Maryland § 15-1703

§ 15-1703.

    (a)    A carrier that uses a physician rating system shall:

        (1)    establish an appeals process for physicians to use to contest their rating; and

        (2)    at least 45 days before making available to enrollees any new or revised quality of performance or cost–efficiency evaluations or any new or revised inclusions or exclusions from a physician rating system, provide each physician included in the physician rating system with:

            (i)    a notice of the proposed change;

            (ii)    an explanation of the data used to assess the physician and how the physician may access the data;

            (iii)    the methodology and measures used to assess the physician;

            (iv)    an explanation of the right to contest the rating of the physician through the appeals process of the carrier; and

            (v)    instructions on how to file a timely appeal with the carrier.

    (b)    If a physician files a timely appeal, as defined by the carrier, regarding the rating of the physician under a physician rating system, the carrier may not disclose the rating of the physician or make a change in the quality of performance or cost–efficiency ratings of the physician until the carrier completes its investigation and renders a decision on the appeal.

    (c)    A carrier shall post the following information prominently on the section of the carrier’s Web site that discloses the rating of a physician to enrollees or to the public:

        (1)    where an enrollee can find the physician performance ratings of the carrier;

        (2)    a disclosure that physician performance ratings are only a guide to choosing a physician because the ratings have a risk of error and should not be the sole basis for selecting a physician;

        (3)    an explanation of the physician rating system, including the basis on which physician performance is measured and the basis for determining that a physician is not currently rated due to insufficient data or a pending appeal;

        (4)    any limitations of the data that the carrier uses to measure physician performance;

        (5)    the factors and criteria used in the carrier’s physician rating system, including quality of performance measures and cost efficiency measures; and

        (6)    how a physician may appeal a physician rating.