Insurer > MHCC Data Regarding HMO Payments to Non-par Providers
MHCC Data Regarding HMO Payments to Non-Participating Providers
Maryland law requires the Maryland Health Care Commission (MHCC) to provide health insurance carriers that operate Health Maintenance Organizations (HMOs) in the State with the minimum rates that must be paid for Evaluation and Management services as defined by the Centers for Medicare and Medicaid Services (CMS) in the Berenson-Eggers Type of Services terminology. These rates are calculated from the CMS Medicare payment rates that applied in August of 2008 adjusted by the cumulative Medicare Economic Index (MEI) prior to the start of each new calendar year. Carriers are required to pay the minimum of 140% of these rates to non-contracting (non-trauma) providers that provide a covered service to an HMO patient.
To derive the rates effective for services provided in 2013, MHCC applied a .6 percent change in the MEI to the 2011 rate. The change in the MEI (adjusted for productivity) is based on the market basket update published by CMS for CY 2012. The attached EXCEL workbook contains a separate worksheet for each of the Medicare localities in Maryland – Baltimore Metro, National Capital, and Other Maryland. Separate payments are provided for facility and non-facility locations consistent with CMS Medicare Fee Schedule payment rules.
This Excel workbook contains a correction for the Other Maryland Area spreadsheet. The MHCC has adjusted the 2009 growth in rates from 1.6% to 2.4%, which was the correct MEI growth rate from 2008-2009. This calculation aligns the growth in fees in the Other Maryland area with the growth in rates for the Baltimore Metro and National Capital areas. MHCC staff discovered that these adjusted rates were not included in the payment information previously posted on the MIA website.
Questions should be referred to MHCC staff member Larry Monroe via e-mail at email@example.com.
- 2013 HMO payment calculations
Provided by the Maryland Health Care Commission