Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.11 - Fair Hearings of Individual Exchange Eligibility Determinations › Section 14.35.11.02 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. In this chapter,
				the following terms have the meanings indicated
B. Terms Defined.
(1) "Administrative law judge" means an
				individual appointed by the Chief Administrative Law Judge under State
				Government Article, §
										9-1604, Annotated
				Code of Maryland, or designated by the Chief Administrative Law Judge under
				State Government Article, §
										9-1607, Annotated
				Code of Maryland, to adjudicate contested cases at the Maryland Office of
				Administrative Hearings.
(2)
				"Affordable Care Act" means the Patient Protection and Affordable Care Act of
				2010 (Pub.L.
				111-148), as amended by the Health Care and
				Education Reconciliation Act of 2010 (Pub.L. 111-152), as amended by
				the Three Percent Withholding Repeal and Job Creation Act (Pub.L.
				112-56).
(3) "Appellant" means any individual who
				requests a fair hearing for the reasons specified in Regulation .03 of this
				chapter or that individual's authorized representative, whether regarding an
				initial determination or a redetermination.
(4) "Authorized representative" has the same
				meaning as in Regulation .14 of this chapter
(5) "Catastrophic plan" means a plan
				established under § 1302(e) of the Affordable Care Act
(6) "Consolidated Services Center" means the
				call center operated by the Maryland Health Benefit Exchange to assist
				consumers who apply for, or participate in, a qualified health plan or the
				insurance affordability programs offered through the Maryland Health
				Connection.
(7) "Delegate agency"
				means the Department of Human Resources and its affiliate local departments
				which, under contractual agreements with the Department, determine initial and
				continuing eligibility in the Program.
(8) "Department" means the Department of
				Health and Mental Hygiene, the single State agency which, pursuant to Title XIX
				of the Social Security Act, implements fair hearing requirements for Program
				applicants and recipients.
(9)
				"Individual Exchange " has the meaning stated in Insurance Article, §
										31-101(h),
				Annotated Code of Maryland
(10)
				"Insurance affordability program" means a program that is one of the following:
(a) The Maryland State Medicaid
				program;
(b) The Maryland
				Children's Health Insurance Program (CHIP), including the program known as
				Maryland Children's Health Program (MCHP) Premium;
(c) A State basic health program established
				under § 1331 of the Affordable Care Act;
(d) A program that makes available to
				eligible individuals coverage in a qualified health plan through the Maryland
				Health Benefit Exchange with advance payments of the premium tax credit
				established under §36B of the Internal Revenue Code;
(e) A program that makes available to
				eligible individuals coverage in a qualified health plan through the Maryland
				Health Benefit Exchange with cost-sharing reductions established under §
				1402 of the Affordable Care Act; or
(f) The State-Based Young Adult Health
				Insurance Subsidies Program established under Insurance Article, §
											31-122, Annotated Code of
				Maryland.
(11) "MAGI"
				means modified adjusted gross income, as calculated for purposes of determining
				or redetermining eligibility for insurance affordability programs under the
				Affordable Care Act, as defined in 26 CFR § 1.36 B- 1(e)(2).
(12) "Maryland Health Benefit Exchange" or
				"Exchange" means the unit of State government that determines initial and
				continuing eligibility for the MAGI-based insurance affordability programs,
				including, by delegation, certain eligibility in the Program.
(13) "Maryland Health Connection" means the
				electronic eligibility system maintained by the Maryland Health Benefit
				Exchange.
(14) "Program" means the
				Department's Medical Assistance Program.
(15) Qualified Health Plan.
(a) "Qualified health plan" means a health
				benefit plan that has been certified by the Maryland Health Benefit Exchange to
				meet the criteria for certification described in § 1311(c) of the
				Affordable Care Act and Insurance Article, §31-115, Annotated Code of
				Maryland.
(b) "Qualified health
				plan" includes a catastrophic plan.