§ 15-103.7. Value-based purchasing program
West's Annotated Code of MarylandHealth--GeneralEffective: April 13, 2021
Effective: April 13, 2021
MD Code, Health - General, § 15-103.7
§ 15-103.7. Value-based purchasing program
(a) In this section, “Program” means the program established by the Department under subsection (b) of this section.
(b)(1) The Department shall establish a value-based purchasing program that awards financial incentives to and assesses penalties on managed care organizations based on the organization's performance on health measures established by the Department.
(c) Not more than 1% of the amount of capitated payments received by a managed care organization each year shall be subject to the collection of penalties under the Program.
(d) For each measurement year, beginning January 1, 2021, the Department may not in any calendar year pay a total amount of incentives to managed care organizations under the Program in an amount that exceeds:
(e)(1) For each measurement year, beginning January 1, 2021, the Department shall base the initial distribution of funding awarded under the Program to a managed care organization in each calendar year on the number of performance targets that the managed care organization meets or exceeds.
(2) For each measurement year, beginning January 1, 2021, if the total amount of penalties that the Department collects under the Program exceeds the total amount of incentive funding awarded in the initial distribution of funds in a calendar year under the Program, the remaining funds shall be allocated as follows:
(iv) Except as provided in item (v) of this paragraph, 10% to establish a reserve in the HealthChoice Performance Incentive Fund to be used in any calendar year in which the amount of penalties the Department collects under the Program are insufficient to pay incentives earned by managed care organizations; and
(f) Subject to the provisions of this section, the Department may modify the Program if the Department:
(1) Adopts by regulation any changes to the core set of performance measures and the methodology for penalties, rewards, disincentives, or incentives under subsection (e)(1) and (2)(i) of this section before the calendar year for which the managed care organizations will be held accountable for the standard compliance with the performance measures; and
(2) Notifies each managed care organization of the core set of performance measures and targets under subsection (e)(1) and (2)(i) of this section at least 3 months before the calendar year for which the managed care organization will be held accountable to the standard for compliance with the performance measures.
(g) Any penalty or capitation adjustment imposed under this section on a managed care organization may not be accomplished or implemented by withholding a capitation payment.
Credits
Added by Acts 2020, c. 538, § 6, eff. June 1, 2020. Amended by Acts 2021, c. 109, § 1, eff. April 13, 2021.
MD Code, Health - General, § 15-103.7, MD HEALTH GEN § 15-103.7
Current with all legislation from the 2023 Regular Session of the General Assembly. Some statute sections may be more current, see credits for details.
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