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<regulation prefix="Regulation" num=".03" citation="COMAR 10.25.08.03" title_num="10" subtitle_num="25" chapter_num="08" heading="Health Benefit Plan Quality and Performance Evaluation System — Implementation.">
  <paragraph num="A.">
    <text>Carrier Participation.</text>
    <paragraph num="(1)">
      <text>Each carrier may participate in the health benefit plan quality and performance evaluation system.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Each carrier that meets the criteria of Regulation .01B of this chapter is required to participate.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>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 the carrier has no more than $1,000,000 in annual premium volume by category of health benefit plan and no more than 65 percent of its Maryland enrollees covered through the Medicaid and Medicare programs.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Performance Measures. The Commission shall choose performance measures that are important, feasible, scientifically sound, and actionable, including performance measures that:</text>
    <paragraph num="(1)">
      <text>Are related to the quality and performance of medical services provided by a health benefit plan;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Allow for comparisons among health benefit plans;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Can be of interest to purchasers, consumers, providers, carriers, or health officials;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Can be used to affect changes in performance; and</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Can be validated through an audit conducted by an independent party for validity, reliability, and comparability.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Notice by the Commission.</text>
    <paragraph num="(1)">
      <text>Beginning in November 2011, and each November thereafter, the Commission shall provide a dated notice posted on the Commission’s website and a written notice to each carrier required to report under Regulation .01A. of this chapter regarding the following:</text>
      <paragraph num="(a)">
        <text>The required categories of health benefit plans for which HEDIS and other performance measures must be submitted for the upcoming measurement year;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The selected HEDIS and other performance measures for each category of health benefit plan to be included in the reporting period; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Quality and performance measures that will be subject to audit.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Beginning in December 2011, and each December thereafter, the Commission shall provide a dated notice posted on the Commission’s website and a written notice to each carrier required to report under Regulation .01A of this chapter regarding the following:</text>
      <paragraph num="(a)">
        <text>The required categories of health benefit plans for which HEDIS and other performance measures must be submitted for the upcoming measurement year;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The selected HEDIS and other performance measures for each category of health benefit plan to be included in the reporting period;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Quality and performance measures that will be subject to audit; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>The HEDIS and other performance measures anticipated to be required in the measurement year occurring after the current measurement year.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>Performance Measures Collection.</text>
    <paragraph num="(1)">
      <text>Beginning in January of each reporting period, a carrier that is required to participate or elects to participate in the health benefit plan quality and performance evaluation system shall collect all required performance measures as follows:</text>
      <paragraph num="(a)">
        <text>Collecting HEDIS measures, a carrier shall follow the specifications contained in the latest version or technical update of HEDIS applicable to the measurement year;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Collecting other performance measures, a carrier shall follow specifications published by a nationally recognized organization involved in quality and performance measurement, and in accordance with the notice provided by the Commission in November for the measurement year; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>A carrier shall use the specifications, templates, and other documents provided by the Commission, which shall be consistent with those published by the National Committee for Quality Assurance for HEDIS measures and, for non-HEDIS performance measures, required by the Commission, consistent with specifications, templates, or documents published by nationally recognized organizations involved in quality of care and performance measurement.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>A carrier is not required to submit HEDIS or other performance measures regarding proprietary information contained in descriptive information on health plan management and activities.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The Commission shall provide technical assistance and auditing services to a carrier required to report the HEDIS and other performance measures.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>Commission Publication of Health Benefit Plan Quality and Performance Evaluation Reports. On or before November 1 of each year, the Commission shall publish on its website one or more reports for use by consumers and purchasers who make health benefit plan enrollment and contracting decisions. The reports shall:</text>
    <paragraph num="(1)">
      <text>Compare quality and performance evaluation results of each health benefit plan on the various HEDIS and other performance measures required by the Commission; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Include information on valid and reliable HEDIS and other performance measures that are comparable on a health benefit plan level, as determined by the Commission.</text>
    </paragraph>
  </paragraph>
</regulation>