2013 Maryland Code
§ 31-110 - Prerequisites to making qualified plans available.
(a) In making qualified plans available to individuals and employers through contracts with carriers, the Exchange first shall seek to:
(1) achieve a robust and stable enrollment in the Exchange; and
(2) decrease the number of State residents without health insurance coverage.
(b) (1) Subject to subsection (e) of this section, the Exchange, with the market impact and leverage attained through a robust and stable enrollment, may use alternative contracting options and active purchasing strategies to increase affordability and quality of care for consumers and lower costs in the health care system overall.
(2) The Exchange’s efforts to increase affordability and quality of care and to lower costs may include pursuing key objectives such as higher standards of care, continuity of care, delivery system reforms, health equity, improved patient experience and outcomes, and meaningful cost controls within the health care system.
(c) In employing contracting strategies to implement this section, the Exchange shall consider, on a continuing basis, the need to balance:
(1) the importance of sufficient enrollment and carrier participation to ensure the Exchange’s success and long-term viability; and
(2) its progress in achieving the key objectives stated in subsection (b)(2) of this section.
(d) Beginning January 1, 2014, the Exchange:
(1) shall allow any qualified plans that meet the minimum standards established by the Exchange under this title to be offered in the Exchange; and
(2) may exercise its authority under § 31-115(b)(9) of this title to establish minimum standards for qualified plans in addition to those required by the Affordable Care Act.
(e) Subject to subsections (f) and (g) of this section, beginning January 1, 2016, in addition to establishing minimum standards for qualified plans, the Exchange may employ alternative contracting options and active purchasing strategies, including:
(1) competitive bidding;
(2) negotiation with carriers to achieve optimal participation and plan offerings in the Exchange; and
(3) partnering with carriers to promote choice and affordability for individuals and small employers among qualified plans offering high value, patient-centered, team-based care, value-based insurance design, and other high quality and affordable options.
(f) During any year in which the Exchange employs alternative contracting options and active purchasing strategies, the participation requirements set forth in §§ 15-1204.1(b) and 15-1303(b) of this article for carriers in the individual and small group markets outside the Exchange shall be suspended.
(g) Before employing an alternative contracting option or active purchasing strategy, the Exchange:
(1) on or after December 1, but not later than the first day of the next regular session of the General Assembly, shall submit to the Senate Finance Committee and the House Health and Government Operations Committee, in accordance with § 2-1246 of the State Government Article, a plan for the use of the alternative contracting option or active purchasing strategy, including an analysis of:
(i) the objectives to be achieved through use of the alternative contracting option or active purchasing strategy; and
(ii) the impact on the insurance markets inside and outside the Exchange and on consumers; and
(2) shall allow the committees to have 90 days for review and comment.
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