Section 19-133 - Maryland medical care data base.
§ 19-133. Maryland medical care data base.
(a) "Code" defined.- In this section, "code" means:
(1) The applicable Current Procedural Terminology (CPT) code as adopted by the American Medical Association; or
(2) If a CPT code is not available, the applicable code under an appropriate uniform coding scheme approved by the Commission.
(b) Established.- The Commission shall establish a Maryland medical care data base to compile statewide data on health services rendered by health care practitioners and facilities selected by the Commission.
(c) Collected information.- In addition to any other information the Commission may require by regulation, the medical care data base shall:
(1) Collect for each type of patient encounter with a health care practitioner or facility designated by the Commission:
(i) The demographic characteristics of the patient;
(ii) The principal diagnosis;
(iii) The procedure performed;
(iv) The date and location of where the procedure was performed;
(v) The charge for the procedure;
(vi) If the bill for the procedure was submitted on an assigned or nonassigned basis;
(vii) If applicable, a health care practitioner's universal identification number; and
(viii) If the health care practitioner rendering the service is a certified registered nurse anesthetist or certified nurse midwife, identification modifiers for the certified registered nurse anesthetist or certified nurse midwife;
(2) Collect appropriate information relating to prescription drugs for each type of patient encounter with a pharmacist designated by the Commission; and
(3) Collect appropriate information relating to health care costs, utilization, or resources from payors and governmental agencies.
(d) Regulations governing retrieval; fees; confidentiality.-
(1) The Commission shall adopt regulations governing the access and retrieval of all medical claims data and other information collected and stored in the medical care data base and any claims clearinghouse licensed by the Commission and may set reasonable fees covering the costs of accessing and retrieving the stored data.
(2) These regulations shall ensure that confidential or privileged patient information is kept confidential.
(3) Records or information protected by the privilege between a health care practitioner and a patient, or otherwise required by law to be held confidential, shall be filed in a manner that does not disclose the identity of the person protected.
(e) Methods of collecting data.-
(1) To the extent practicable, when collecting the data required under subsection (c) of this section, the Commission shall utilize any standardized claim form or electronic transfer system being used by health care practitioners, facilities, and payors.
(2) The Commission shall develop appropriate methods for collecting the data required under subsection (c) of this section on subscribers or enrollees of health maintenance organizations.
(f) Limitation of data collection.- Until the provisions of § 19-134 of this subtitle are fully implemented, where appropriate, the Commission may limit the data collection under this section.
(g) Annual report.-
(1) By October 1, 1995 and each year thereafter, the Commission shall publish an annual report on those health care services selected by the Commission that:
(i) Describes the variation in fees charged by health care practitioners and facilities on a statewide basis and in each health service area for those health care services; and
(ii) Describes the geographic variation in the utilization of those health care services.
(2) (i) On an annual basis, the Commission shall publish:
1. The total reimbursement for all health care services over a 12-month period;
2. The total reimbursement for each health care specialty over a 12-month period;
3. The total reimbursement for each code over a 12-month period; and
4. The annual rate of change in reimbursement for health services by health care specialties and by code.
(ii) In addition to the information required under subparagraph (i) of this paragraph, the Commission may publish any other information that the Commission deems appropriate, including information on capitated health care services.
(h) Consultations in development of plan.- In developing the medical care data base, the Commission shall consult with representatives of the Health Services Cost Review Commission, health care practitioners, payors, and hospitals to ensure that the medical care data base is compatible with information collected by the Health Services Cost Review Commission.
(i) Regulations regarding standards for electronic submission of data and uniform claims forms.- The Commission, in consultation with the Insurance Commissioner, payors, health care practitioners, and hospitals, may adopt by regulation standards for the electronic submission of data and submission and transfer of the uniform claims forms established under § 15-1003 of the Insurance Article.
[1993, ch. 9, § 1; 1994, ch. 258, § 1; 1995, ch. 341; ch. 499, § 3; 1997, ch. 70, § 4; 1999, ch. 532; ch. 702, § 2; 2000, ch. 64, § 1; 2001, ch. 29, § 1; ch. 565, §§ 1, 2; 2007, ch. 627.]