Ch. 9

1993 LAWS OF MARYLAND

(6) THE COMMISSION SHALL ESTABLISH REASONABLE DEADLINES FOR
THE PHASING IN OF ELECTRONIC TRANSMITTAL OF CLAIMS FROM THOSE HEALTH CARE
PRACTITIONERS DESIGNATED UNDER PARAGRAPH (5) OF THIS SUBSECTION.

(7) ON OR BEFORE JULY 1, 1995, AS DESIGNATED BY THE COMMISSION
PAYORS OF HEALTH CARE SERVICES IN MARYLAND AND MEDICAID AND MEDICARE
SHALL TRANSMIT EXPLANATIONS OF BENEFITS AND ANY OTHER INFORMATION
REASONABLY RELATED TO THE MEDICAL CARE DATA BASE ELECTRONICALLY IN A
STANDARD FORMAT AS REQUIRED BY THE COMMISSION WHETHER BY MEANS OF A
CLAIMS CLEARINGHOUSE OR OTHER METHOD APPROVED BY THE COMMISSION.

(B) THE COMMISSION SHALL COLLECT THE MEDICAL CARE CLAIMS
INFORMATION SUBMITTED TO ANY LICENSED CLAIMS CLEARINGHOUSE FOR USE IN THE
DATA BASE ESTABLISHED UNDER § 19-1507 OF THIS SUBTITLE.

(C) (1) THE COMMISSION SHALL:

(I) ON OR BEFORE JANUARY 1, 1994, ESTABLISH AND IMPLEMENT A
SYSTEM TO COMPARATIVELY EVALUATE THE QUALITY OF CARE OUTCOMES AND
PERFORMANCE MEASUREMENTS OF HEALTH MAINTENANCE ORGANIZATION BENEFIT
PLANS AND SERVICES ON AN OBJECTIVE BASIS; AND

(II) ANNUALLY PUBLISH THE SUMMARY FINDINGS OF THE
EVALUATION.

(2) THE PURPOSE OF A COMPARABLE PERFORMANCE MEASUREMENT
SYSTEM ESTABLISHED UNDER THIS SECTION IS TO ASSIST HEALTH MAINTENANCE
ORGANIZATION BENEFIT PLANS TO IMPROVE THE QUALITY OF CARE PROVIDED BY
ESTABLISHING A COMMON SET OF PERFORMANCE MEASUREMENTS AND
DISSEMINATING THE FINDINGS OF THE PERFORMANCE MEASUREMENTS TO HEALTH
MAINTENANCE ORGANIZATIONS AND INTERESTED PARTIES.

(3) THE SYSTEM, WHERE APPROPRIATE, SHALL SOLICIT PERFORMANCE
INFORMATION FROM ENROLLEES OF HEALTH MAINTENANCE ORGANIZATIONS.

(4) (I) THE COMMISSION SHALL ADOPT REGULATIONS TO ESTABLISH
THE SYSTEM OF EVALUATION PROVIDED UNDER THIS SECTION.

(II) BEFORE ADOPTING REGULATIONS TO IMPLEMENT AN
EVALUATION SYSTEM UNDER THIS SECTION, THE COMMISSION SHALL CONSIDER ANY
RECOMMENDATIONS OF THE QUALITY OF CARE SUBCOMMITTEE OF THE GROUP
HEALTH ASSOCIATION OF AMERICA AND THE NATIONAL COMMITTEE FOR QUALITY
ASSURANCE.

(5) THE COMMISSION MAY CONTRACT WITH A PRIVATE, NONPROFIT ENTITY
TO IMPLEMENT THE SYSTEM REQUIRED UNDER THIS SECTION PROVIDED THAT THE
ENTITY IS NOT AN INSURER.

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