Ch. 352

1996 LAWS OF MARYLAND

1. COMPLIES WITH ANY HEALTH CARE QUALITY
IMPROVEMENT SYSTEM DEVELOPED BY THE HEALTH CARE FINANCING
ADMINISTRATION;

2. COMPLIES WITH THE QUALITY REQUIREMENTS OF
APPLICABLE STATE LICENSURE LAWS AND REGULATIONS;

3. COMPLIES WITH PRACTICE GUIDELINES AND PROTOCOLS
SPECIFIED BY THE DEPARTMENT;

4.       PROVIDES FOR AN ENROLLEE GRIEVANCE SYSTEM
INCLUDING AN ENROLLEE HOTLINE;

5.       PROVIDES A PROVIDER GRIEVANCE SYSTEM;

5. 6. PROVIDES FOR ENROLLEE AND PROVIDER
SATISFACTION SURVEYS, TO BE TAKEN AT LEAST ANNUALLY;

6. 7. PROVIDES FOR A CONSUMER ADVISORY BOARD TO
RECEIVE REGULAR INPUT FROM ENROLLEES;

7. 8. PROVIDES FOR AN ANNUAL CONSUMER ADVISORY
BOARD REPORT TO BE SUBMITTED TO THE SECRETARY; AND

8. 9. COMPLIES WITH SPECIFIC QUALITY, ACCESS, DATA,
AND PERFORMANCE MEASUREMENTS ADOPTED BY THE DEPARTMENT FOR
TREATING ENROLLEES WITH SPECIAL NEEDS;

(ii) Collect and submit TO ENABLE THE DEPARTMENT TO MONITOR
COMPLIANCE AND PROGRESS OF THE PROGRAM AND TO PROVIDE MANAGED CARE
ORGANIZATIONS WITH TIMELY FEEDBACK TO ASSIST THE MANAGED CARE
ORGANIZATION IN PROVIDING MORE EFFICIENT AND COST-EFFECTIVE CARE,
SUBMIT to the Department: service specific

1.       SERVICE-SPECIFIC data by service type in a format to be
established by the Department; AND

2.       UTILIZATION AND OUTCOME REPORTS, SUCH AS THE
HEALTH PLAN EMPLOYER DATA AND INFORMATION SET (HEDIS), AS DIRECTED BY
THE DEPARTMENT;

(iii) Promote timely access to and continuity of health care SERVICES
for Program recipients ENROLLEES;

(iv) Develop special programs tailored to meet the individual health
care needs of Program recipients;

(IV) DEMONSTRATE ORGANIZATIONAL CAPACITY TO PROVIDE
SPECIAL PROGRAMS, INCLUDING OUTREACH, CASE MANAGEMENT, AND HOME
VISITING, TAILORED TO MEET THE INDIVIDUAL NEEDS OF ALL ENROLLEES;

(v) Provide assistance to Program recipients ENROLLEES in securing
necessary health care services;

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