Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 590 - MAINE HEALTH DATA ORGANIZATION › Chapter 100 - ENFORCEMENT PROCEDURES › Section 590-100-2 - DEFINITIONS

Current through 2024-29, July 17, 2024
A.
Carrier.
"Carrier" means an
				insurance company licensed in accordance with 24-A M.R.S., including a health
				maintenance organization, a multiple employer welfare arrangement licensed
				pursuant to Title 24-A, chapter 81, a preferred provider organization, a
				fraternal benefit society, or a nonprofit hospital or medical service
				organization or health plan licensed pursuant to 24 M.R.S. An employer exempted
				from the applicability of 24-A M.R.S., chapter 56-A under the federal Employee
				Retirement Income Security Act of 1974,
				29 United States Code,
				Sections 1001 to
				1461 (1988) is not considered a
				carrier.
B.
Entity.
"Entity" means an assessed, commercial, educational, or non-profit entity as
				defined by the MHDO Prices for Data Sets, Fees for Programming and Report
				Generation, and Duplication Rates Rule (90-590 C.M.R. Chapter 50).
C.
Health care facility.
"Health
				care facility" means a public or private, proprietary or not-for-profit entity
				or institution providing health services including, but not limited to an
				independent radiological services center licensed under 22 M.R.S., chapter 160,
				a health care facility licensed under 22 M.R.S., chapter 405 or certified under
				chapter 405-D, a rural health clinic certified by the Division of Licensing and
				Certification within the Department of Human Services, a home health care
				provider licensed under 22 M.R.S., chapter 419, a hospice provider licensed
				under 22 M.R.S., chapter 1681, a community rehabilitation program licensed
				under 20-A M.R.S., chapter 701, a state institution as defined under 34-B
				M.R.S., chapter 1 and a mental health facility licensed under 34-B M.R.S.,
				chapter 1.
D.
Health care
				practitioner.
"Health care practitioner" means physicians and all others
				certified, registered or licensed in the healing arts, including but not
				limited to, nurses, podiatrists, optometrists, chiropractors, physical
				therapists, dentists, psychologists and physicians' assistants as defined in 24
				M.R.S., chapter 21. "Health care practitioner" also includes licensed clinical
				social workers as defined in 32 M.R.S., chapter 83 and marriage and family
				therapists and licensed clinical professional counselors as defined in 32
				M.R.S., chapter 119.
E.
Health care provider.
"Health care provider" means a health care
				facility, health care practitioner, health product manufacturer, health product
				vendor or pharmacy.
F.
Hospital.
"Hospital" means any acute care institution required to
				be licensed pursuant to 22 M.R.S., chapter 405.
G.
Manufacturer.
"Manufacturer"
				means an entity that manufactures or repackages, and sets the wholesale
				acquisition cost for, prescription drugs that are distributed in the
				State.
H.
MHDO.
"MHDO"
				means the Maine Health Data Organization.
I.
M.R.S.
"M.R.S." means
Maine Revised Statutes
.
J.
Parent entity.
"Parent
				entity" means the organization or corporation that has control, directly or
				indirectly through majority ownership, affiliation, contract or membership of a
				hospital and/or any affiliated health care facility. A parent entity may be an
				individual hospital or, as a parent of a health care facility, considered a
				health care facility.
K.
Payor.
"Payor" means a third-party payor or third-party
				administrator.
L.
Person.
"Person" means an individual, trust, estate, partnership,
				corporation including associations, joint stock companies and insurance
				companies, the State or any political subdivision or instrumentality, including
				a municipal corporation of the State, or any other legal entity recognized by
				State law.
M.
Pharmacy
				Benefits Manager (PBM).
"Pharmacy benefits manager (PBM)" means an
				entity that performs pharmacy benefits management, as defined in
				24-A
				M.R.S. §4347, sub-section 17.
N.
Third-party administrator.
"Third-party administrator" means any person who, on behalf of a plan sponsor,
				health care service plan, nonprofit hospital or medical service organization,
				health maintenance organization or insurer, receives or collects charges,
				contributions or premiums for, or adjusts or settles claims on residents of
				this State.
O.
Third-party
				payor.
"Third-party payor" means a health insurance carrier, nonprofit
				hospital, medical services organization, or managed care organization licensed
				in the State of Maine. "Third-party payor" does not include carriers licensed
				to issue limited benefit health policies or accident, specified disease,
				vision, disability, long-term care or nursing home care policies.
P.
Wholesale drug distributor.
"Wholesale drug distributor" means an entity that
i. is licensed by the State to engage in the
				sale of prescription drugs to persons and/or entities other than a consumer or
				patient; and
ii. distributes
				prescription drugs, of which it is not the manufacturer, to persons and /or
				entities other than a consumer or patient in the State.