Contracts with clinically integrated organizations
(a) In this subtitle the following words have the meanings indicated.
(b) “Carrier” means:
(1) an insurer;
(2) a nonprofit health service plan; or
(3) a health maintenance organization.
(c) “Clinically integrated organization” means:
(1) a joint venture between a hospital and physicians that:
(i) has received an advisory opinion from the Federal Trade Commission or its staff; and
(ii) has been established to:
1. evaluate and improve the practice patterns of the health care providers; and
2. create a high degree of cooperation, collaboration, and mutual interdependence among the health care providers who participate in the joint venture in order to promote the efficient, medically appropriate delivery of covered medical services; or
(2) a joint venture between a hospital and physicians that:
(i) is accountable for total spending and quality; and
(ii) the Commissioner determines meets the criteria established by the federal Department of Health and Human Services for an accountable care organization.
(d) “Covered medical services” means the health care services that are included as benefits under a health benefit plan issued by a carrier.
(e) “Health benefit plan” has the meaning stated in § 15-1301 of this title.
(f) “Qualifying individual” means an individual covered under a health benefit plan issued by a carrier.
(a) Notwithstanding any other provision of this article or the Health – General Article, a contract between a carrier and a clinically integrated organization may include a provision to pay:
(1) for services associated with the coordination of covered medical services to qualifying individuals; and
(2) a bonus, fee-based incentive, bundled fees, or other incentives to promote the efficient, medically appropriate delivery of covered medical services to qualifying individuals.
(b) The Commissioner, in consultation with the Maryland Health Care Commission, may adopt regulations specifying the types of payments and incentives permissible under this section.
(c)(1) A carrier shall file a copy of a contract between the carrier and a clinically integrated organization with the Commissioner.
(2) If the contract includes a provision to pay a bonus or other incentive that does not comply with § 15-113 of this title, the Commissioner shall provide a copy of the contract to the executive director of the Maryland Health Care Commission.
(3) Notwithstanding any other provision of law, a copy of a contract filed with the Commissioner or provided by the Commissioner to the executive director of the Maryland Health Care Commission under this subsection, is:
(i) confidential and privileged;
(ii) not subject to:
1. Title 4 of the General Provisions Article;
2. subpoena; or
3. discovery; and
(iii) not admissible in evidence in any private action.
Notwithstanding any other provision of this article or the Health – General Article, a carrier shall share medical information about a qualifying individual with a clinically integrated organization and its members if:
(1) the carrier has a written agreement with the clinically integrated organization specifying the type and proposed use of medical information to be shared;
(2) the medical information is used by the clinically integrated organization to:
(i) promote the efficient, medically appropriate delivery of covered medical services to qualifying individuals;
(ii) coordinate care, including efforts to coordinate, plan, develop, monitor, share information related to, and otherwise initiate a treatment plan for a qualifying individual;
(iii) perform the functions of a medical review committee as described in § 1-401(c) of the Health Occupations Article; or
(iv) offer or provide covered medical services or seek payment for or evaluate covered medical services provided by the members of the clinically integrated organization; and
(3) the clinically integrated organization or the carrier implements procedures for disclosing to qualifying individuals how the clinically integrated organization and the carrier share medical information to deliver more coordinated, higher quality care.