PARRIS N. GLENDENING, Governor Ch. 14

(8) For cause, the Department may disenroll enrollees from a managed care
organization and enroll them in another managed care organization.

(9) Each managed care organization shall:

(i) Have a quality assurance program in effect which is subject to the
approval of the Department and which, at a minimum:

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;

6. Provides for enrollee and provider satisfaction surveys, to be
taken at least annually;

7. Provides for a consumer advisory board to receive regular

input from enrollees;

8. Provides for an annual consumer advisory board report to be
submitted to the Secretary; and

9. Complies with specific quality, access, data, and performance
measurements adopted by the Department for treating enrollees with special needs;

(ii) Submit to the Department:

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

enrollees;

(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 enrollees in securing necessary health care

services;

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