In past years, Maryland insurance carriers have reported membership and claims information to the Maryland Medical Care Data Base (MCDB), which is Maryland’s All Payer Claims Database (APCD). In recognition of the impact of benefit design on cost and utilization patterns and emerging payment non-fee-for-service payment models, the Maryland Health Care Commission (MHCC) expanded the reporting requirements under COMAR 10.25.06 to include two new reports: Plan Benefit Design Report and Non-Fee-for-Service Total Medical Expenditure Report.

MHCC convened a multi-stakeholder workgroup to inform the development of these reports on October 29, 2013. The agenda and presentation for the meeting are provided below:

• Agenda - Workgroup Meeting, October 29, 2013
• Presentation - APCD Council and NAHDO overview of current practices and considerations.

Due to the complexity of these reports and the challenges cited by payors in reporting this information, MHCC contracted the APCD Council and NAHDO to conduct an analysis of payor practices and requirements in other APCD states. MHCC staff participated in payor interviews and discussions with other APCD states, and the report was ultimately developed as a resource, not only for Maryland, but other APCD states. Based on findings from this effort, MHCC has decided to pursue State (Insurance Exchange, MLR reports) and Federal (HIOS, SBC, and MLR reporting) as a means of establishing a use case for this data before pursing direct reporting from payors. The report is provided below:

• Report - Recommendations for Collecting Payer Information on Plan Benefit Design and Payments to Providers for Non-claim based Services.

If you have any questions or comments about this workgroup or report, please contact Srinivas Sridhara at srinivas.sridhara@maryland.gov.