reglab/statecodes huggingface dataset:
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.16 - Plan Certification Standards › Section 14.35.16.08 - Qualified Health Plan Certification-Network Adequacy

Current through Register Vol. 51, No. 14, July 12, 2024
A. Each health benefit plan shall meet the
				network adequacy standards stated in
				45 CFR §
										156.230, Insurance Article, §
									15-112, Annotated Code of
				Maryland, and COMAR 31.10.44.
B.
				Each health benefit plan shall meet the provider panel sufficiency requirements
				under COMAR
				31.10.34.04A.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.16 - Plan Certification Standards › Section 14.35.16.09 - Qualified Health Plan Certification-Covered Prescription Drugs and Formularies

Current through Register Vol. 51, No. 14, July 12, 2024
A. An
				authorized carrier's application under Regulation .04A of this chapter shall
				identify drugs covered under the health benefit plan's medical
				benefit.
B. Drug Formulary List
				Location.
(1) An authorized carrier shall
				provide the Internet address for the drug formulary for each health plan with
				the application submitted for the health benefit plan to the Exchange under
				Regulation .04A of this chapter.
(2) The Internet address required under
				§B(1) of this regulation shall link directly to the health benefit plan's
				list of covered drugs without further navigation.
(3) The health benefit plan's list of covered
				drugs shall:
(a) Include plain language drug
				category information for each drug category;
(b) Include information on utilization
				management tools such as prior authorization, step therapy, quantity
				limitations, and generic substitutions; and
(c) Be up to date, accurate, and
				complete.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.16 - Plan Certification Standards › Section 14.35.16.10 - Qualified Health Plan Certification-Waiver Authority

Current through Register Vol. 51, No. 14, July 12, 2024
The Exchange, with the approval of the Board, may grant a
				  waiver to a specific provision of this chapter, with or without conditions,
				  under the procedure in COMAR 14.35.15.10.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.16 - Plan Certification Standards › Section 14.35.16.11 - Qualified Health Plan Denial, Suspension, and Revocation of Certification and Other Remedies

Current through Register Vol. 51, No. 14, July 12, 2024
A. If the
				Exchange determines that a carrier has failed to comply with this chapter,
				Insurance Article, Title 31, Annotated Code of Maryland, or any other federal
				or State laws or regulations applicable to carrier offerings in the Exchange
				that are not otherwise specified in Insurance Article, §
									31-115(k),
				Annotated Code of Maryland, the Exchange may initiate one or more of the
				following actions against the carrier:
(1)
				Deny certification for participation in the Exchange;
(2) Suspend the carrier's certification for
				participation in the Exchange;
(3)
				Revoke the carrier's certification for participation in the Exchange;
				or
(4) Another remedy defined under
				§D of this regulation.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.16 - Plan Certification Standards › Section 14.35.16.12 - Qualified Health Plan Certification-On-going Compliance with Qualified Health Plan Certification Standards

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Exchange may conduct compliance
				reviews of a QHP during the plan benefit year.
B. The Exchange may require an authorized
				carrier to develop, submit for approval, and follow, as amended by the
				Exchange, a corrective action plan for compliance issues noted by the Exchange
				during its compliance review of a QHP.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.17 - State Reinsurance Program › Section 14.35.17.01 - Scope

Current through Register Vol. 51, No. 14, July 12, 2024
This chapter sets forth the structure, implementation, and
				  eligibility standards for the State Reinsurance Program, as required under
				  Insurance Article, §
									31-117, Annotated Code of
				  Maryland.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.17 - State Reinsurance Program › Section 14.35.17.03 - Eligibility for Receipt of Reinsurance Payments

Current through Register Vol. 51, No. 14, July 12, 2024
A. Except as provided in §B of this
				regulation, a qualified health plan is eligible to receive reinsurance payments
				from the State Reinsurance Program, provided that the qualified health plan is
				offered by a carrier that:
(1) Is authorized
				to offer individual non-Medigap health benefit plans in Maryland;
(2) Complies with the assessment under
				Insurance Article, §
										6-102.1, Annotated Code of
				Maryland; and
(3) Meets all
				obligations set forth in the Carrier Business Agreement.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.17 - State Reinsurance Program › Section 14.35.17.04 - Calculation of Reinsurance Payments Under the State Reinsurance Program

Current through Register Vol. 51, No. 14, July 12, 2024
A. A carrier of a
				reinsurance-eligible plan, as provided for in Regulation .03 of this chapter,
				becomes eligible for reinsurance payments from the State Reinsurance Program
				when its claims costs for individual enrollees' covered benefits in a benefit
				year exceed the attachment point established under the process identified in
				§B of this regulation.
B. Each
				year the Board shall set the payment parameters for the State Reinsurance
				Program by determining the following factors:
(1) An attachment point;
(2) A coinsurance rate;
(3) A reinsurance cap; and
(4) A market-level dampening factor provided
				by the Commissioner, if determined necessary by the Board.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.17 - State Reinsurance Program › Section 14.35.17.05 - Data Collection and Maintenance for Reinsurance Payments

Current through Register Vol. 51, No. 14, July 12, 2024
A. The carriers of
				reinsurance-eligible plans shall submit to the Exchange data required to
				determine reinsurance payments as described in Regulation .06 of this chapter,
				or shall provide access to such data, according to the data requirements
				specified by the Exchange in the Annual letter to Issuers.
B. The Individual Exchange shall establish a
				process through which an issuer of a reinsurance-eligible plan that does not
				generate individual enrollee claims in the normal course of business may use
				estimated claims costs to make a request for payment, or to submit data to be
				considered for reinsurance payments, in accordance with the requirements of
				Regulation .09 of this chapter. The State shall ensure that such requests for
				reinsurance payment, or a subset of such requests, are subject to
				validation.
C. The Individual
				Exchange shall maintain documents and records relating to the State Reinsurance
				Program, whether paper, electronic, or in other media, for each benefit year
				for at least 10 years. The documents and records shall be sufficient to enable
				the evaluation of the State Reinsurance Program's compliance with federal
				standards.
D. The Individual
				Exchange shall ensure that the collection of personally identifiable
				information is limited to information reasonably necessary for use in the
				calculation of reinsurance payments. Any use and disclosure of personally
				identifiable information shall be limited to those purposes for which the
				personally identifiable information was collected, including for purposes of
				data validation.
E. The Individual
				Exchange shall maintain standards that provide administrative, physical, and
				technical safeguards for the personally identifiable information consistent
				with applicable State and federal standards.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.17 - State Reinsurance Program › Section 14.35.17.06 - Disbursement of Reinsurance Payments

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Individual Exchange shall make
				reinsurance payments to the carrier of a reinsurance-eligible plan after it
				receives a valid claim for payment from that carrier in accordance with the
				processes established in Regulation .07 of this chapter.
B. For each applicable benefit year, the
				Individual Exchange shall:
(1) Notify
				carriers annually of reinsurance payments under the State Reinsurance Program
				payment parameters to be made for the applicable benefit year no later than
				September 30 of the year following the applicable benefit year; and
(2) Provide to each issuer of a
				reinsurance-eligible plan the calculation of total reinsurance payment requests
				made under the State Reinsurance Program payment parameters.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.17 - State Reinsurance Program › Section 14.35.17.07 - Request for Reinsurance Payment

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				A carrier may make a request for payment when a carrier's claims costs for an
				enrollee of a reinsurance-eligible plan has met the criteria for reinsurance
				payment set forth by the Board for the applicable benefit year.
B. A carrier of a reinsurance-eligible plan
				shall make requests for payment in accordance with the requirements of the
				Annual letter to Issuers for the applicable benefit year.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.17 - State Reinsurance Program › Section 14.35.17.08 - Document Retention and Audits

Current through Register Vol. 51, No. 14, July 12, 2024
A. A carrier of a reinsurance-eligible plan
				shall maintain documents and records, whether paper, electronic, or in other
				media, sufficient to substantiate the requests for reinsurance payments made
				pursuant to Regulation .07 of this chapter for a period of at least 10 years
				and shall make those documents and records available upon request by the Board
				or the Individual Exchange or its designee to any such entity for purposes of
				verification, investigation, audit, or other review of reinsurance payment
				requests.
B. The Individual
				Exchange may audit a carrier of a reinsurance-eligible plan to assess its
				compliance with the requirements of this chapter. The issuer shall ensure that
				its relevant contractors, subcontractors, or agents cooperate with any audit
				under this section. If an audit results in a finding of material weakness or
				significant deficiency with respect to compliance with any requirement of these
				regulations, the carrier shall complete all of the following:
(1) Within 30 calendar days of the issuance
				of the final audit report, provide a written corrective action plan to the
				Exchange for approval;
(2)
				Implement the corrective action plan; and
(3) Provide to the Exchange written
				documentation of the corrective actions once taken.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.17 - State Reinsurance Program › Section 14.35.17.09 - State Reinsurance Program Surplus

Current through Register Vol. 51, No. 14, July 12, 2024
For the Benefit Year 2019 and after, the Individual Exchange
				  shall reserve any surplus, after all reinsurance payments have been remitted,
				  for claims in future years of the State Reinsurance Program.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.18 - Small Business Health Options Program › Section 14.35.18.01 - Scope

Current through Register Vol. 51, No. 14, July 12, 2024
This chapter sets forth the requirements for the Small
				  Business Health Options Program. This chapter does not address the individual
				  exchange or qualified dental plans or qualified vision plans.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.18 - Small Business Health Options Program › Section 14.35.18.02 - 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) "Common law employee" has the meaning
				stated in 20 CFR §
											404.1007.
(2) "Date of enrollment" means the date of
				enrollment of an individual covered under a group health plan or, if earlier,
				the first day of the waiting period for such enrollment.
(3) "Employer group health insurance coverage
				" means health coverage offered by an employer to an employee and the
				employee's dependents, if eligible, under:
(a)
				Government health coverage, such as the Federal Employees Health Benefit
				program;
(b) Health coverage
				offered in the small or large group market by an employer within a state;
				or
(c) Grandfathered health
				coverage offered by an employer in a group market.
(4) "Full-time employee" means a common law
				employee working on average, at least 30 hours per week.
(5) "Independent contractor" means a 1099
				employee working 30 or more hours per week.
(6) "Member" means any person enrolled in a
				health benefit plan.
(7) "Part-time
				employee" means a common law employee working fewer than 30 hours per week, or
				seasonal worker working more than 120 days per year.
(8) "Participation rate" means the percentage
				of eligible employees electing to participate in a health benefit plan out of
				all eligible employees.
(9)
				"Participation requirement" means a policy provision, or a carrier's
				underwriting guideline if there is no such provision, which requires that a
				group attain a certain participation rate in order for a carrier to accept the
				group for enrollment in the plan.
(10) "Qualified employee" means an employee
				who:
(a) Works on a full-time basis with a
				normal work week of thirty or more hours, but does not include an employee who
				works on a temporary or substitute basis; and
(b) Is hired to work for a period of not less
				than 5 months.
(11)
				"Qualified employer" means a small employer that elects to make its full-time
				employees and, at the option of the employer, some or all of its part-time
				employees eligible for one or more qualified health plans offered through the
				SHOP Exchange, provided that the employer:
(a) Has its principal place of business in
				the State and elects to provide coverage through the SHOP Exchange to all of
				its eligible employees, wherever employed; or
(b) Elects to provide coverage through the
				SHOP Exchange to all of its eligible employees who are principally employed in
				the State.
(12)
				"Rescission" means a cancellation or discontinuance of coverage that has
				retroactive effect.
(13) "Waiting
				period" means the period of time that must pass before coverage for a qualified
				employee who is otherwise eligible to enroll under the terms of a small group
				health plan can become effective.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.18 - Small Business Health Options Program › Section 14.35.18.03 - Eligibility for SHOP Exchange

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				Nondiscrimination. No policy shall exclude a qualified employee or dependent on
				the basis of age, sex, sexual orientation, gender identity, occupation, actual
				or expected health condition, claims experience, duration of coverage, or
				medical condition.
B. SHOP Exchange
				Employer Eligibility.
(1) An employer is
				eligible to purchase insurance on the SHOP Exchange if it meets the following
				requirements as established by Insurance Article, §
										31-101(aa),
				Annotated Code of Maryland:
(a) Has, on
				average, 50 or fewer employees during the preceding calender year;
(b) Has at least one full-time employee who
				is not the spouse or other dependent of the owner;
(c) Has its principal place of business in
				Maryland;
(d) Elects to offer, at a
				minimum, all full-time employees coverage in a qualified health plan through
				the SHOP Exchange; and
(e) Either:
(i) Elects to provide coverage through the
				SHOP to all eligible employees, wherever employed; or
(ii) Elects to provide coverage through the
				SHOP to all of its eligible employees who are principally employed in
				Maryland.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.18 - Small Business Health Options Program › Section 14.35.18.04 - Enrollment

Current through Register Vol. 51, No. 14, July 12, 2024
A. Rolling
				Enrollment Period. A qualified employer may purchase coverage for its small
				group at any point during the year.
B. Length of Plan Year. The employer's plan
				year shall consist of the 12-month period beginning with the qualified
				employer's effective date of coverage.
C. Effective Coverage Dates.
(1) The effective date of coverage is:
(a) No later than the first day of the
				following month for a group enrollment received on the first through the
				fifteenth day of any month; or
(b)
				No later than the first day of the second following month for a group
				enrollment received on the sixteenth though the last day of any
				month.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.18 - Small Business Health Options Program › Section 14.35.18.05 - Termination, Cancellation, and Renewal of Qualified Health Plan

Current through Register Vol. 51, No. 14, July 12, 2024
A. Termination.
(1) A qualified employer who participates in
				the SHOP and who terminates SHOP coverage terminates the enrollment of the
				employees enrolled in plans under the SHOP.
(2) An employee who is the certificate holder
				of a qualified health plan purchased through the SHOP, who terminates
				enrollment in a qualified health plan also terminates the enrollment of the
				other enrollees in the employee's household.
(3) Each enrollee who is not the certificate
				holder may terminate enrollment in a qualified health plan without affecting
				the enrollment status of the employee's household or each individual member of
				the employee's household other than the enrollee.
(4) A carrier shall process the SHOP
				Exchange's termination determination promptly and without undue
				delay.
(5) A carrier shall maintain
				records of termination of enrollment in a qualified health plan in the format
				specified by the SHOP Exchange in an electronic data interchange format for a
				period of 10 years.
(6) A carrier
				shall make reasonable accommodations for all individuals with disabilities (as
				defined by the Americans with Disabilities Act), including head-of-household
				and non-head-of-household enrollees, before terminating the individual's
				enrollment.
(7) A carrier shall
				send an electronic transaction to the SHOP Exchange documenting, or
				acknowledging, each termination of coverage carried out under this chapter,
				promptly and without undue delay.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.18 - Small Business Health Options Program › Section 14.35.18.06 - Coverage Models

Current through Register Vol. 51, No. 14, July 12, 2024
A. Employer
				Choice Model Requirements. A qualified employer may elect to make available to
				qualified employees a choice of qualified health plans offered through the SHOP
				Exchange by:
(1) A single issuer across all
				available coverage levels; or
(2)
				One or more qualified health plans offered by a single issuer.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.18 - Small Business Health Options Program › Section 14.35.18.07 - Employer Contribution

Current through Register Vol. 51, No. 14, July 12, 2024
A. An
				employer is not required to contribute to the qualified health plan premiums of
				its employees.
B. If an employer
				chooses to contribute to the qualified health plan premiums of its employees,
				the employer shall:
(1) Select a reference
				plan on which the contributions will be based; and
(2) Make a contribution that is:
(a) A fixed percentage of the premium of the
				reference plan, based on the coverage level selected by the qualified employee
				and the qualified employee 'sjob classification; or
(b) A dollar amount that ensures that all of
				the qualified employer's employees with the same coverage level and job
				classification would pay the same amount if they purchased the reference
				plan.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.18 - Small Business Health Options Program › Section 14.35.18.08 - Premium Rating

Current through Register Vol. 51, No. 14, July 12, 2024
A. Premium
				Rating.
(1) The total premium charged to a
				small group shall be developed using a per-member rating method.
(2) For each covered employee and their
				covered dependents, the premium shall be determined as follows:
(a) For each adult age 21 and over, multiply
				the base rate by the applicable age and geographic area factors; and
(b) For each covered child age 0-20, multiply
				the base rate of the oldest three children by the applicable age and geographic
				area factors.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.19 - State-Based Young Adult Health Insurance Subsidies Program › Section 14.35.19.01 - Scope

Current through Register Vol. 51, No. 14, July 12, 2024
This chapter sets forth the structure, implementation, and
				  eligibility standards for the State-Based Young Adult Health Insurance
				  Subsidies Program, as required under Insurance Article, §
									31-117 Annotated Code of
				  Maryland.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.19 - State-Based Young Adult Health Insurance Subsidies Program › Section 14.35.19.02 - 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) "Enrollee" means a qualified individual
				who is enrolled in a qualified health plan through the Individual
				Exchange.
(2) "Essential health
				benefit" has the meaning set forth in Insurance Article, §
										31-116(a),
				Annotated Code of Maryland, and
				42 U.S.C. §
											18022(b).
(3) "Federal poverty level (FPL)" means the
				most recently published federal poverty level guidelines, updated periodically
				in the Federal Register by the Secretary of HHS as set forth in
				42 U.S.C. §
											9902(2), as of the first day
				of the open enrollment period for QHPs offered through the Individual Exchange
				for a calendar year.
(4) "Program"
				means the State-Based Young Adult Health Insurance Subsidies Program.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.19 - State-Based Young Adult Health Insurance Subsidies Program › Section 14.35.19.03 - Eligibility Requirements for Subsidies Through the Program

Current through Register Vol. 51, No. 14, July 12, 2024
A. An enrollee
				is eligible to receive subsidies from the Program during a month if:
(1) The enrollee is a member of a tax filer's
				tax household and the tax filer has met the eligibility requirements for APTC
				in accordance with the requirements in COMAR
				14.35.07.08A-C,
				E, and G;
(2) The enrollee is a
				member of a tax filer's tax household and the tax filer attests to a household
				income, as defined in 26 CFR
				§
											1.36B-1(e), greater
				than or equal to 138 percent but not more than 400 percent of the FPL for the
				benefit year for which coverage is requested;
(3) The enrollee is at least 18 years old;
				and
(4) The enrollee is under the
				age of 35 years.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.19 - State-Based Young Adult Health Insurance Subsidies Program › Section 14.35.19.04 - Calculation of Subsidies Under the Program

Current through Register Vol. 51, No. 14, July 12, 2024
A. The subsidy may
				not exceed the enrollee's premium amount.
B. The subsidy shall be calculated for
				eligible enrollees in a tax household and applied to the premium for each
				eligible enrollee.
C. The subsidy
				shall be applied to the premium balance remaining after application of the
				Advance Premium Tax Credit.
D.
				Basis of Calculation.
(1) For enrollees with
				a greater than 0 percent premium contribution based on the payment parameters
				set by the Board, the subsidy shall be calculated based on, and applied only
				to, the portion of premium allocated to essential health benefits.
(2) For enrollees with a 0 percent premium
				contribution based on the payment parameters set by the Board, the subsidy
				shall also be applied to nonessential health benefits so that the enrollee's
				total premium responsibility is equal to $0.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.19 - State-Based Young Adult Health Insurance Subsidies Program › Section 14.35.19.05 - Exchange Data Collection, Reporting, and Maintenance

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Exchange shall track data on the
				Program including:
(1) On a monthly basis, or
				more frequently as required to appropriately monitor enrollment and spending
				under the program, the average number of young adults receiving subsidies under
				the Program;
(2) On a monthly
				basis, or more frequently as required to appropriately monitor enrollment and
				spending under the program, the average subsidy amount received by young adults
				under the Program; and
(3) The
				impact the Program has on rates in the individual insurance market.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.19 - State-Based Young Adult Health Insurance Subsidies Program › Section 14.35.19.06 - Disbursement of Subsidies

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				Individual Exchange shall transmit subsidies directly to the carrier with whom
				the recipient is enrolled, to be applied to the recipient's premium.
B. A carrier that receives notice from the
				Individual Exchange that an individual enrolled in the carrier's QHP is
				eligible for subsidies shall:
(1) Reduce the
				portion of the premium charged to or for the individual for the applicable
				month or months by the amount of the subsidy;
(2) Notify the Exchange of the reduction in
				the portion of the premium charged to the individual in accordance with
				45 CFR §
											156.265(g); and
(3) Include with each billing statement, as
				applicable, to or for the individual the amount of the subsidy for the
				applicable month or months, and the remaining premium owed.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.19 - State-Based Young Adult Health Insurance Subsidies Program › Section 14.35.19.07 - Document Retention and Audits

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				Carriers shall maintain documents and records, whether paper, electronic, or in
				other media, sufficient to substantiate the disbursement of subsidies made
				pursuant to Regulations .03 and .06 of this chapter for a period of at least 10
				years and shall make those documents and records available upon request by the
				Board or its designee to any such entity for purposes of verification,
				investigation, audit, or other review of subsidy disbursement.
B. The Individual Exchange or its designee
				may audit a carrier offering subsidies through the program to assess its
				compliance with the requirements of this chapter. The carrier shall ensure that
				its relevant contractors, subcontractors, or agents cooperate with any audit
				under this section. If an audit results in a finding of material weakness or
				significant deficiency with respect to compliance with any requirement of these
				regulations, the carrier shall complete all of the following:
(1) Within 30 calendar days of the issuance
				of the final audit report, provide a written corrective action plan to the
				Individual Exchange for approval;
(2) Implement the corrective action plan;
				and
(3) Provide to the Individual
				Exchange written documentation of the corrective actions once taken.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.20 - Hearings by the Board of Trustees › Section 14.35.20.01 - Scope

Current through Register Vol. 51, No. 14, July 12, 2024
A. In General.
				This chapter applies to hearings conducted by the Board of Trustees of the
				Maryland Health Benefit Exchange.
B. Determinations Entitled to Hearings. This
				chapter applies only to the appeal of an Exchange determination regarding:
(1) The amount of State-based subsidy paid by
				the Exchange to carriers pursuant to COMAR 14.35.19;
(2) Contested cases under COMAR 14.35.10 in
				which the Board has revoked delegation authority;
(3) Rehearings held pursuant to COMAR
				14.35.10.11E;
				and
(4) Any other matter in which
				the Board has the authority to conduct hearings, and the Board has determined
				that a hearing is necessary.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.20 - Hearings by the Board of Trustees › Section 14.35.20.02 - 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) "Board" means the Maryland Health Benefit
				Exchange Board of Trustees.
(2)
				"Board Secretary" means the Secretary for the 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 Exchange;
(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 Exchange, 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
				Exchange 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) "Maryland Health
				Benefit Exchange" has the meaning set forth under Insurance Article, §
										31-101(e),
				Annotated Code of Maryland.
(8)
				"Office" means the Office of Administrative Hearings.
(9) "Person" has the meaning set forth under
				COMAR 28.02.01.02B(12).
(10) "Presiding officer" means the Board
				member selected by the board to conduct, manage, and oversee the hearing and
				the administrative matters of an appeal on behalf of the Board of Trustees of
				the Maryland Health Benefit Exchange.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.20 - Hearings by the Board of Trustees › Section 14.35.20.03 - 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
				.01B of this chapter.
B. Except as
				provided in §D of this regulation, a person aggrieved may request a
				hearing by submitting a written statement to the Board Chair, 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 Board 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 14.35.20 - Hearings by the Board of Trustees › Section 14.35.20.04 - Service of Notices, Decisions, Orders, and Other Documents

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Board
				Secretary shall provide notice of a hearing pursuant to State Government
				Article, §
									10-209, Annotated
				Code of Maryland.
B. The notice
				shall state:
(1) The date, time, place, and
				nature of the hearing;
(2) The
				right to call witnesses and submit documents or other evidence under State
				Government Article, §
										10-213(f),
				Annotated Code of Maryland;
(3) Any
				applicable right to request subpoenas for witnesses and evidence and specify
				the costs, if any, associated with such a request;
(4) That a copy of the hearing procedure is
				available on request and specify the costs associated with such a
				request;
(5) Any right or
				restriction pertaining to representation;
(6) That failure to appear for the scheduled
				hearing may result in an adverse action against the party; and
(7) That, unless otherwise prohibited by law,
				the parties may agree to the evidence and waive their right to appear at the
				hearing.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.20 - Hearings by the Board of Trustees › Section 14.35.20.05 - Discovery

Current through Register Vol. 51, No. 14, July 12, 2024
A. By written
				request served on other parties and filed with the presiding officer not later
				than 30 calendar days before the scheduled hearing, a party may require any
				other party to produce, within 15 calendar days, for inspection or copying, any
				file, memorandum, correspondence, document, object, or tangible item:
(1) Relevant to the subject matter of the
				case; and
(2) Not
				privileged.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.20 - Hearings by the Board of Trustees › Section 14.35.20.06 - Subpoenas

Current through Register Vol. 51, No. 14, July 12, 2024
A. On request
				of a party, the presiding officer may issue subpoenas requiring the attendance
				and testimony of witnesses and the production, at the hearing, of any tangible
				items in the possession or under the control of a witness.
B. Subpoena Requests.
(1) A request for a subpoena shall:
(a) Be made, in writing, to the Board Chair;
				and
(b) Specify the:
(i) Name and full address of the person to be
				subpoenaed; and
(ii) Name, full
				address, and telephone number of the party requesting the subpoena.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.20 - Hearings by the Board of Trustees › Section 14.35.20.07 - Conduct of Hearing-In General

Current through Register Vol. 51, No. 14, July 12, 2024
A. A hearing
				conducted under this chapter shall be audio recorded and presided over by a
				quorum of the Board.
B. The
				presiding officer will determine whether a hearing will be open to the public,
				unless otherwise required by law.
C. Parties to Proceeding.
(1) The necessary parties to a contested case
				proceeding or other matter for which a hearing is being held are:
(a) The Exchange; and
(b) A person who requests a hearing due to
				being aggrieved by:
(i) A determination made
				by the Exchange; or
(ii) Any other
				act of or failure to act by the Exchange, involving an authorization or a
				certification issued by the Exchange.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.20 - Hearings by the Board of Trustees › Section 14.35.20.08 - Postponements

Current through Register Vol. 51, No. 14, July 12, 2024
A. At the
				discretion of the presiding officer, a hearing may be postponed if a written
				request for postponement is filed with the presiding officer not later than 15
				calendar days before the date of the hearing.
B. A hearing may not be postponed, except for
				good cause, when the request for postponement is filed within 15 calendar days
				of the date of the hearing.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.20 - Hearings by the Board of Trustees › Section 14.35.20.09 - Default Orders

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				presiding officer may issue a 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 Board, 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 14.35.20 - Hearings by the Board of Trustees › Section 14.35.20.10 - Decisions

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				presiding officer shall:
(1) Sign the final
				order following a hearing; and
(2)
				File a copy of the final order with the Exchange and serve a copy on all
				parties to the hearing.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.20 - Hearings by the Board of Trustees › Section 14.35.20.11 - 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 14.35.20 - Hearings by the Board of Trustees › Section 14.35.20.12 - Judicial Review

Current through Register Vol. 51, No. 14, July 12, 2024
A party adversely affected by a final decision of the Board
				  may obtain judicial review of the decision as provided by
				  law.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 36 - MARYLAND LONGITUDINAL DATA SYSTEM CENTER › Chapter 14.36.01 - Inspection and Copying of Public Records › Section 14.36.01.01 - Purpose

Current through Register Vol. 51, No. 14, July 12, 2024
This chapter sets forth procedures for the disclosure,
				  inspection, or copying of public records maintained by the Maryland
				  Longitudinal Data System Center The procedures for data requests by the public
				  from data maintained by the Maryland Longitudinal Data System Center are set
				  forth in COMAR 14.36.04.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 36 - MARYLAND LONGITUDINAL DATA SYSTEM CENTER › Chapter 14.36.01 - Inspection and Copying of Public Records › Section 14.36.01.02 - Policy

Current through Register Vol. 51, No. 14, July 12, 2024
It is the policy of the Maryland Longitudinal Data System
				  Center to facilitate public access to the Center's public records when access
				  is authorized by law.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 36 - MARYLAND LONGITUDINAL DATA SYSTEM CENTER › Chapter 14.36.01 - Inspection and Copying of Public Records › Section 14.36.01.03 - 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) "Act" means the Public Information Act,
				General Provisions Article, Title 4, Annotated Code of Maryland.
(2) "Applicant" has the meaning stated in
				General Provisions Article, §
										4-101(b),
				Annotated Code of Maryland.
(3)
				"Center" means the Maryland Longitudinal Data System Center, its advisory
				councils, its committees, any other public bodies under the authority and
				acting on behalf of the Maryland Longitudinal Data System Center, and any
				employees, agents, or contractors acting on behalf of the Maryland Longitudinal
				Data System Center
(4) "Custodian"
				has the meaning stated in General Provisions Article, §
										4-101(d),
				Annotated Code of Maryland.
(5)
				"Executive Director" means the Executive Director of the Maryland Longitudinal
				Data System Center
(6) "Governing
				Board" has the meaning stated in Education Article, §
										24-701, Annotated Code of
				Maryland
(7) "Official custodian"
				has the meaning stated in General Provisions Article, §
										4-101(f),
				Annotated Code of Maryland.
(8)
				"Person in interest" means:
(a) A person or
				governmental unit that is the subject of a public record;
(b) An authorized designee of the person or
				governmental unit that is the subject of a public record; or
(c) If the person has a legal disability, a
				parent or legal representative of the person that is the subject of a public
				record
(9) "Public
				record" has the meaning stated in General Provisions Article, §
										4-101(j),
				Annotated Code of Maryland.
(10)
				"Working day" means a day other than Saturday, Sunday or a State holiday or
				service reduction day.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 36 - MARYLAND LONGITUDINAL DATA SYSTEM CENTER › Chapter 14.36.01 - Inspection and Copying of Public Records › Section 14.36.01.04 - Official Custodian

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				Executive Director shall designate an official custodian of public records for
				the Center.
B. The website for the
				Center shall provide the name and contact information for the custodian of
				public records.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 36 - MARYLAND LONGITUDINAL DATA SYSTEM CENTER › Chapter 14.36.01 - Inspection and Copying of Public Records › Section 14.36.01.05 - Who May Request Public Records

Current through Register Vol. 51, No. 14, July 12, 2024
Any person may request to inspect or copy public records of
				  the Center.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 36 - MARYLAND LONGITUDINAL DATA SYSTEM CENTER › Chapter 14.36.01 - Inspection and Copying of Public Records › Section 14.36.01.06 - Necessity for Written Request

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				Inspection.
(1) Except as otherwise provided
				in this chapter, the custodian shall make public records of the Center
				available for inspection by an applicant without demanding a written request.
(2) The custodian shall require a
				written request if the custodian reasonably believes that:
(a) The Act or any other law may prohibit the
				disclosure of the public record to the applicant; or
(b) A written request will materially assist
				the Center in responding.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 36 - MARYLAND LONGITUDINAL DATA SYSTEM CENTER › Chapter 14.36.01 - Inspection and Copying of Public Records › Section 14.36.01.07 - Contents of Written Request

Current through Register Vol. 51, No. 14, July 12, 2024
A written request shall:
A. Contain the applicant's name and address;
B. Be signed by the applicant; and
C. Reasonably identify, by brief
				description, the public record sought.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 36 - MARYLAND LONGITUDINAL DATA SYSTEM CENTER › Chapter 14.36.01 - Inspection and Copying of Public Records › Section 14.36.01.08 - Addressee

Current through Register Vol. 51, No. 14, July 12, 2024
A request to inspect or copy a public record shall be
				  addressed to the custodian of the record. If the custodian is unknown, the
				  request may be addressed to the Executive Director.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 36 - MARYLAND LONGITUDINAL DATA SYSTEM CENTER › Chapter 14.36.01 - Inspection and Copying of Public Records › Section 14.36.01.09 - Response to Request

Current through Register Vol. 51, No. 14, July 12, 2024
A. If the
				custodian decides to grant a request for inspection, the custodian shall
				produce the public record for inspection, without unreasonable delay, as
				follows:
(1) Immediately for records
				designated by the Center for inspection, as set forth in §B of this
				regulation; or
(2) If additional
				time is needed to retrieve the public record and conduct any necessary review,
				within a reasonable time period, not to exceed 30 days after the date of the
				request.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 36 - MARYLAND LONGITUDINAL DATA SYSTEM CENTER › Chapter 14.36.01 - Inspection and Copying of Public Records › Section 14.36.01.10 - Notice to Person Possibly Affected by Disclosure

Current through Register Vol. 51, No. 14, July 12, 2024
A. Unless prohibited by law, the custodian
				may provide notice of a request for inspection or copying of any public record
				of the Center to any person who, in the judgment of the custodian, could be
				adversely affected by disclosure of the public record.
B. The custodian may consider the views of
				the possibly affected person before deciding whether to disclose the public
				record to an applicant.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 36 - MARYLAND LONGITUDINAL DATA SYSTEM CENTER › Chapter 14.36.01 - Inspection and Copying of Public Records › Section 14.36.01.11 - Public Record Temporarily Unavailable

Current through Register Vol. 51, No. 14, July 12, 2024
If a requested public record of the Center is in the custody
				  and control of the person to whom the application is made but is not
				  immediately available for inspection or copying, the custodian shall promptly:
A. Notify the applicant that the
				public record is not immediately available; and
B. Schedule a date within a reasonable time
				for inspection or copying.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 36 - MARYLAND LONGITUDINAL DATA SYSTEM CENTER › Chapter 14.36.01 - Inspection and Copying of Public Records › Section 14.36.01.12 - Public Record Destroyed or Lost

Current through Register Vol. 51, No. 14, July 12, 2024
If the custodian knows that a requested public record of the
				  Center has been destroyed or lost, the custodian shall promptly:
A. Notify the applicant that the public
				record is not available; and
B.
				Explain the reasons why the public record cannot be produced.