ROBERT L. EHRLICH, JR., Governor

Ch. 429

M00Q01.03 Medical Care Provider
Reimbursements

All appropriations provided for the program
- M00Q01.03 are to be used only for the
purposes herein appropriated, and there
shall be no budgetary transfer to any
other program or purpose-
Further provided that the Department of
Health and Mental Hygiene (DHMH)
shall work with managed care entities
and other health providers to establish a
plan to: (1) identify Medicaid enrollees at
risk for chronic kidney disease through
routine clinical laboratory assessment of
kidney function; (2) evaluate those
individuals; and (3) determine if early

identification and appropriate

management of risk factors can improve
health conditions and prolonged kidney
function, thereby delaying disease
progression to End Stage Renal Disease.
DHMH shall also prepare information for
physicians and other health care
providers regarding generally accepted
standards of clinical care in the clinical
management of high risk individuals and
shall report on projected cost savings and
health outcomes that result from early
identification and clinical management of
individuals at highest risk for chronic
kidney disease-
Further provided that the Department of
Health and Mental Hygiene (DHMH)
shall sanction HealthChoice managed
care organizations with calendar 2002
medical loss ratios below 85 84 percent
and calendar 2002 Health Plan Employer
Data Information Set (HEDIS) outcomes
that are below the average for all of
Maryland's Medicaid managed care
organizations. The penalty shall equal 50
percent of the difference between the
premium paid to the managed care
organization and the premium that would
have resulted in an 85 84 percent medical

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