Md. Code Regs. 10.67.04.03-1

Current through Register Vol. 51, No. 25, December 13, 2024

Section 10.67.04.03-1 - HealthChoice Health Equity Incentive Program

A. The Department shall award a defined amount of funding annually to MCOs based on the county of residence of their members and the socioeconomic disadvantage index described in this regulation.

B. Socioeconomic Disadvantage Index.

(1) The Department shall calculate a ranking for each service area in Maryland in accordance with the following domains:

(a) Community safety;

(b) Food security;

(c) Housing security; and

(d) Transportation access.

(2) The Department shall select component measures and calculate rankings that aggregate to the domains defined in §B of this regulation.

(3) Rankings shall range from first to twenty-fourth, with first being the lowest ranking for socioeconomic disadvantage and twenty-fourth being the highest ranking for socioeconomic disadvantage.

(4) Each service area shall be assigned a single summary score by calculating the equal-weighted average across each service area's domain rankings.

C. The Department shall award available equity funding to MCOs serving members in Maryland service areas based on the following criteria:

(1) Allocation of equity funding shall be made proportionally to the MCO's membership in the service areas at the top quartile of the socioeconomic disadvantage index.

(2) Funding for each calendar year shall be determined based on available funding in the Department's budget and specified in the annual HealthChoice Managed Care Organization Agreement.

(3) The annual allocation for HealthChoice Health Equity Incentive Program shall be funded outside of managed care capitation rates.

D. Incentive funds awarded under the HealthChoice Health Equity Incentive Program are not appealable under 10.67.10.

Md. Code Regs. 10.67.04.03-1

Regulations .03-1 amended and recodified from .19-3 effective 48:21 Md. R. 889, eff. 10/18/2021; adopted effective 51:12 Md. R. 620, eff. 6/24/2024.