ROBERT L. EHRLICH, JR., Governor                             Ch. 399

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;

(vi) Provide or assure alcohol and drug abuse treatment for
substance abusing pregnant women and all other enrollees of managed care
organizations who require these services;

(vii) Educate enrollees on health care prevention and good health
habits;

(viii) Assure necessary provider capacity in all geographic areas
under contract;

(ix) Be accountable and hold its subcontractors accountable for
standards established by the Department and, upon failure to meet those standards,
be subject to one or more of the following penalties:

1.       Fines;

2.       Suspension of further enrollments;

3.       Withholding of all or part of the capitation payment;

4.       Termination of the contract;

5.       Disqualification from future participation in the Program;
and

6.       Any other penalties that may be imposed by the
Department;

(x) Subject to applicable federal and State law, include incentives
for enrollees to comply with provisions of the managed care organization;

(xi) Provide or arrange to provide primary mental health services;
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