PARRIS N. GLENDENING, Governor                          Ch. 341

(b)    The Commission [shall] MAY 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 subsection provided that the entity is not an
insurer.

19-1509.

(a) (1) In this section the following words have the meanings indicated.

(2)    "Code" means the applicable current procedural terminology (CPT)
code as adopted by the American Medical Association or other applicable code under an
appropriate uniform coding scheme approved by the Commission.

(3)    "Payor" means:

(i) A health insurer or nonprofit health service plan that holds a
certificate of authority and provides health insurance policies or contracts in the State in
accordance with Article 48A of the Code or the Health - General Article;

(ii) A health maintenance organization that [is licensed to operate in
the State] HOLDS A CERTIFICATE OF AUTHORITY.

(4)    "Unbundling" means the use of two or more codes by a health care
provider to describe a surgery or service provided to a patient when a single, more
comprehensive code exists that accurately describes the entire surgery or service.

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