5. ARE GROUPED INTO THE FOLLOWING CATEGORIES OF
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PERFORMANCE:
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A. "ACCEPTABLE";
B. "INCENTIVE";. AND
C. "DISINCENTIVE";
(II) PROVIDE FOR A SYSTEM OF FINANCIAL INCENTIVES AND
DISINCENTIVES LINKED TO THE SCORES OF THE MANAGED CARE ORGANIZATIONS
ON EACH OF THE QUALITY MEASURES AND PERFORMANCE STANDARDS;
(III) SERVE AS THE SINGLE, COMPREHENSIVE QUALITY
MEASUREMENT AND IMPROVEMENT INITIATIVE OF THE SECRETARY; AND
(IV) BE ADOPTED BY REGULATION.
SECTION 2. AND BE IT FURTHER ENACTED, That the requirements of this
Act may not be implemented until the Secretary of Health and Mental Hygiene
adopts regulations as required by this Act. The Secretary shall adopt regulations as
required by this Act on or before December 31, 2005:
(a) Prior to making any adjustments to capitation payments for a managed
care organization, the Secretary of Health and Mental Hygiene, in consultation with
the Maryland Insurance Commissioner, shall adopt regulations to implement the
provisions of § 15-605(c)(5) of the Insurance Article.
(b) The regulations adopted under subsection (a) of this section shall:
(1) establish the definition of "loss ratio" for uniform application by all
managed care organizations;
(2) establish procedures requiring the Secretary of Health and Mental
Hygiene to consider the financial performance of a managed care organization in
prior periods;
(3) establish standard data collection and reporting requirements for all
managed care organizations;
(4) consistent with the provisions of § 15-605(c)(5) of the Insurance
Article, establish a process for allowing a managed care organization to appeal a
decision of the Secretary of Health and Mental Hygiene to adjust a managed care
organization's capitation payments; and
(5) establish a mechanism for, and the conditions under which, an
adjustment to the capitation rates of a managed care organization are made.
- 3786 -
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