Md. Code Ann., Health-Gen. § 19-134 - Electronic claims clearinghouses; evaluation system

Electronic claims clearinghouses; evaluation system
 
In order to efficiently establish a medical care database, the Health Care Commission must establish standards to operate a medical care electronic claims clearinghouses in Maryland.
 
The Health Care Commission must establish a system to comparatively evaluate the quality of care and performance of health benefit plans. The Commission must annually publish the summary findings of the evaluation. The purpose of the evaluation system is to assist health insurers to improve care by establishing a set of quality and performance measurements and disseminating the findings to insurers and other interested parties. The system must solicit performance information from enrollees of health plans, establish a set of measures regarding racial and ethnic variations in quality and outcomes, and include information on the actions taken by health insurers to track and reduce health disparities, including whether the health plan offers culturally appropriate educational materials for its members.
 
The Health Care Commission, in consultation with the Department of Health and Mental Hygiene and the Department of Aging, must develop a system to evaluate the quality of care and performance of nursing facilities and annually publish the summary findings of the evaluation.
 
The Health Care Commission may develop a system to evaluate the quality of care outcomes and performance measurements of hospitals and ambulatory surgical facilities and annually publish the summary findings of the evaluation.
 
The Health Care Commission must compile data on:

• Racial and ethnic disparities in insurance coverage for low-income, nonelderly individuals;
• The racial and ethnic composition of the physician population compared to the racial and ethnic composition of the State's population; and
• Morbidity and mortality rates based on race and ethnicity for cardiovascular disease, cancer, diabetes, HIV/AIDS, infant mortality, asthma, and other diseases.

The Commission must provide the information to the Office of Minority Health and Health Disparities and analyze the information jointly with the Office of Minority Health and Health Disparities for publication in the "Health Care Disparities Policy Report Card." The commission must evaluate the feasibility of obtaining information from urban and rural populations in order to identify geographic disparities.