Maryland Register

Issue Date:  September 28, 2018

Volume 45 • Issue 20 • Page 935-936


Title 10 


10.09.65 Maryland Medicaid Managed Care Program: Managed Care Organizations

Authority: Health-General Article, §§2-104, 15-102.3, and 15-103; Insurance Article, §§15-112, 15-605, and 15-1008; Annotated Code of Maryland

Notice of Proposed Action


     The Secretary of Health proposes to amend Regulation .03 under COMAR 10.09.65 Maryland Medicaid Managed Care Program: Managed Care Organizations.

Statement of Purpose

The purpose of this action is to update the value-based purchasing (VBP) incentive methodology to remove postpartum care from the core performance measures. The proposed action also adds a requirement for an MCO to validate and evaluate its provider networks to ensure compliance with network adequacy and access standards.

Comparison to Federal Standards

There is a corresponding federal standard to this proposed action, but the proposed action is not more restrictive or stringent.

Estimate of Economic Impact

I. Summary of Economic Impact. The economic impact on MDH is indeterminable at this time. Because the Department cannot predict the future performance of MCOs in CY 2019, the projected cost is indeterminable. There is a cap on how much VBP will cost, but there is flexibility to fund it at various levels within that cap.



Revenue (R+/R-)


II. Types of Economic Impact.

Expenditure (E+/E-)




A. On issuing agency:



B. On other State agencies:


C. On local governments:




Benefit (+)
Cost (-)




D. On regulated industries or trade groups:







E. On other industries or trade groups:


F. Direct and indirect effects on public:


III. Assumptions. (Identified by Impact Letter and Number from Section II.)

A. and D. The economic impact on MDH is indeterminable at this time. Previously, the Department paid incentives to high-performing MCOs via disincentives imposed on lower performing MCOs. Since the new VBP methodology eliminates disincentives, it will require new (general and federal) funding streams to pay incentives to MCOs with net positive scores. However, since the Department cannot predict the future performance of MCOs in CY 2019, the projected cost is indeterminable.

Economic Impact on Small Businesses

The proposed action has minimal or no economic impact on small businesses.

Impact on Individuals with Disabilities

The proposed action has no impact on individuals with disabilities.

Opportunity for Public Comment

Comments may be sent to Michele Phinney, Director, Maryland Department of Health, 201 West Preston Street, Room 512, Baltimore, MD 21201, or call 410-767-6499, or email to, or fax to 410-767-6483. Comments will be accepted through October 29, 2018. A public hearing has not been scheduled.

.03 Quality Assessment and Improvement.

A. (text unchanged)

B. An MCO shall participate in all quality assessment activities required by the Department [in order] to determine if the MCO is providing medically necessary enrollee health care. These activities include, but are not limited to:

(1)—(2) (text unchanged)

(3) The annual collection and evaluation of a set of performance measures with targets as determined by the Department as follows:

(a)—(e) (text unchanged)

(f) Effective January 1, 2019, the core performance measures are:

(i)—(vii) (text unchanged)

[(viii) Postpartum care;]

[(ix)(viii)[(x)] (ix) (text unchanged)

(g)—(j) (text unchanged)

(4) (text unchanged)

(5) An annual Maryland Healthy Kids audit in order to determine the quality of the clinical care provided to all children younger than 21 years old enrolled in the HealthChoice Program as follows:

(a) — (b) (text unchanged)

(c) The Department shall issue a final report of the audit results; [and]

(6) Performance improvement projects to be conducted by the MCOs that focus on clinical or nonclinical areas as determined by the Department or CMS and include the following:

(a) — (d) (text unchanged)

(e) Reporting of results to the Department or CMS; and

(7) Validation and evaluation of MCO provider networks to ensure compliance with the network adequacy and access standards set forth in COMAR 10.09.66.

C.—D. (text unchanged)

Secretary of Health