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10.25.08.00.htm 10.25.08.00. Title 10 MARYLAND DEPARTMENT OF HEALTH Subtitle 25 MARYLAND HEALTH CARE COMMISSION Chapter 08 Evaluation of Quality and Performance of Health Benefit Plans Authority: Health-General Article, §19-109(a)1) and (7) 19-132, and 19-134(c) Annotated Code of Maryland
10.25.08.01.htm 10.25.08.01. 01 Scope.. This chapter applies to each carrier that participates in the health benefit plan quality and performance evaluation system.This chapter requires participation in the health benefit plan quality and performance evaluation system by each carrier that:1) Holds a certificate of authority in the State;. 2) Has a premium volume in Maryland for each category of health benefit plan that exceeds $1,000,000; and3) Has no more than 65 percent of its Maryland enr
10.25.08.02.htm 10.25.08.02. 02 Definitions.. In this chapter, the following terms have the meanings indicated.. Terms Defined.. 1) “Carrier” means an 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 Insurance Article, Annotated Code of Maryland, or a health maintenance organization that holds a certificate of authority in the State.2) “Commission” means the Maryland Health Care Commission..
10.25.08.03.htm 10.25.08.03. 03 Health Benefit Plan Quality and Performance Evaluation System ― Implementation.. Carrier Participation.. 1) Each carrier may participate in the health benefit plan quality and performance evaluation system.2) Each carrier that meets the criteria of Regulation .01B of this chapter is required to participate.3) A carrier that chooses not to participate in the health benefit plan quality and performance evaluation system must present clear evidence to the Commission that shows that
10.25.08.04.htm 10.25.08.04. 04 Audits.. In order to verify the validity, reliability, and comparability of HEDIS and other performance measures required by the Commission, a carrier shall participate in certified audits as specified by the Commission, which may include:1) A process audit;. 2) One or more site visits;. 3) Specification and source code review and verification; and. 4) Medical records review.. Each carrier that is required to participate or elects to participate in the health benefit plan qua
10.25.08.05.htm 10.25.08.05. 05 Extension of Time.. A carrier may request an extension of not more than 30 days for submission of the performance measures report.A request for an extension of time shall:. 1) Be submitted to the Executive Director of the Commission not later than 30 days before the carrier’s performance measures report is due;2) Explain the good cause for the requested extension; and. 3) Propose a reasonable date certain, not to exceed 30 days after the original due date, for submiss
10.25.08.06.htm 10.25.08.06. 06 Penalty for Failure to File Reports.. A carrier that is required to participate under Regulation .01B of this chapter and that does not timely file a performance measures report may be subject to the penalties provided in COMAR 10.25.12.
10.25.08.9999.htm 10.25.08.9999. Administrative History Effective date: October 17, 2011 (38:21 Md. R. 1278).
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