Maryland HealthChoice Program Encounter Data Validation Report Measurement Year 2024
02/01/2026
The Maryland Department of Health (Department) is responsible for evaluating the quality of care provided to eligible enrollees by contracted managed care organizations (MCOs) through the Maryland Medicaid Managed Care Program, known as HealthChoice. HealthChoice operates under a Centers for Medicare & Medicaid Services (CMS) 1115 waiver of the Social Security Act and Code of Maryland Regulations (COMAR) to serve Marylanders on Medicaid. Guiding principles for HealthChoice’s operations are to provide quality healthcare that is equitable, patient-focused, prevention-oriented, coordinated, accessible, and cost-effective.
Federal regulations require the Department to contract with an external quality review organization (EQRO) to provide annual, independent reviews for assessing quality, access, and timeliness of care. This independent review ensures services provided to enrollees meet the standards governing the HealthChoice program in the Code of Federal Regulations (CFR) and COMAR. The Department contracts with Qlarant to meet federal regulations; evaluate quality, access, and timeliness of care; and validate encounter data.
Hilltop performed Activity 3 of this evaluation, which is included in Appendix A of Qlarant’s report.