reglab/statecodes huggingface dataset:
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.07 - Eligibility Standards for Enrollment in a Qualified Health Plan, Eligibility Standards for APTC and CSR, and Eligibility Standards for Enrollment in a Catastrophic Qualified Health Plan in the Individual Exchange › Section 14.35.07.09 - Eligibility Requirements for Cost-Sharing Reductions

Current through Register Vol. 51, No. 14, July 12, 2024
A. An applicant shall be determined eligible
				for cost-sharing reductions if the applicant:
(1) Meets the requirements for eligibility
				for enrollment in a QHP through the Exchange under Regulation .05 of this
				chapter;
(2) Meets the requirements
				for APTC under Regulation .08 of this chapter; and
(3) Except as provided under §E of this
				regulation, attests to household income that does not exceed 250 percent of the
				FPI for the benefit year for which coverage is requested.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.07 - Eligibility Standards for Enrollment in a Qualified Health Plan, Eligibility Standards for APTC and CSR, and Eligibility Standards for Enrollment in a Catastrophic Qualified Health Plan in the Individual Exchange › Section 14.35.07.10 - Eligibility Requirements for Enrollment in a Catastrophic Plan

Current through Register Vol. 51, No. 14, July 12, 2024
A. An applicant
				shall be determined eligible for enrollment through the Individual Exchange in
				a catastrophic plan if the applicant has met the requirements for eligibility
				for enrollment in a QHP through the Individual Exchange under Regulation .05 of
				this chapter and either:
(1) Is younger than
				30 years old before the beginning of the plan year; or
(2) Has a certification in effect for any
				plan year that the applicant is exempt from the requirement to maintain minimum
				essential coverage set forth in §5000A of the Internal Revenue Code by
				reason of:
(a)
											§5000A (e)(1) of the
				Internal Revenue Code, regarding individuals without affordable coverage;
				or
(b)
											§5000A (e)(5) of the
				Internal Revenue Code, regarding individuals with hardships.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.07 - Eligibility Standards for Enrollment in a Qualified Health Plan, Eligibility Standards for APTC and CSR, and Eligibility Standards for Enrollment in a Catastrophic Qualified Health Plan in the Individual Exchange › Section 14.35.07.11 - Enrollment in a QHP or Insurance Affordability Program Through the Individual Exchange

Current through Register Vol. 51, No. 14, July 12, 2024
A. A
				qualified individual may enroll in a QHP or an insurance affordability program
				under Regulation .02B(12)(c) and .02B(12)(d) of this chapter, through the
				Individual Exchange only during:
(1) The
				annual open enrollment period of the Individual Exchange, or
(2) A special enrollment period for which the
				Individual Exchange has determined that the qualified individual is
				eligible.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.07 - Eligibility Standards for Enrollment in a Qualified Health Plan, Eligibility Standards for APTC and CSR, and Eligibility Standards for Enrollment in a Catastrophic Qualified Health Plan in the Individual Exchange › Section 14.35.07.12 - Special Enrollment Periods - Loss of Minimum Essential Coverage or Termination of Other Specified Coverage Through the Individual Exchange

Current through Register Vol. 51, No. 14, July 12, 2024
A. A qualified
				individual and, when specified in this regulation, an enrollee, a qualified
				individual's dependent, or an enrollee's dependent are eligible for a special
				enrollment period for loss of minimum essential coverage or other specified
				coverage if:
(1) The qualified individual or
				the qualified individual's dependent loses minimum essential
				coverage;
(2) A qualified
				individual or a qualified individual's dependent was enrolled in coverage
				through a non-calendar year group health plan, individual health insurance
				coverage, or qualified small employer health reimbursement arrangement (as
				defined in §9831(d)(2) of the Internal Revenue Code) and the policy or
				plan year ends in the middle of the calendar year, even if the qualified
				individual or the qualified individual's dependent has the option to renew the
				coverage;
(3) A qualified
				individual or the qualified individual's dependent loses pregnancy-related
				coverage described in COMAR
				10.09.24.03A(2)
				and 45 CFR §
											155.420(d)(1)(iii) or loses
				access to health care services through coverage provided to a pregnant women's
				unborn child based on the definition of a child in
				42 CFR §
											457.10; or
(4) A qualified individual or the qualified
				individual's dependent loses the medically needy coverage under COMAR
				10.09.24.03E.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.07 - Eligibility Standards for Enrollment in a Qualified Health Plan, Eligibility Standards for APTC and CSR, and Eligibility Standards for Enrollment in a Catastrophic Qualified Health Plan in the Individual Exchange › Section 14.35.07.13 - Special Enrollment Periods - Change in Family Status Through the Individual Exchange

Current through Register Vol. 51, No. 14, July 12, 2024
A. A
				qualified individual, an enrollee, a qualified individual's dependent, and an
				enrollee's dependent are eligible for a special enrollment period for change in
				family status if the qualified individual or enrollee gains a dependent or
				becomes a dependent through:
(1)
				Marriage;
(2) Birth;
(3) Adoption;
(4) Placement for adoption;
(5) Placement in foster care;
(6) A child support order; or
(7) Other court order.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.07 - Eligibility Standards for Enrollment in a Qualified Health Plan, Eligibility Standards for APTC and CSR, and Eligibility Standards for Enrollment in a Catastrophic Qualified Health Plan in the Individual Exchange › Section 14.35.07.14 - Special Enrollment Period - Error, Misrepresentation, or Inaction Through the Individual Exchange

Current through Register Vol. 51, No. 14, July 12, 2024
A. Prior to
				January 1, 2020, a qualified individual or a qualified individual's dependent
				shall be eligible for the special enrollment period set forth in
				45 CFR §
										155.420(c)(3) if the
				triggering event set forth in
				45 CFR §
										155.420(d)(4)
				occurs.
B. Effective January 1,
				2020, as evaluated and determined by the Individual Exchange, a qualified
				individual or qualified individual's dependent is eligible for a special
				enrollment period when the individual or dependent's enrollment or
				non-enrollment in a QHP is:
(1)
				Unintentional, inadvertent, or erroneous; and
(2) The result of the error,
				misrepresentation, or inaction of an officer, employee, or agent of the
				Individual Exchange its instrumentalities, or a non-Exchange entity providing
				enrollment assistance or conducting enrollment activities.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.07 - Eligibility Standards for Enrollment in a Qualified Health Plan, Eligibility Standards for APTC and CSR, and Eligibility Standards for Enrollment in a Catastrophic Qualified Health Plan in the Individual Exchange › Section 14.35.07.15 - Special Enrollment Period-Misconduct Through the Individual Exchange

Current through Register Vol. 51, No. 14, July 12, 2024
A. Prior to January
				1, 2020, a qualified individual or qualified individual's dependent is eligible
				for a special enrollment period set forth in
				45 CFR §
										155.420(c)(3) if the
				triggering event set forth in
				45 CFR §
										155.420(d)(4)
				occurs.
B. Effective January 1,
				2020, a qualified individual or qualified individual's dependent is eligible
				for a special enrollment period if:
(1) The
				Individual Exchange determines, in collaboration and coordination with the
				Maryland Insurance Administration that, as a result of misconduct on the part
				of the Individual Exchange, or a non-Exchange entity providing enrollment
				assistance or conducting enrollment activities, the qualified individual or
				qualified individual's dependent:
(a) Was not
				enrolled in a QHP;
(b) Was not
				enrolled in the QHP selected by the qualified individual, enrollee, or
				dependent; or
(c) Is eligible for,
				but is not receiving APTC or CSR; and
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.07 - Eligibility Standards for Enrollment in a Qualified Health Plan, Eligibility Standards for APTC and CSR, and Eligibility Standards for Enrollment in a Catastrophic Qualified Health Plan in the Individual Exchange › Section 14.35.07.16 - Special Enrollment Period-Violation of Material Provision Through the Individual Exchange

Current through Register Vol. 51, No. 14, July 12, 2024
A. Prior
				to January 1, 2020, an enrollee or an enrollee's dependent shall be eligible
				for a special enrollment period set forth in
				45 CFR §
										155.420(c)(3) if the
				triggering event set forth in
				45 CFR §
										155.420(d)(5)
				occurs.
B. Effective January 1,
				2020, an enrollee or an enrollee's dependent is eligible for a special
				enrollment period if the enrollee or the enrollee's dependent:
(1) Demonstrates, as determined by the
				Individual Exchange in collaboration and coordination with the Maryland
				Insurance Administration, that the carrier of the QHP in which the enrollee or
				dependent is enrolled substantially violated a material provision of its
				contract in relation to the enrollee or the enrollee's dependent; and
(2) Notifies the Exchange or the Maryland
				Insurance Administration of the alleged violation by the later of:
(a) 30 days of the violation; or
(b) 30 days of when the enrollee or dependent
				reasonably should have known about the violation.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.07 - Eligibility Standards for Enrollment in a Qualified Health Plan, Eligibility Standards for APTC and CSR, and Eligibility Standards for Enrollment in a Catastrophic Qualified Health Plan in the Individual Exchange › Section 14.35.07.17 - Special Enrollment Period-Exceptional Circumstances Through the Individual Exchange

Current through Register Vol. 51, No. 14, July 12, 2024
A. Prior
				to January 1, 2020, an individual, an enrollee or an enrollee's dependent is
				eligible for a special enrollment period set forth in
				45 CFR §
										155.420(c)(3) if the
				triggering event set forth in
				45 CFR §
										155.420(d)(9)
				occurs.
B. Effective January 1,
				2020, a qualified individual, enrollee, qualified individual's dependent, or
				enrollee's dependent is eligible for a special enrollment period if:
(1) The Individual Exchange determines that,
				at the time of the qualified individual's, enrollee's, qualified individual's
				dependent's, or enrollee's dependent's application for coverage, the individual
				experienced exceptional circumstances that prevented the qualified individual,
				enrollee, qualified individual's dependent or the enrollee's dependent from
				enrolling during open enrollment or a special enrollment period, if the
				individual was determined eligible for the special enrollment period by the
				Individual Exchange; and
(2) The
				qualified individual, the enrollee, the qualified individual's dependent, or
				the enrollee's dependent notifies the Exchange within 30 calendar days of the
				exceptional circumstances.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.07 - Eligibility Standards for Enrollment in a Qualified Health Plan, Eligibility Standards for APTC and CSR, and Eligibility Standards for Enrollment in a Catastrophic Qualified Health Plan in the Individual Exchange › Section 14.35.07.18 - Special Enrollment Period - Permanent Move

Current through Register Vol. 51, No. 14, July 12, 2024
A. A qualified individual, enrollee,
				qualified individual's dependent, or enrollee's dependent is eligible for a
				special enrollment period if the qualified individual, enrollee, qualified
				individual's dependent, or enrollee's dependent:
(1) Gains access to a new QHP as a result of
				a permanent move;
(2) Was enrolled
				in minimum essential coverage for one or more days in the 60 days prior to the
				move, unless the qualified individual, enrollee, qualified individual's
				dependent, or enrollee's dependent:
(a) lived
				in a foreign country or a United States territory for 1 or more days during the
				60 days preceding the date of the move;
(b) Is moving from a state that did not
				expand Medicaid or MCHP eligibility set forth in § 2001 of the ACA and the
				individual was not eligible for APTC or CSR in the individual's previous state
				of residence because the individual's household income was below 100 percent of
				the FPL;
(c) Is leaving
				incarceration, except if the individual was incarcerated pending
				disposition;
(d) Lived in a service
				area where no QHP was available through the Exchange for 1 or more days during
				the 60 days preceding the move or during the most recent preceding open
				enrollment or special enrollment period;
(e) Had pregnancy related coverage or access
				to healthcare services through unborn child coverage described in
				45 CFR §
												155.420(d)
				(1)(iii);
(f) Had medically needy coverage described in
				45 CFR §
												155.420(d)(1)(iv);
				or
(g) Is an Indian; and
(3) Notifies the Individual
				Exchange within 60 days from the date of the permanent move that the qualified
				individual, the enrollee, the qualified individual's dependent, or the
				enrollee's dependent has gained access to a new QHP as a result of that
				move.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.07 - Eligibility Standards for Enrollment in a Qualified Health Plan, Eligibility Standards for APTC and CSR, and Eligibility Standards for Enrollment in a Catastrophic Qualified Health Plan in the Individual Exchange › Section 14.35.07.19 - Special Enrollment Period - Other

Current through Register Vol. 51, No. 14, July 12, 2024
A. An enrollee
				or an enrollee's dependent enrolled in the same plan is eligible for a special
				enrollment period if the enrollee or enrollee's dependent:
(1) Is determined newly eligible or
				ineligible for APTC; or
(2) Has a
				change in eligibility for cost-sharing reductions.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.07 - Eligibility Standards for Enrollment in a Qualified Health Plan, Eligibility Standards for APTC and CSR, and Eligibility Standards for Enrollment in a Catastrophic Qualified Health Plan in the Individual Exchange › Section 14.35.07.20 - Exemptions

Current through Register Vol. 51, No. 14, July 12, 2024
A. As set forth in
				45 CFR §
										155.625(b), the Individual
				Exchange has delegated administration of all exemption determinations for
				Maryland residents to HHS.
B. An
				applicant shall follow:
(1) The procedures
				specified by HHS to apply for an exemption set forth in 45 CFR Part 155,
				Subpart G; and
(2) The procedures
				specified by the Internal Revenue Service to apply for an exemption under
				26 CFR §
											1.5000A-3.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.07 - Eligibility Standards for Enrollment in a Qualified Health Plan, Eligibility Standards for APTC and CSR, and Eligibility Standards for Enrollment in a Catastrophic Qualified Health Plan in the Individual Exchange › Section 14.35.07.21 - Authorized Representative

Current through Register Vol. 51, No. 14, July 12, 2024
An applicant or enrollee in the Individual Exchange may
				  designate an individual or an organization to act as the applicant or
				  enrollee's representative as set forth in COMAR 14.35.11.14.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.07 - Eligibility Standards for Enrollment in a Qualified Health Plan, Eligibility Standards for APTC and CSR, and Eligibility Standards for Enrollment in a Catastrophic Qualified Health Plan in the Individual Exchange › Section 14.35.07.22 - Medicaid to Private Plan Enrollment Program

Current through Register Vol. 51, No. 14, July 12, 2024
A. To the
				extent permissible by federal law, the Exchange shall enroll an individual into
				a QHP if the individual was enrolled in Medicaid or MCHP through the Exchange
				and loses Medicaid or MCHP eligibility after:
(1) A redetermination based on a change in
				circumstances reported after April 15, 2023, pursuant to which the individual
				is determined eligible for a QHP but does not enroll in a QHP following receipt
				of the QHP eligibility determination; or
(2) A renewal conducted between April 15,
				2023, and April 30, 2024, provided the Exchange verifies that the individual's
				most recent attested income exceeds the Medicaid-eligible amount as described
				in Health-General Article, §15-103(a)(2), Annotated Code of Maryland, and
				the individual meets eligibility requirements under this chapter to enroll in a
				QHP.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.08 - Captive Producer Training and Authorization Standards › Section 14.35.08.01 - Scope

Current through Register Vol. 51, No. 14, July 12, 2024
This chapter sets forth the training and required standards
				  for an individual who applies to receive a producer authorization and holds a
				  current and exclusive appointment with a single carrier.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.08 - Captive Producer Training and Authorization Standards › Section 14.35.08.02 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. In this
				subtitle, the following terms have the meanings indicated.
B. Terms Defined.
(1) "Appointment" has the meaning stated in
				Insurance Article, §
										1-101(f),
				Annotated Code of Maryland.
(2)
				"Captive Producer" means an insurance producer who:
(a) Is licensed in the State and authorized
				by the Commissioner to sell, solicit, or negotiate health insurance;
(b) Receives an authorization and meets the
				other requirements set forth in Insurance Article, §
											31-113(n)(2),
				Annotated Code of Maryland;
(c)
				Holds a current and exclusive appointment with a single carrier; and
(d) Receives compensation as a captive
				producer only from that carrier.
(3) "Commissioner" means the Maryland
				Insurance Commissioner.
(4)
				"Individual Exchange" or "Exchange" has the meaning stated in Insurance
				Article, §
										31-101(h),
				Annotated Code of Maryland.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.08 - Captive Producer Training and Authorization Standards › Section 14.35.08.03 - Eligibility Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
To qualify for authorization as a captive producer, an
				  applicant shall:
A. Meet the
				requirements set forth under COMAR
				14.35.04.02; and
B. Hold a current and exclusive appointment
				with a single carrier.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.08 - Captive Producer Training and Authorization Standards › Section 14.35.08.04 - Application Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. In
				order to obtain an authorization, the applicant shall submit to the Exchange
				all required materials set forth under COMAR
				14.35.04.03A.
B. The Exchange may not consider
				an application to be complete until it has received all required
				materials.
C. If the application is
				not completed with all required materials within 45 days after the Exchange
				receives the signed application form, the Exchange may consider the application
				withdrawn.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.08 - Captive Producer Training and Authorization Standards › Section 14.35.08.05 - Training Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
In order to obtain an authorization, an individual shall
				  complete the training program as specified under COMAR
				  14.35.04.04B.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.08 - Captive Producer Training and Authorization Standards › Section 14.35.08.06 - Certification Term, Renewal, Reinstatement, and Suspension or Revocation

Current through Register Vol. 51, No. 14, July 12, 2024
A. Term. A captive
				producer authorization expires 2 years after the date it is issued unless it is
				renewed.
B. Renewal. A captive
				producer shall apply for renewal of authorization in accordance with the
				requirements set forth under COMAR 14.35.05.02.
C. Suspension or Revocation. The Exchange may
				suspend or revoke a captive producer authorization for the reasons listed under
				Insurance Article, §
									31-113(l)(1),
				Annotated Code of Maryland.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.09 - Consolidated Service Center Employee Training and Permit Standards › Section 14.35.09.01 - Scope

Current through Register Vol. 51, No. 14, July 12, 2024
This chapter sets forth the qualifications, training, and
				  permit standards for an individual who applies to receive a Consolidated
				  Service Center enrollment permit for the Individual Exchange and is required
				  under Insurance Article, §
									31-113.1(c),
				  Annotated Code of Maryland, to hold an Individual Exchange enrollment
				  permit.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.09 - Consolidated Service Center Employee Training and Permit Standards › Section 14.35.09.02 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. In this
				subtitle, the following terms have the meanings indicated.
B. Terms Defined
(1) "Administration" means Maryland Insurance
				Administration.
(2) "Commissioner"
				means the Maryland Insurance Commissioner
(3) "Consolidated Service Center" or "CSC"
				has the meaning stated in Insurance Article, §
										31-101(c-2),
				Annotated Code of Maryland
(4)
				"Department" means the Department of Health and Mental Hygiene.
(5) "Exchange" has the meaning stated in
				Insurance Article, §
										31-101(c),
				Annotated Code of Maryland
(6)
				"Individual Exchange " has the meaning stated in Insurance Article, §
										31-101(h),
				Annotated Code of Maryland
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.09 - Consolidated Service Center Employee Training and Permit Standards › Section 14.35.09.03 - Eligibility Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
To qualify for an Individual Exchange CSC enrollment permit,
				  an applicant shall meet the requirements set forth under Insurance Article,
				  §
									31-113.1(c)(3),
				  Annotated Code of Maryland
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.09 - Consolidated Service Center Employee Training and Permit Standards › Section 14.35.09.04 - Application Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. In
				order to obtain an Individual Exchange CSC enrollment permit, the applicant
				shall submit to the Exchange all required materials set forth under COMAR 14.3
				5.02.03A.
B. The Exchange may not
				consider an application to be complete until it has received all required
				materials.
C. If the application is
				not completed with all required materials within 45 days after the Exchange
				receives the signed application form, the Exchange may consider the application
				withdrawn.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.09 - Consolidated Service Center Employee Training and Permit Standards › Section 14.35.09.05 - Training Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
In order to obtain an Individual Exchange CSC enrollment
				  permit, an individual shall:
A.
				Complete the training program specified under Insurance Article, §
									31-113(k),
				Annotated Code of Maryland, and COMAR
				14.35.02.04A;
				and
B. Successfully pass the
				examination specified under COMAR
				14.35.02.04D.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.09 - Consolidated Service Center Employee Training and Permit Standards › Section 14.35.09.06 - General Permit Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				Term. An Individual Exchange CSC enrollment permit expires 2 years after the
				date it is issued unless it is renewed
B. Renewal A CSC employee holding an
				Individual Exchange CSC enrollment permit shall apply for renewal of the permit
				in accordance with the requirements set forth under COMAR
				14.35.03.02.
C. Suspension or
				Revocation.
(1) The Commissioner may suspend
				or revoke an Individual Exchange CSC enrollment permit for the reasons listed
				under Insurance Article, §
										31-113(l)(1),
				Annotated Code of Maryland
(2) An
				Individual Exchange CSC enrollment permit is no longer valid upon an
				individual's voluntary or involuntary termination from employment or engagement
				by the Consolidated Services Center
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.10 - Appeals from Determinations Regarding Producer Authorization or Individual Exchange Navigator Certification › Section 14.35.10.01 - Scope

Current through Register Vol. 51, No. 14, July 12, 2024
A. This chapter
				applies to contested case hearings delegated by the Board to the Office in
				accordance with State Government Article, §10 - 205(a)(1)(ii), Annotated
				Code of Maryland.
B. Except as
				explicitly stated in this chapter, COMAR 28.02.01 governs the conduct of a
				hearing before the Office of Administrative Hearings.
C. Determinations entitled to contested case
				appeals. This chapter applies only to the appeal of an Exchange determination
				regarding:
(1) Suspension of SHOP Exchange
				producer authorization;
(2)
				Revocation of SHOP Exchange producer authorization;
(3) Renewal of SHOP Exchange producer
				authorization;
(4) Suspension of
				Individual Exchange producer authorization;
(5) Revocation of Individual Exchange
				producer authorization;
(6) Renewal
				of Individual Exchange producer authorization;
(7) Suspension of captive producer
				authorization;
(8) Revocation of
				captive producer authorization;
(9)
				Renewal of captive producer authorization; and
(10) Denial of Individual Exchange initial
				navigator certification.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.10 - Appeals from Determinations Regarding Producer Authorization or Individual Exchange Navigator Certification › Section 14.35.10.02 - 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 " has the
				meaning set forth under COMAR
				28.02.01.02B(1).
(2) "Board" means the Maryland Health Benefit
				Exchange Board of Trustees.
(3)
				Contested Case.
(a) "Contested case" has the
				meaning stated in State Government Article, §
											10-202(d),
				Annotated Code of Maryland
(b)
				"Contested case " includes a proceeding:
(i)
				Arising out of a determination made by the Board;
(ii) Regarding an authorization,
				certification, or permit issued by the Exchange; or
(iii) Arising out of any act of or failure to
				act by the Board involving an authorization or a certification issued by the
				Exchange, that aggrieves a person.
(c) "Contested case" does not include any
				other quasi-legislative hearing.
(4) Determination.
(a) "Determination" means a decision by the
				Board that requires the Board to provide the opportunity for a hearing to a
				person aggrieved by the decision.
(b) "Determination" includes:
(i) A decision as to whether a person against
				whom an administrative complaint has been received violated a law, regulation,
				or order; and
(ii) An order issued
				pursuant to the Board's authority.
(5) "Exchange " means the Maryland Health
				Benefit Exchange.
(6) "Executive
				Director" means the Executive Director of the Maryland Health Benefit Exchange,
				appointed pursuant to Insurance Article, §
										31-105, Annotated Code of
				Maryland
(7) "Hearing officer"
				means the Board or the Board's authorized designee.
(8) "Maryland Health Benefit Exchange" has
				the meaning set forth under Insurance Article, §
										31-101(e),
				Annotated Code of Maryland
(9)
				"Office " means the Office of Administrative Hearings.
(10) "Person" has the meaning set forth under
				COMAR 28.02.01.02B(12).
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.10 - Appeals from Determinations Regarding Producer Authorization or Individual Exchange Navigator Certification › Section 14.35.10.03 - Request for Hearing-In General

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				Scope. This regulation applies to all requests for a hearing permitted under
				Regulation .01C of this chapter
B.
				A person aggrieved may request a hearing by submitting a written statement to
				the Office, signed by the requesting person and containing the following
				information:
(1) The action or nonaction of
				the Exchange causing the person requesting the hearing to be
				aggrieved;
(2) The facts related to
				the incident or incidents about which the person requests the Exchange to act
				or not to act; and
(3) The ultimate
				relief requested
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.10 - Appeals from Determinations Regarding Producer Authorization or Individual Exchange Navigator Certification › Section 14.35.10.04 - Delegation of Authority

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				Scope. This regulation applies to all requests for a hearing permitted under
				Regulation .01C of this chapter.
B.
				In accordance with State Government Article, §
									10-205(a)(1)(ii),
				Annotated Code of Maryland, the Board delegates to the Office the authority to:
(1) The case:
(a) Involves novel or unanticipated factual
				or legal issues;
(b) Has
				significant social, fiscal, or legal issues;
(c) Involves policy issues; or
(d) Requires further investigation;
				or
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.10 - Appeals from Determinations Regarding Producer Authorization or Individual Exchange Navigator Certification › Section 14.35.10.05 - Service of Notices, Decisions, Orders, and Other Documents

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Office shall
				provide notice of a hearing, decisions, orders and other documents issued by
				the Office pursuant to State Government Article, §§
									10-208 and
				10-209, Annotated
				Code of Maryland.
B. A hearing may
				be rescheduled if there is satisfactory showing that the notice was sent not
				less than 30 calendar days before the hearing, or upon agreement of all
				parties.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.10 - Appeals from Determinations Regarding Producer Authorization or Individual Exchange Navigator Certification › Section 14.35.10.06 - Default Orders

Current through Register Vol. 51, No. 14, July 12, 2024
A. With respect
				to hearings conducted on behalf of the Exchange, a hearing officer may issue a
				proposed default order against a party other than the Exchange that, after
				receiving proper notice, fails to appear at a hearing if:
(1) Notice is issued by the Office, and the
				party failing to appear is the person against whom the notice was issued;
				or
(2) In any other contested case
				hearing, the party failing to appear is the person that requested the
				hearing.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.10 - Appeals from Determinations Regarding Producer Authorization or Individual Exchange Navigator Certification › Section 14.35.10.07 - Administrative Decisions

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				Contents. The hearing officer shall submit to the Board a decision that
				contains :
(1) Final findings of fact and
				conclusions of law; and
(2) A
				proposed order.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.10 - Appeals from Determinations Regarding Producer Authorization or Individual Exchange Navigator Certification › Section 14.35.10.08 - Exceptions

Current through Register Vol. 51, No. 14, July 12, 2024
A. On receipt of a
				proposed order, the parties affected have:
(1) 20 calendar days after receipt to request
				to present argument, file exceptions to the proposed order with the Board, or
				both of these; or
(2) 10 calendar
				days to:
(a) File a written request for a
				transcript, at the party's own expense, with the Board in order to file
				exceptions; or
(b) File with the
				Board a copy of that party's written request to its stenographer, at the
				party's own expense, for the party's preparation of a transcript based on its
				own record of the testimony in order to file
				exceptions.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.10 - Appeals from Determinations Regarding Producer Authorization or Individual Exchange Navigator Certification › Section 14.35.10.09 - Final Order Following Proposed Decision

Current through Register Vol. 51, No. 14, July 12, 2024
A. Issuance. After consideration of the
				Office's proposed order, and any exceptions filed by the parties, the Board
				shall issue a final order or a remand order.
B. Effect of Proposed Order. In reviewing the Office's
				proposed order, the Board is:
(1) Bound by
				the findings of fact that are supported by competent, material, and substantial
				evidence; and
(2) Not bound by any
				legal analysis, conclusions of law, or proposed order.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.10 - Appeals from Determinations Regarding Producer Authorization or Individual Exchange Navigator Certification › Section 14.35.10.10 - Decisions

Current through Register Vol. 51, No. 14, July 12, 2024
The Board shall sign the final order, and the order is
				  effective when issued unless a different date is specified in the decision. A
				  copy of the final order shall be filed with the Exchange and served on all
				  parties to the hearing.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.10 - Appeals from Determinations Regarding Producer Authorization or Individual Exchange Navigator Certification › Section 14.35.10.11 - Mistake or Error in the Final Order

Current through Register Vol. 51, No. 14, July 12, 2024
The Board may correct an order if, upon review, the final
				  order was issued as a result of fraud, mistake, or inadvertence or contains a
				  clerical error.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.10 - Appeals from Determinations Regarding Producer Authorization or Individual Exchange Navigator Certification › Section 14.35.10.12 - Judicial Review

Current through Register Vol. 51, No. 14, July 12, 2024
A party adversely affected by a final decision of the Board,
				  or the entity delegated authority to make the final decision, may obtain
				  judicial review of the decision as provided by law.
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 14.35.11.01 - Scope

Current through Register Vol. 51, No. 14, July 12, 2024
This chapter applies to eligibility determinations and
				  redeterminations for enrollment in qualified health plans, advance payments of
				  the premium tax credit, cost-sharing reductions, and State-based subsidies
				  offered through the Individual Exchange, as well as for MAGI-based eligibility
				  determinations and redeterminations for the Maryland State Medicaid program and
				  the Maryland Children's Health Insurance Program.
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 14.35.11.03 - Opportunity for a Fair Hearing

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				An opportunity for a fair hearing shall be granted if an applicant claims that:
(1) The determination or redetermination
				received from the Exchange of the applicant's eligibility for enrollment in a
				qualified health plan is incorrect;
(2) The determination or redetermination
				received from the Exchange of the applicant's eligibility for an insurance
				affordability program is incorrect; or
(3) The determination or redetermination
				received from the Exchange of the applicant's eligibility for enrollment in a
				qualified health plan or an insurance affordability program is untimely as set
				forth in applicable law.
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 14.35.11.04 - Notification of Right to Request a Fair Hearing

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Exchange shall notify an individual
				and the individual's authorized representative, if previously designated by the
				individual or recognized as valid by the Exchange, in writing:
(1) Of the right to obtain a fair
				hearing;
(2) Of the method to
				obtain the hearing;
(3) That the
				individual may represent the individual or use an authorized representative at
				a fair hearing;
(4) Of the
				circumstances under which the individual's eligibility may be maintained or
				reinstated pending an appeal decision; and
(5) That an appeal decision for one household
				member may result in a change in eligibility for other household members, and
				that such a change will be handled as a redetermination of eligibility for
				other household members.
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 14.35.11.05 - Request for Fair Hearing

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				Statement of Request.
(1) Any individual,
				either personally or through an authorized representative, may request a fair
				hearing by giving a clear statement, oral, electronic, or written, that the
				individual desires an opportunity to present for review any matter which is the
				proper subject of a fair hearing as provided in Regulation .03 of this chapter.
				The request shall be made by:
(a) Contacting
				the Exchange in writing, by mail, telephone, email, or fax;
(b) Contacting the Consolidated Services
				Center maintained by the Exchange by mail, telephone, or fax;
(c) Contacting the delegate agency in person
				or by mail, telephone, or fax;
(d)
				Contacting the Department's Office of Health Services in person or by mail,
				telephone, or fax; or
(e)
				Contacting the Office of Administrative Hearings in person, or by mail or
				fax.
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 14.35.11.06 - Prehearing Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. A
				hearing summary shall be prepared containing pertinent information detailing
				the specific action that is the basis for the appeal. The summary shall be
				forwarded to the appellant or the appellant's authorized representative and to
				the Office of Administrative Hearings at least 6 days before the hearing
				date.
B. The appellant and the
				Exchange may request the names of all witnesses that the other party intends to
				call at the fair hearing.
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 14.35.11.07 - Hearing Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				appellant and the Exchange shall have the opportunity to:
(1) Present witnesses;
(2) Present documentary evidence;
(3) Present oral and written argument without
				undue interference;
(4) Establish
				all facts and circumstances the administrative law judge judges to be relevant;
				and
(5) Question or refute any
				testimony or evidence, including an opportunity to confront and cross-examine
				all witnesses the administrative law judge judges to be adverse.
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 14.35.11.08 - The Record

Current through Register Vol. 51, No. 14, July 12, 2024
A. A verbatim
				recording of the fair hearing shall be made. Nonrecorded or confidential
				information, which the appellant does not have an opportunity to hear or see,
				may not be made a part of the hearing record. One transcribed copy of the
				recording shall be supplied to the appellant at no cost if the appellant takes
				a further appeal.
B. The following
				shall constitute the exclusive record of the hearing:
(1) The transcript or recording of testimony
				and exhibits, or an official report containing the substance of what happened
				at the hearing;
(2) All papers and
				requests, including those maintained electronically, filed in the proceeding;
				and
(3) The administrative law
				judge's decision.
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 14.35.11.09 - Findings, Timing of Decision, and Effect of Decision

Current through Register Vol. 51, No. 14, July 12, 2024
A. Findings.
(1) The administrative law judge shall:
(a) Prepare a written summary of findings and
				conclusions based exclusively on the record; and
(b) Make a decision based on his findings and
				conclusions.
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 14.35.11.10 - Confidentiality

Current through Register Vol. 51, No. 14, July 12, 2024
A. If the appellant
				waives in writing his privilege of confidentiality as to the fair hearing, the
				administrative law judge shall permit members of the public to attend the
				hearing.
B. The administrative law
				judge may cause the removal of any member of the public whose conduct impedes
				the orderly progress of the hearing, or recess the hearing until it may proceed
				in orderly fashion.
C. The
				administrative law judge may exclude from the hearing individuals who have not
				given the Exchange advance notice of their intention to attend if the size of
				the hearing room is too small to accommodate them.
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 14.35.11.11 - Program Benefits During Appeals Process

Current through Register Vol. 51, No. 14, July 12, 2024
A. Benefits Pending Outcome of the Hearing.
(1) The Program may terminate or reduce
				services effective as of the date specified in the notice if the Program timely
				mails the notice as required under Regulation .04 of this chapter and:
(a) The appellant or the appellant's
				authorized representative does not timely request a hearing in accordance with
				Regulation .05 of this chapter; or
(b) The appellant or the appellant's
				authorized representative withdraws in writing or abandons a request for a fair
				hearing.
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 14.35.11.12 - Eligibility for Enrollment in a Qualified Health Plan, for Advance Payments of Premium Tax Credit, for Cost-Sharing Reductions, and for the State-Based Young Adult Health Insurance Subsidies Program Pending Appeal

Current through Register Vol. 51, No. 14, July 12, 2024
A. Eligibility for Enrollment in a Qualified
				Health Plan.
(1) If, upon initial
				determination, an applicant has been determined to be ineligible to enroll in a
				qualified health plan, the applicant may not enroll in a qualified health plan
				pending the outcome of the appeal.
(2) Except where the applicant does not
				appeal a redetermination of eligibility within 90 days of such redetermination,
				an applicant enrolled in a qualified health plan who, upon redetermination, is
				found ineligible to remain enrolled in the qualified health plan may remain
				enrolled in the qualified health plan pending the outcome of the
				appeal.
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 14.35.11.13 - Applicability of Regulations

Current through Register Vol. 51, No. 14, July 12, 2024
If a conflict exists between this chapter and the Rules of
				  Procedure of the Office of Administrative Hearings in COMAR 28.02.01, this
				  chapter shall govern.