Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.16 - Electronic Health Record Incentives › Section 10.25.16.02 - 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) "Achieved NCQA level two recognition"
				  means a primary care practice has received recognition from NCQA for meeting
				  NCQA's 2011 or later standards for a level two patient-centered medical
				  home.
(2) "Attested to meaningful
				  use" means a physician or nurse practitioner within a primary care practice has
				  achieved the meaningful use requirements under either the Medicaid or Medicare
				  EHR Incentive Program and has received confirmation of the attestation from:
(a) The Centers for Medicare and Medicaid
				  Services; or
(b) The Maryland
				  Medical Assistance Program (Medicaid).
(3) "EHR adoption incentive" means a payment
				  that an eligible primary care practice can receive from a payor to assist the
				  primary care practice in adopting an electronic health record and attaining a
				  required use level that:
(a) Consists of a
				  one-time cash payment not to exceed $15,000 or an incentive of equivalent value
				  agreed upon by the primary care practice and payor; and
(b) Is based on a $25 per-patient payment
				  applied to the total number of patients on the practice panel who are Maryland
				  residents.
(4)
				  "Electronic health record" or "EHR" means a complete electronic record system
				  that is certified by an authorized testing and certification body designated by
				  the Office of the National Coordinator for Health Information Technology and
				  that contains health-related information on an individual.
(5) Fully Insured Health Benefit Plan.
(a) "Fully insured health benefit plan" means
				  a medical policy, contract, or certificate for which an:
(i) Employer pays a per-employee premium to a
				  payor and the payor assumes the risk of providing health coverage for insured
				  events and incurred administrative costs; or
(ii) Individual pays a premium to a
				  payor.
(b) "Fully
				  insured health benefit plan" does not include a self-insured health plan or a
				  health plan for which a payor is acting only as a third-party
				  administrator.
(6)
				  Health Care Provider.
(a) "Health care
				  provider" means a person who is licensed, certified, or otherwise authorized
				  under Health Occupations Article, Annotated Code of Maryland, to provide health
				  care services in the ordinary course of business or practice of a profession or
				  in an approved education or training program.
(b) "Health care provider" includes a
				  facility where health care is provided to patients or recipients, including:
(i) A facility, as defined in Health-General
				  Article, §10-101(e), Annotated Code of Maryland;
(ii) A hospital, as defined in Health-General
				  Article, §19-301, Annotated Code of Maryland;
(iii) A related institution, as defined in
				  Health-General Article, §19-301, Annotated Code of Maryland;
(iv) An outpatient clinic;
(v) A freestanding medical facility, as
				  defined in Health-General Article, § 19-3 A-01, Annotated Code of
				  Maryland;
(vi) An ambulatory
				  surgical facility, as defined in Health-General Article, § 19-3 B-01,
				  Annotated Code of Maryland; and
(vii) A nursing home, as defined in
				  Health-General Article, §19-1401, Annotated Code of Maryland.
(c) For purposes of this chapter,
				  "health care provider" does not include a health maintenance organization as
				  defined in Health-General Article, §19-701, Annotated Code of
				  Maryland.
(7)
				  "Implementation period" means the first 120 days after the effective date of
				  this chapter.
(8) "Incentive of
				  equivalent value" means:
(a) Specific
				  services;
(b) A gain-sharing
				  arrangement;
(c) Rewards for
				  quality and efficiency;
(d) In-kind
				  payment; or
(e) Other items or
				  services that can be assigned a specific monetary value.
(9) "Meaningful use" means the criteria and
				  requirements established by the Centers for Medicare and Medicaid Services as
				  detailed under 42 CFR 142, 143, 422, et al. (2010) and subsequent
				  regulations.
(10) "Medicare and
				  Medicaid EHR Incentive Programs" means the programs described at 42 CFR 412,
				  413, 422, and 495 (2010) and 42 CFR 412, 413, and 495 (2012), adopted by the
				  Centers for Medicare and Medicaid Services (CMS) to implement provisions of the
				  American Recovery and Reinvestment Act of 2009, the Medicare EHR Incentive
				  Program as administered by CMS, and the Medicaid EHR Incentive Program as
				  administered by Medicaid.
(11)
				  "MHCC" or "Commission" means the Maryland Health Care Commission.
(12) "NCQA" means the National Committee for
				  Quality Assurance, a health care quality accreditation, certification, and
				  recognition body.
(13) "NPI" or
				  "national provider identifier" means the unique individual identification
				  number issued by the National Provider System to a health care provider
				  typically used in administrative and financial transactions.
(14) Payor.
(a) "Payor" means a State-regulated carrier
				  that issues or delivers health benefit plans in the State and includes:
(i) Aetna, Inc;
(ii) CareFirst BlueCross
				  BlueShield;
(iii) CIGNA HealthCare
				  Mid-Atlantic;
(iv) Coventry Health
				  Care;
(v) Kaiser Permanente;
				  and
(vi) United Healthcare,
				  Mid-Atlantic Region.
(b)
				  "Payor" does not include a managed care organization as defined in
				  Health-General Article, Title 15, Subtitle 1, Annotated Code of
				  Maryland.
(15) "Practice
				  panel" means:
(a) The patients who are
				  Maryland residents and enrolled in a fully insured health benefit plan assigned
				  by a payor to a provider within a primary care practice at the time the primary
				  care practice requests an EHR incentive payment; or
(b) When a payor does not assign patients
				  enrolled in a fully insured health benefit plan to a provider within a primary
				  care practice, the patients who are Maryland residents and enrolled with that
				  payor in a fully insured health benefit plan who have been treated by the
				  primary care practice within the 24 months preceding a primary care practice's
				  request for an EHR adoption incentive payment.
(16) "Primary care practice" means a medical
				  practice located in the State that is composed of:
(a) One or more physicians who provide health
				  care in family practice, general practice, geriatric medicine, internal
				  medicine, pediatric medicine, or gynecologic practice and that uses one of the
				  following CMS specialty codes in claims submissions:
(i) Family practice (08);
(ii) General practice (01);
(iii) Geriatric medicine (38);
(iv) Internal medicine (11);
(v) Pediatric medicine (37); or
(vi) Obstetrics & Gynecology (16);
				  or
(b) One or more nurse
				  practitioners who provide health care in family practice, general practice,
				  geriatric medicine, internal medicine, pediatric medicine, or gynecologic
				  practice and that uses CMS taxonomy code in claims submissions:
(i) Adult Health (363LA2100X);
(ii) Family (363LF0000X);
(iii) Gerontology (363LG0600X);
(iv) Obstetrics & Gynecology
				  (363LX0001X);
(v) Pediatric
				  (363LP0200X);
(vi) Primary Care
				  (363LP2300X); or
(vii) Women's
				  Health (363LW0102X).
(17) "State" means the State of
				  Maryland.
(18) "Third-party
				  administrator" means a person that is registered as an administrator under
				  Insurance Article, Title 8, Subtitle 3, Annotated Code of Maryland.