reglab/statecodes huggingface dataset:
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.01 - Small Employer Health Benefits Plan Premium Subsidy Program › Section 10.25.01.18 - Closing the Premium Subsidy Program to the Entry of New Businesses

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Executive
				  Director may close the program to the entry of new businesses by closing the
				  Commission registry to new registration, notifying the participating carriers,
				  and posting notice on the Commission's official website.
B. This action shall be taken when the
				  subsidies for the coming year are projected to reach or exceed the subsidy
				  program cap, and may be taken at other times for reasons that the Executive
				  Director considers sufficient.
C.
				  Advance notice of this action is desirable, but not required.
D. This action shall be reviewed by the
				  Commission at its next meeting.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.01 - Small Employer Health Benefits Plan Premium Subsidy Program › Section 10.25.01.19 - Closing the Premium Subsidy Program to the Entry of Additional Employees of Enrolled Employers

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  Executive Director may close the Premium Subsidy Program to the entry of new
				  employees by closing the Commission registry to registration of additional
				  employees, notifying the participating carriers and enrolled employers, and
				  posting notice on the Commission's official website.
B. This action shall be reviewed by the
				  Commission at its next meeting.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.01 - Small Employer Health Benefits Plan Premium Subsidy Program › Section 10.25.01.20 - Reopening the Premium Subsidy Program

Current through Register Vol. 51, No. 14, July 12, 2024
A. Following closure of the Premium Subsidy
				  Program under Regulation .18 or .19 of this chapter, the Commission may reopen
				  the Premium Subsidy Program through a formal action specifying both the
				  application process and the criteria that will be used to select new
				  participants from among those applying. Selection criteria may include the
				  average wage of the business, the geographic distribution of enrolled
				  employers, or any other factor formally designated by the Commission.
B. The Commission shall notify the
				  participating carriers and shall post notice on the Commission's official
				  website of the reopening of the Premium Subsidy Program. If the Premium Subsidy
				  Program was closed under Regulation .19 of this chapter, the Commission shall
				  also notify enrolled employers.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.01 - Small Employer Health Benefits Plan Premium Subsidy Program › Section 10.25.01.21 - Penalties

Current through Register Vol. 51, No. 14, July 12, 2024
A. In any conduct
				  relating to the Premium Subsidy Program, employers, employees, participating
				  carriers, subsidy administrators, and licensed insurance producers are subject
				  to criminal and civil penalties under applicable law for any knowing and
				  willful making of a materially false or fraudulent statement and the knowing
				  and willful use of a false or fraudulent document.
B. Employers, employees, participating
				  carriers, subsidy administrators, and licensed insurance producers deemed by
				  the Commission to be in violation of this chapter may be temporarily or
				  permanently excluded from participation in the Premium Subsidy Program by the
				  Commission.
C. If temporarily
				  excluded from the Premium Subsidy Program by the Commission, an enrolled
				  employer and its enrolled employees are not eligible for the Premium Subsidy
				  Program for 12 months and must requalify for the Premium Subsidy Program at the
				  time of reapplication.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.01 - Small Employer Health Benefits Plan Premium Subsidy Program › Section 10.25.01.22 - Decisions of the Commission - Delegation of Program Administration to the Executive Director

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  Decisions of the Commission relating to policies, regulations, and program
				  design under Regulations .17-.20 of this chapter may not be
				  delegated.
B. All other decisions
				  of the Commission regarding program administration, including determinations of
				  eligibility under Regulations .04, .05, .06, .12, and 13 of this chapter,
				  subsidy calculations under Regulation .11 of this chapter, and penalties under
				  Regulation .21 of this chapter are delegated to the Executive
				  Director.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.01 - Small Employer Health Benefits Plan Premium Subsidy Program › Section 10.25.01.23 - Appeals of Decisions of the Executive Director

Current through Register Vol. 51, No. 14, July 12, 2024
A. Decisions of the Executive Director may be
				  appealed to the Commission.
B. The
				  appeal shall be in writing and filed with the Commission within 30 days of the
				  date of the decision of the Executive Director.
C. The appeal shall state specifically the
				  facts of the situation and the justification for the Commission to change the
				  decision of the Executive Director. The appeal may:
(1) Present significant, relevant information
				  that was not previously presented to the Commission and that, with reasonable
				  diligence, could not have been presented before the Executive Director made a
				  decision;
(2) Demonstrate that
				  there have been significant changes in factors or circumstances relied upon by
				  the Executive Director in reaching the decision; or
(3) Demonstrate that the Executive Director
				  has materially failed to follow the Commission's adopted procedures in reaching
				  the decision.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.01 - Small Employer Health Benefits Plan Premium Subsidy Program › Section 10.25.01.24 - Appeals of Decisions of a Participating Carrier

Current through Register Vol. 51, No. 14, July 12, 2024
Actions taken by a participating carrier, including actions
					 taken by a participating carrier that affect a small employer's eligibility for
					 participation in the Premium Subsidy Program or the amount of the premium
					 subsidy, shall be handled through the customary appeals processes for carrier
					 decisions and may not be appealed to the Commission.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.02 - User Fee Assessment on Health Care Practitioners › Section 10.25.02.01 - 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) "Affected licensing board" means a
				  licensing board of which all licensees are required by the Commissioner to pay
				  a user fee.
(2) "Commission" means
				  the Maryland Health Care Commission.
(3) "Health care practitioner" has the
				  meaning stated in Health-General Article, §19-111, Annotated Code of
				  Maryland.
(4) "Licensing board"
				  means a unit within the Department of Health and Mental Hygiene that regulates
				  health care practitioners by the issuance and renewal of licenses to practice a
				  health care profession.
(5) "User
				  fee" means the amount set forth in the fee schedule that each assessed health
				  care practitioner pays as part of a license renewal fee.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.02 - User Fee Assessment on Health Care Practitioners › Section 10.25.02.02 - Method of User Fee Assessment

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  The Commission annually shall identify the health care practitioners to be
				  assessed a user fee.
B. Based on
				  the Commission budget, the Commission shall establish a fee schedule which sets
				  forth the fee that each health care practitioner shall pay as part of the
				  renewal fee required to be paid to an affected licensing board.
C. The formula the Commission shall use to
				  calculate the fee set forth in the fee schedule is 16 percent of the total
				  assessed fees per fiscal year divided by the number of health care
				  practitioners identified pursuant to §A of this regulation.
D. The Commission shall provide the affected
				  licensing boards with the fee schedule within sufficient time for the user fee
				  to be included in the license renewal billing cycle.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.02 - User Fee Assessment on Health Care Practitioners › Section 10.25.02.03 - Waiver of the Fee Assessment Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Commission shall identify the average
				  annual wage for health care practitioners by using comparable classifications
				  in the State Classification and Salary Compensation Plan.
B. The Commission shall determine the average
				  annual wage by utilizing a salary range based on compensation from lowest to
				  highest for each health care practitioner.
C. The Commission shall waive the assessment
				  for a health care practitioner whose average annual wage is substantially below
				  that of other health care practitioners.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.03 - User Fee Assessment on Payers, Hospitals, and Nursing Homes › Section 10.25.03.01 - 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) "Assessment" means the total dollar
				  amount that the Commission bills payers, hospitals, and nursing homes for a
				  given fiscal year.
(2) "Commission"
				  means the Maryland Health Care Commission.
(3) "Health benefit plan" has the meaning
				  stated in Insurance Article, §
											15-201, Annotated Code of
				  Maryland.
(4) "Hospital" has the
				  meaning stated in Health-General Article, §19-301, Annotated Code of
				  Maryland.
(5) "Nursing home" means
				  a related institution, as defined in Health-General Article, §19-301,
				  Annotated Code of Maryland, that is classified as a nursing home.
(6) "Payer" means a:
(a) Health insurer;
(b) Nonprofit health service plan that holds
				  a certificate of authority and provides health insurance policies or contracts
				  in the State; or
(c) Health
				  maintenance organization that holds a certificate of authority in this
				  State.
(7) "User fee"
				  means that portion of the assessment that each payer remits to the
				  Administration pursuant to the formula established in Health-General Article,
				  §19-111, Annotated Code of Maryland.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.03 - User Fee Assessment on Payers, Hospitals, and Nursing Homes › Section 10.25.03.02 - Method of User Fee Assessment

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  On or before June 30 of each year, the Commission shall assess each payer,
				  hospital, and nursing home a fee in accordance with §B of this
				  regulation.
B. Assessment of Fees.
(1) For each fiscal year, the Commission
				  shall assess a fee on payers, hospitals, and nursing homes.
(2) Fees shall be assessed on each payer by
				  apportioning the total amount of fees to be assessed payers based on the ratio
				  of each payer's total premiums collected in the State for health benefit plans
				  to the total collected premiums of all payers collected in the State. The
				  apportionment shall be based on premium information reported by the Insurance
				  Commissioner.
(3) A fee shall be
				  assessed on each hospital that is equal to the sum of:
(a) The amount equal to one-half of the total
				  fees to be assessed on hospitals under §C of this regulation times the
				  ratio of admissions of the hospital to total admissions of all hospitals;
				  and
(b) The amount equal to
				  one-half of the total fees to be assessed on hospitals under §C of this
				  regulation times the ratio of gross operating revenue of each hospital to total
				  gross operating revenues of all hospitals.
(4) A fee shall be assessed on each nursing
				  home that is equal to the sum of:
(a) The
				  amount equal to one-half of the total fees to be assessed on nursing homes
				  under §C of this regulation times the ratio of admissions of the nursing
				  home to total admissions of all nursing homes; and
(b) The amount equal to one-half of the total
				  fees to be assessed on nursing homes under §C of this regulation times the
				  ratio of gross operating revenue of each nursing home to total gross operating
				  revenues of all nursing homes.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.03 - User Fee Assessment on Payers, Hospitals, and Nursing Homes › Section 10.25.03.02 - Method of User Fee Assessment

Current through Register Vol. 51, No. 14, July 12, 2024
A. On or before June 30 of each year, the Commission shall assess each payer, hospital, and nursing home a fee in accordance with §B of this regulation.
B. Assessment of Fees.
(1) For each fiscal year, the Commission shall assess a fee on payers, hospitals, and nursing homes.
(2) Fees shall be assessed on each payer by apportioning the total amount of fees to be assessed payers based on the ratio of each payer's total premiums collected in the State for health benefit plans to the total collected premiums of all payers collected in the State. The apportionment shall be based on premium information reported by the Insurance Commissioner.
(3) A fee shall be assessed on each hospital that is equal to the sum of:
(a) The amount equal to one-half of the total fees to be assessed on hospitals under §C of this regulation times the ratio of admissions of the hospital to total admissions of all hospitals; and
(b) The amount equal to one-half of the total fees to be assessed on hospitals under §C of this regulation times the ratio of gross operating revenue of each hospital to total gross operating revenues of all hospitals.
(4) A fee shall be assessed on each nursing home that is equal to the sum of:
(a) The amount equal to one-half of the total fees to be assessed on nursing homes under §C of this regulation times the ratio of admissions of the nursing home to total admissions of all nursing homes; and
(b) The amount equal to one-half of the total fees to be assessed on nursing homes under §C of this regulation times the ratio of gross operating revenue of each nursing home to total gross operating revenues of all nursing homes.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.03 - User Fee Assessment on Payers, Hospitals, and Nursing Homes › Section 10.25.03.03 - Payment of User Fees

Current through Register Vol. 51, No. 14, July 12, 2024
A. On or
				  before September 1, each payer assessed a user fee in accordance with the
				  provisions of Health-General Article, §19-111, Annotated Code of Maryland,
				  and this chapter shall make payment in the manner directed by the
				  Commission.
B. The Commission may
				  make provisions upon the request of a payer for installment payments of the
				  user fee, as the Commission considers necessary and appropriate.
C. Any bill not paid within 30 days of the
				  payment due date may be subject to an interest penalty to be determined and
				  collected by the Commission.
D. In
				  addition to any penalties the Commission may impose on a payer, hospital, or
				  nursing home that fails to pay the user fee in a timely manner, the Commission
				  may refer the payer's delinquent account to the Department of Budget and
				  Management's Central Collection Unit pursuant to the procedures in State
				  Finance and Procurement Article, §
										3-301
				  et seq., Annotated Code of Maryland, and COMAR 17.01.01.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.04 - Hospital Quality and Performance Evaluation System › Section 10.25.04.01 - 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) "Commission" means the Maryland Health
				  Care Commission.
(2) "Hospital" has
				  the meaning stated in Health-General Article, §19-301, Annotated Code of
				  Maryland.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.04 - Hospital Quality and Performance Evaluation System › Section 10.25.04.02 - Hospital Evaluation - Data Collection and Reporting Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. Each hospital
				  shall file with the Commission data on measures to be included in the
				  Commission's comparative quality and performance evaluation system and the
				  Health Services Cost Review Commission's quality-based reimbursement
				  initiative. The measures may be drawn from, but are not limited to, the:
(1) National Quality Forum;
(2) Hospital Quality Alliance;
(3) Quality Indicator Project of the Maryland
				  Hospital Association;
(4) Agency
				  for Healthcare Research and Quality;
(5) Hospital Quality Initiative of the
				  Centers for Medicare and Medicaid Services;
(6) Centers for Disease Control and
				  Prevention's National Healthcare Safety Network;
(7) Joint Commission's
				  ORYXR initiative; or
(8) Work of academic, professional,
				  healthcare research, and patient safety organizations.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.04 - Hospital Quality and Performance Evaluation System › Section 10.25.04.03 - Summary Studies, Reports, and Compilations

Current through Register Vol. 51, No. 14, July 12, 2024
A. Subject to §B of this regulation,
				  summary studies, reports, or other compilations of data developed by the
				  Commission from the data submitted in accordance with this chapter are public
				  information.
B. Disclosure under
				  §A of this regulation may not be made in such a way that the data
				  furnished for a specific patient can be identified.
C. The Commission shall publish annually, on
				  a comparative basis, the results of the quality and performance evaluation
				  system through one or more reports. The reports may also compare hospital
				  performance to public health goals established by the Secretary of Health and
				  Mental Hygiene or the United States Public Health Service, United States
				  Department of Health and Human Services.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.04 - Hospital Quality and Performance Evaluation System › Section 10.25.04.04 - Extension of Time

Current through Register Vol. 51, No. 14, July 12, 2024
A. A hospital
				  may request an extension of time of up to 30 days for submission of data
				  required in Regulation .02 of this chapter.
B. The hospital shall:
(1) Submit the request to the Executive
				  Director of the Commission not later than 30 days before the data are
				  due;
(2) Explain the reason for the
				  extension request; and
(3) Propose
				  a reasonable specific date for submission of the report.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.04 - Hospital Quality and Performance Evaluation System › Section 10.25.04.05 - Penalty for Failure to File Reports

Current through Register Vol. 51, No. 14, July 12, 2024
A hospital that does not timely file data may be subject to
					 penalties described in COMAR 10.25.12.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.05 - Small Group Market Data Collection › Section 10.25.05.03 - Types of Data Available for Release

Current through Register Vol. 51, No. 14, July 12, 2024
A. The types of data specified in §C of
				  this regulation may be released to an applicant whose application has been
				  approved in accordance with the requirements of this chapter.
B. The availability of the types of data
				  specified in §C of this regulation requesting Medicaid data are subject to
				  a determination of availability by Medicaid.
C. Data may be provided pursuant to an
				  approved application at the following levels of detail:
(1) De-identified standard analytic file: A
				  data extract that contains only data elements that are not considered PHI
				  because the extract excludes direct and indirect individual identifiers as
				  defined in the HIPAA Privacy Rule.
(2) Limited data set: A data extract that
				  contains a limited set of indirect individual identifiers as defined in the
				  HIPAA Privacy Rule and excludes direct individual identifiers.
(3) Custom data file: A data extract that is
				  created based on criteria provided by an applicant and deemed the minimum
				  amount necessary for an applicant's proposed use of the data and consists of:
(a) Indirect individual identifiers that can
				  be used to identify individuals when combined with other information or data;
				  or
(b) Aggregate, summary data in
				  which the risk of identifying individuals is minimal.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.05 - Small Group Market Data Collection › Section 10.25.05.04 - Requests for Medicaid Data

Current through Register Vol. 51, No. 14, July 12, 2024
A. An
				  application submitted to the Commission that includes a request for Medicaid
				  data shall be referred to Medicaid for review after Commission staff has
				  reviewed the application and determined the application to be complete in
				  accordance with Regulation .06 of this chapter.
B. Medicaid shall review an application
				  referred pursuant to §A of this regulation and notify Commission staff in
				  writing within 15 business days of the date of referral of Medicaid's decision
				  to:
(1) Proceed with its own independent
				  application review and decision-making process on that part of an application
				  requesting Medicaid data:
(a) Without further
				  involvement or participation of Commission staff, the DRAC, or the full
				  Commission; and
(b) That is not
				  governed by the review and decision-making process in Regulations .07-14 of
				  this chapter;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.05 - Small Group Market Data Collection › Section 10.25.05.05 - Requests for Data from Governmental Entities

Current through Register Vol. 51, No. 14, July 12, 2024
A. A governmental entity requesting data
				  shall submit a written data request in the form and manner specified by the
				  Commission that shall:
(1) Be signed by the
				  agency head or chief executive officer of a governmental entity; and
(2) Include a signed statement by a
				  governmental entity's legal counsel that the governmental entity has legal
				  authority to use the requested data for the purpose described in the written
				  data request.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.05 - Small Group Market Data Collection › Section 10.25.05.06 - Requests for Data from Nongovernmental Entities

Current through Register Vol. 51, No. 14, July 12, 2024
A. Submission of Applications.
(1) An applicant shall complete and submit a
				  written application in the form and manner specified by the
				  Commission.
(2) An applicant shall
				  disclose on an application all potential or approved funding sources at the
				  time of submission of an application.
(3) If applicable, an applicant shall
				  disclose any data sharing or other requirements imposed by a funding source as
				  a condition of receipt of funding.
(4) An applicant shall disclose on an
				  application whether an applicant or any person or entity that is an officer,
				  owner, operator, or part of management of an applicant's organization who will
				  have access and use of the requested data is currently, or has been within 10
				  years prior to the date of the application, a subject of or a party to a state
				  or federal regulatory agency action or civil or criminal action involving a
				  data breach, HIPAA violation, or other matter involving unauthorized access,
				  use, and disclosure of data regardless of whether there has been a finding or
				  admission of guilt, including being:
(a)
				  Convicted of a felony or pleading guilty, nolo contendere, entering a best
				  interest plea of guilty, or receiving a diversionary disposition regarding a
				  felony;
(b) A subject of an
				  investigation conducted by, or a pending complaint, charge, or indictment
				  issued by, a local, state, or federal governmental regulatory agency or other
				  state or federal law enforcement agency; or
(c) A party to a final dispositive action in
				  a state or federal governmental agency regulatory action or a civil action that
				  resulted in entry into a settlement agreement, consent agreement, decree or
				  order, corporate integrity agreement, corrective action agreement, or other
				  similar agreement or other disposition in a civil action regardless of whether
				  there has been an admission or finding of guilt or liability.
(5) A person who signs an
				  application shall:
(a) Be an officer of an
				  applicant's organization who has been given signatory authority to bind the
				  organization, unless an applicant is not part of an organization and is
				  requesting data in an applicant's individual capacity, in which case the
				  applicant shall sign an application; and
(b) Sign the following affirmation statement:
				  "I solemnly affirm under the penalties of perjury that the contents of the
				  application and any supplementary information are true to the best of my
				  knowledge, information, and belief."
(6) An applicant shall pay a nonrefundable
				  application fee in the amount specified in the list of fees published on the
				  Commission's website at the time of submission of an application.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.05 - Small Group Market Data Collection › Section 10.25.05.07 - Transparency of Data Request and Data Release Process

Current through Register Vol. 51, No. 14, July 12, 2024
A. Except for applications submitted by
				  governmental entities pursuant to an express state or federal statutory or
				  regulatory mandate, all completed applications shall be published on the
				  Commission's website during the pendency of the review process, without those
				  parts of the application that specify an applicant's proposed data management
				  plan and security measures.
B.
				  Members of the public may submit written comment on an application for a period
				  of 10 business days following the date on which an application is published on
				  the Commission's website.
C.
				  Commission staff shall provide all public comments received on an application
				  to the DRAC for review and consideration in accordance with Regulation .09 of
				  this chapter.
D. After a decision
				  has been made on an application, the following information shall be published
				  on the Commission's website:
(1) The
				  disposition of an application; that is, whether the application has been:
(a) Approved;
(b) Approved with conditions;
(c) Disapproved; or
(d) Withdrawn;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.05 - Small Group Market Data Collection › Section 10.25.05.08 - Data Release Advisory Committee

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  The Commission shall establish a Data Release Advisory Committee (DRAC) that
				  meets the membership composition requirements and performs the review functions
				  of a privacy board as described in
				  45 CFR §
											164.512.
B. The Commission shall appoint the members
				  of the DRAC and a chairperson from among the appointed members.
C. The number of members appointed to the
				  DRAC shall be at the discretion of the Commission but large enough to:
(1) Represent the appropriate range of
				  stakeholder groups described in §D of this regulation; and
(2) Provide relevant experience, professional
				  competency, and subject matter expertise in the areas of consumer privacy and
				  advocacy, data analytics, data privacy, data security, health policy research,
				  individual privacy issues, information technology, public health, and the use
				  and analysis of health care claims data.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.05 - Small Group Market Data Collection › Section 10.25.05.09 - Data Release Advisory Committee Review

Current through Register Vol. 51, No. 14, July 12, 2024
A. The following data requests are not
				  subject to review by the DRAC:
(1) Those
				  categories of data requests and data release described in Regulation
				  .01D(1)"(5) of this chapter;
(2)
				  Requests for data submitted by a governmental entity that the Executive
				  Director determines warrants an expedited review under Regulation .05 of this
				  chapter; and
(3) Requests for
				  aggregate, summarized data as described in Regulation .03C(3)(b) of this
				  chapter.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.05 - Small Group Market Data Collection › Section 10.25.05.10 - Executive Director Review and Decision on Requests for Data

Current through Register Vol. 51, No. 14, July 12, 2024
A. Before making a
				  decision on an application requesting data, the Executive Director shall:
(1) Review and consider the DRAC's written
				  report and recommendation;
(2)
				  Review all public comment received;
(3) Determine whether the approval criteria
				  set forth in Regulation .09C of this chapter have been met; and
(4) Determine whether any of the disapproval
				  criteria set forth in Regulation .09C of this chapter exists for disapproval of
				  an application under Regulation .09D of this chapter.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.05 - Small Group Market Data Collection › Section 10.25.05.11 - Review of Decisions on Requests for Data

Current through Register Vol. 51, No. 14, July 12, 2024
A. Request for Further Review of Decisions on
				  Requests for Data.
(1) An applicant may
				  submit a written request for full Commission review of a written decision
				  issued by the Executive Director or a review panel, as applicable, under
				  Regulation .10G of this chapter, within 20 business days of the date the
				  written decision is issued, which shall:
(a)
				  State with particularity the grounds and factual basis for an applicant's
				  disagreement with the decision and include citations to specific documentation
				  or authority for each argument made in support of an applicant's disagreement
				  with the decision;
(b) Include all
				  relevant supporting documentation and authority cited in §A(1)(a) of this
				  regulation;
(c) Specify the remedy
				  requested:
(i) Reversal of the decision and
				  unconditional release of the requested data; or
(ii) Modification of the decision to release
				  the requested data subject to conditions; and
(d) If desired, include a written request to
				  present oral argument to the full Commission, which shall be scheduled if
				  requested.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.05 - Small Group Market Data Collection › Section 10.25.05.12 - Fees

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Commission
				  may charge fees to an applicant and data recipient for:
(1) Submission of an application;
				  and
(2) The cost of accessing data,
				  which may include but is not limited to the costs of producing and releasing
				  data to a data recipient.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.05 - Small Group Market Data Collection › Section 10.25.05.14 - Compliance and Enforcement

Current through Register Vol. 51, No. 14, July 12, 2024
A. If a
				  data recipient fails to comply with any of the terms and conditions of a data
				  use agreement, or it becomes known after execution of a data use agreement that
				  a data recipient provided false information during the application process, the
				  Commission, acting through the Executive Director, may take one or more of the
				  following administrative and judicial enforcement actions, depending upon the
				  facts, circumstances, and gravity of the acts of noncompliance:
(1) Terminate a data recipient's current
				  access to data;
(2) Suspend a data
				  recipient's current access to data for a period of time:
(a) Subject to conditions that a data
				  recipient must satisfy before the suspension may be lifted and access to data
				  reinstated; or
(b) If required by
				  the Executive Director, until a data recipient enters into a new data use
				  agreement that requires compliance with a corrective action plan addressing the
				  acts of noncompliance;
(3) Require a data recipient to suspend or
				  retract for a designated period of time a product that has been created or
				  published from the data, subject to conditions that a data recipient must
				  satisfy before the suspension or retraction may be lifted;
(4) Demand the secure destruction or return
				  of data and require documentary proof that all data released to a data
				  recipient has been destroyed;
(5)
				  Terminate a data use agreement; or
(6) Prohibit a data recipient from submitting
				  a new application requesting data for a designated period of time.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.06 - Maryland Medical Care Data Base and Data Collection › Section 10.25.06.01 - Scope and Purpose

Current through Register Vol. 51, No. 14, July 12, 2024
These regulations establish appropriate methods for
					 collecting and compiling Statewide data on selected health care services
					 provided either under a Maryland contract or to Maryland residents by health
					 care practitioners and facilities:
A.
				  From payors;
B. From third-party
				  administrators;
C. From managed
				  behavioral health care organizations;
D. From pharmacy benefit managers;
				  and
E. Regarding providers for
				  whom the Maryland Health Care Commission otherwise receives data.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.06 - Maryland Medical Care Data Base and Data Collection › Section 10.25.06.03 - Persons Designated to Provide Data to the Commission

Current through Register Vol. 51, No. 14, July 12, 2024
A. Reporting Entities. By December 31 of each
				  year, the Commission shall make available a list of each payor, third-party
				  administrator, pharmacy benefit manager, and managed behavioral health care
				  organization meeting the criteria for designation as a reporting entity and who
				  shall file the reports under this chapter in the following year.
(1) The Commission shall designate as a
				  reporting entity each payor and third-party administrator whose total lives
				  covered exceeds 1,000, as reported to the Maryland Insurance
				  Administration.
(2) The Commission
				  shall designate as a reporting entity each payor offering a qualified health
				  plan, qualified dental plan, or qualified vision plan certified by the Maryland
				  Health Benefit Exchange, under Insurance Article, §
											31-115, Annotated Code of
				  Maryland.
(3) The Commission shall
				  designate as a reporting entity each payor that is a managed care organization
				  participating in the Maryland Medical Assistance Program in connection with the
				  enrollment of an individual in the Maryland Medical Assistance Program or the
				  Maryland Children's Health Program.
(4) The Commission may conduct surveys as
				  needed to fulfill the purposes of the MCDB.
(a) The Commission may conduct a survey of
				  any reporting entity to determine if the reporting entity is required to report
				  data or for other purposes consistent with this chapter.
(b) If necessary, the Commission may
				  institute an annual survey to obtain information needed to determine and
				  designate a third-party administrator whose annual covered lives report filed
				  with the Maryland Insurance Administration does not delineate the number of
				  covered lives for the following:
(i) A
				  behavioral health services plan; or
(ii) A pharmacy benefit management services
				  plan.
(c) A reporting
				  entity shall timely report information sought by the Commission in a
				  survey.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.06 - Maryland Medical Care Data Base and Data Collection › Section 10.25.06.04 - Process for Submitting Data

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  Commission shall provide each reporting entity with an annual update to the
				  MCDB Submission Manual, and each current Manual update available, as specified
				  in Regulation .15 of this chapter.
B. Each reporting entity shall provide each
				  of the following reports, if applicable:
(1)
				  Professional Services Data Report;
(2) Pharmacy Data Report;
(3) Provider Directory Report;
(4) Institutional Services Data
				  Report;
(5) Eligibility Data
				  Report;
(6) Plan Benefit Design
				  Report;
(7) Dental Services Data
				  Report; and
(8) Non-Fee-for-Service
				  Expenses Report.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.06 - Maryland Medical Care Data Base and Data Collection › Section 10.25.06.05 - Time Period for Submitting Data Reports

Current through Register Vol. 51, No. 14, July 12, 2024
A. Unless a different reporting time period
				  is specified in the MCDB Submission Manual pursuant to §B of this
				  regulation, each reporting entity shall submit to the Commission a complete set
				  of the entity's data for claims paid during each quarter of a calendar year in
				  the form and manner described in Regulations .07-.14 of this chapter within 2
				  months of the last day in the applicable quarter.
B. Each reporting entity shall submit at
				  least quarterly to the Commission a complete set of the reporting entity's data
				  for claims paid during the specific time period in the form and manner
				  described in Regulations .07-.14 of this chapter and within the time period
				  specified in the MCDB Submission Manual, unless a more frequent submission
				  schedule is instituted by the Commission pursuant to §C of this
				  regulation.
C. Before instituting a
				  requirement that a reporting entity submit data for claims paid more frequently
				  than quarterly, as required in §§A and B of this regulation, the
				  Commission shall:
(1) Establish a
				  multi-stakeholder group consisting of representatives of reporting entities,
				  involved State agencies, and other stakeholders, as appropriate, to discuss the
				  benefits and costs of expanding data collection; and
(2) Include a transition period for reporting
				  entities to adjust to the new data submission schedule and process.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.06 - Maryland Medical Care Data Base and Data Collection › Section 10.25.06.06 - Protection of Confidential Information in Submissions

Current through Register Vol. 51, No. 14, July 12, 2024
A. To assure that confidential records or
				  information are protected, each reporting entity shall encrypt each of the
				  following data elements in such a manner that each unique value for a data
				  element produces an identical unique encrypted data element:
(1) Patient or enrollee identifier;
				  and
(2) Internal subscriber
				  contract number.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.06 - Maryland Medical Care Data Base and Data Collection › Section 10.25.06.07 - Professional Services Data Report Submission

Current through Register Vol. 51, No. 14, July 12, 2024
A. Each reporting entity shall submit a
				  professional services data report that provides the data for each
				  fee-for-service and capitated encounter, including fee-for-service equivalents
				  prices for capitated services, provided by a health care practitioner or office
				  facility. This report shall include all health care services provided:
(1) To each Maryland resident insured by that
				  entity under a fully insured or a self-insured contract; and
(2) To each non-Maryland resident insured
				  under a Maryland contract.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.06 - Maryland Medical Care Data Base and Data Collection › Section 10.25.06.08 - Pharmacy Data Report Submission

Current through Register Vol. 51, No. 14, July 12, 2024
A. Each reporting entity shall submit a
				  pharmacy data report for each prescription drug encounter for services provided
				  by a pharmacy located in or out of the State. This report shall include all
				  pharmacy services provided to each Maryland resident insured under a fully
				  insured contract or a self-insured contract, and to each non-Maryland resident
				  insured under a Maryland contract.
B. Each pharmacy data report shall contain
				  the information specified by the Commission in its annual update to the MCDB
				  Submission Manual and be filed in a form and manner specified in the
				  Manual.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.06 - Maryland Medical Care Data Base and Data Collection › Section 10.25.06.09 - Provider Directory Report Submission

Current through Register Vol. 51, No. 14, July 12, 2024
A. Each reporting entity shall submit a
				  provider directory report detailing each health care practitioner or supplier
				  that provided services to any enrollee of that reporting entity during the
				  reporting period. This report shall contain information for each in-State
				  Maryland practitioner or supplier, and for each out-of-State practitioner or
				  supplier that has served a Maryland resident or a non-Maryland resident under a
				  Maryland contract.
B. Each provider
				  directory report shall include a crosswalk to each practitioner or supplier ID
				  listed in the professional services data report submitted under Regulation .07
				  of this chapter or the pharmacy data report submitted under Regulation .08 of
				  this chapter.
C. Each provider
				  directory report shall contain the information specified by the Commission in
				  its annual update to the MCDB Submission Manual and be filed in a form and
				  manner specified in the Manual.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.06 - Maryland Medical Care Data Base and Data Collection › Section 10.25.06.10 - Institutional Services Data Report Submission

Current through Register Vol. 51, No. 14, July 12, 2024
A. Each reporting entity shall submit an
				  institutional services data report that reports all institutional health care
				  services provided to each Maryland resident insured under a fully insured
				  contract or self-insured contract, and each non-Maryland resident insured under
				  a Maryland contract, whether those services were provided:
(1) By a health care facility located
				  in-State or out-of-State; or
(2)
				  Under a general health benefit plan.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.06 - Maryland Medical Care Data Base and Data Collection › Section 10.25.06.11 - Eligibility Data Report Submission

Current through Register Vol. 51, No. 14, July 12, 2024
A. Each reporting entity shall submit an
				  eligibility data report that provides information on the characteristics of
				  each enrollee that is a Maryland resident insured under a fully insured
				  contract or a selfinsured contract, and each enrollee that is a non-Maryland
				  resident insured under a Maryland contract, for services covered under each
				  policy or contract issued by the reporting entity that are subject to this
				  chapter.
B. Each eligibility data
				  report shall contain the information specified by the Commission in its annual
				  update to the MCDB Submission Manual and be filed in a form and manner
				  specified in the Manual.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.06 - Maryland Medical Care Data Base and Data Collection › Section 10.25.06.12 - Plan Benefit Design Report

Current through Register Vol. 51, No. 14, July 12, 2024
Each plan benefit design report shall contain the
					 information specified by the Commission in its annual update to the MCDB
					 Submission Manual and be filed in a form and manner specified in the
					 Manual.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.06 - Maryland Medical Care Data Base and Data Collection › Section 10.25.06.13 - Dental Services Data Report

Current through Register Vol. 51, No. 14, July 12, 2024
Each dental services data report shall contain the
					 information specified by the Commission in its annual update to the MCDB
					 Submission Manual and be filed in a form and manner specified in the
					 Manual.