reglab/statecodes huggingface dataset:
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.10 - Maryland Trauma Physician Services Fund › Section 10.25.10.14 - Appeals

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Commission's
				  executive director, or designee, shall review any appeal from an audit finding,
				  a denial, or partial denial, of an uncompensated care shortfall payment, or an
				  on-call payment.
B. To secure
				  review of an audit finding, denial, or partial denial, an applicant shall file
				  a written appeal of the denial with the Commission, together with any
				  supporting memoranda and documentation, within 15 days of the date of receipt
				  of audit finding, the denial, or the partial denial, from the Fund.
C. In reviewing an audit finding, a denial,
				  or a partial denial, of an uncompensated care shortfall payment or on-call
				  payment, the executive director, or designee, shall consider all relevant
				  factors and render a decision upon the written information, without an oral
				  hearing, in a timely fashion. The executive director, or designee, may seek and
				  consider further information from the applicant or supplementation of the
				  application, if necessary or appropriate.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.10 - Maryland Trauma Physician Services Fund › Section 10.25.10.15 - Annual Reconciliation Reporting Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. On or before January 31 of each year,
				  trauma physicians who have received uncompensated care reimbursement from the
				  Fund during the prior calendar year shall file an annual reconciliation report
				  with the Commission.
B. The annual
				  reconciliation report shall include:
(1) The
				  name, address, and telephone number of the physician, practice, or
				  center;
(2) The name, address, and
				  telephone number of the physician, practice, or center's contact person for the
				  report;
(3) The name of the trauma
				  center where care was provided;
(4)
				  The amount of money recovered from another payer source for claims that had
				  been reimbursed by the Fund, including:
(a)
				  The physician's name providing the care;
(b) The patient's name, Trauma Registry
				  number, Social Security number, dates of service, and total amount paid by the
				  Trauma Fund;
(c) The source of the
				  additional funds received;
(d) The
				  amount of the other payment received; and
(e) The amount returned to the Trauma Fund;
				  and
(5) A certification
				  by an authorized designee of the physician, practice, or center that the facts
				  stated in the annual reconciliation report are true and accurate.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.10 - Maryland Trauma Physician Services Fund › Section 10.25.10.16 - Prohibited Acts

Current through Register Vol. 51, No. 14, July 12, 2024
A. An applicant
				  for payment from the Fund may not:
(1) Make,
				  or cause to be made, a false statement or false claim; or
(2) Engage in fraud in submitting a claim or
				  application.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.10 - Maryland Trauma Physician Services Fund › Section 10.25.10.17 - Reporting Requirements to the General Assembly

Current through Register Vol. 51, No. 14, July 12, 2024
On or before November 1 of each year, the Commission and
					 the HSCRC shall report to the General Assembly in accordance with State
					 Government Article, §
										2-1246, Annotated
					 Code of Maryland, on:
A. The amount of
				  money in the Fund on the last day of the previous fiscal year;
B. The amount of payments applied for by
				  trauma physicians and trauma centers during the previous fiscal year;
C. The amount of money distributed in the
				  form of trauma physician and trauma center disbursements during the previous
				  fiscal year;
D. Any recommendations
				  for altering the manner in which trauma physicians and trauma centers are
				  reimbursed from the Fund;
E. The
				  costs incurred in administering the Fund during the previous fiscal year;
				  and
F. The physician and facility
				  costs of each trauma center and the amount that each trauma center contributes
				  toward these costs.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.10 - Maryland Trauma Physician Services Fund › Section 10.25.10.18 - Expiration of Fund

Current through Register Vol. 51, No. 14, July 12, 2024
A. This chapter
				  remains in effect unless the Fund ceases to be funded or expires by operation
				  of law.
B. In the event the Fund
				  ceases to operate, unless otherwise provided by law, the Fund shall make any
				  final disbursements for the current reporting period based upon available
				  funds.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.10 - Maryland Trauma Physician Services Fund › Section 10.25.10.19 - Effective Date

Current through Register Vol. 51, No. 14, July 12, 2024
Trauma services provided by a trauma physician to a trauma
					 patient on or after July 1, 2008, are eligible for reimbursement pursuant to
					 the provisions set forth in this chapter.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.11 - Institutional Review Board › Section 10.25.11.01 - Scope

Current through Register Vol. 51, No. 14, July 12, 2024
A. This chapter
				  provides one method by which the Commission may consider requests for encounter
				  level data from the Maryland medical care data base and any other Commission
				  data base that contains data elements that qualify as "individually
				  identifiable health information", as defined in the Health Insurance
				  Portability and Accountability Act of 1996,
				  P.L.
				  104-191(1996). The Commission may also use another
				  recognized Institutional Review Board to consider requests for encounter level
				  data from the Maryland medical care data base or any other requests for
				  Commission information that require consideration by an Institutional Review
				  Board.
B. This chapter does not
				  apply to:
(1) Requests for information from
				  the Maryland medical care data base or any other Commission data base
				  considered public under applicable laws and regulations; or
(2) Internal activities of the Commission
				  that are required for it to conduct its lawful business of assembling the
				  Maryland medical care data base, or any other data base that it is authorized
				  to create, and performing research.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.11 - Institutional Review Board › Section 10.25.11.02 - 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) "Application" means a request for
				  information made pursuant to this chapter.
(2) "Commission" means the Maryland Health
				  Care Access and Cost Commission.
(3) "Data base" means the Maryland medical
				  care data base established at Health-General Article, § 19-1507, Annotated
				  Code of Maryland.
(4) "IRB" means
				  the Institutional Review Board.
(5)
				  "Personal records" has the meaning set forth in State Government Article,
				  §10-624, Annotated Code of Maryland.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.11 - Institutional Review Board › Section 10.25.11.03 - IRB Membership

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  Commission shall appoint the IRB.
B. The IRB shall consist of at least nine
				  members of which:
(1) Each member shall have
				  expertise in health services research and information security; and
(2) At least one member's primary expertise
				  is ethics.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.11 - Institutional Review Board › Section 10.25.11.04 - IRB Review of Applications

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  IRB shall review all applications submitted pursuant to this chapter.
B. The IRB shall recommend:
(1) Approval, disapproval, or termination;
				  or
(2) Modifications in research or
				  security to secure approval.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.11 - Institutional Review Board › Section 10.25.11.05 - Criteria for Approval

Current through Register Vol. 51, No. 14, July 12, 2024
The IRB shall recommend approval of an application only
					 if:
A. It is satisfied that:
(1) The use proposed to be made of the
				  requested information is in the public interest,
(2) The risks of release of the requested
				  information are reasonable in relation to the anticipated benefits,
				  and
(3) Safeguards adequate to
				  prevent inappropriate disclosures will be implemented by the applicant;
				  and
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.11 - Institutional Review Board › Section 10.25.11.06 - Commission Review of IRB Recommendations

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Commission shall review:
(1) All IRB recommendations for approval of
				  applications; and
(2) IRB denials
				  of applications only for good cause shown by the applicant, which shall consist
				  of evidence demonstrating that the IRB failed to follow the process set forth
				  in this chapter.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.11 - Institutional Review Board › Section 10.25.11.07 - Expedited Review Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  The IRB may use an expedited review procedure to review applications relating
				  to minor changes to already approved information requests.
B. Under an expedited review procedure, the
				  review shall be carried out by:
(1) The
				  chairperson of the IRB; or
(2) An
				  IRB member designated by the chairperson.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.11 - Institutional Review Board › Section 10.25.11.08 - Suspension or Termination of IRB Approval

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Commission shall require an applicant
				  to file periodic progress reports concerning any aspect of the use of data
				  released under this chapter.
B. The
				  Commission may:
(1) Investigate use made of
				  data released under this chapter; and
(2) Require an applicant to provide
				  information necessary to assist the Commission in its investigation.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.11 - Institutional Review Board › Section 10.25.11.09 - Cooperative Research Activities

Current through Register Vol. 51, No. 14, July 12, 2024
Data release to a party with which the Commission has
					 contracted pursuant to the State procurement process may not be referred to the
					 IRB. However, other cooperative research activities involving data within the
					 scope of this chapter shall be referred to the IRB for its opinion and
					 recommendation.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.11 - Institutional Review Board › Section 10.25.11.10 - IRB Records

Current through Register Vol. 51, No. 14, July 12, 2024
A. The IRB
				  shall maintain the following records:
(1)
				  Minutes of all IRB meetings describing:
(a)
				  Time and date of the meetings;
(b)
				  Members present;
(c) Actions
				  taken;
(d) Votes on the actions
				  including the number:
(i) Voting
				  for,
(ii) Voting against,
				  and
(iii) Abstaining;
(e) The basis for requiring
				  changes in or disapproving research; and
(f) A discussion of controverted issues and
				  their resolution;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.11 - Institutional Review Board › Section 10.25.11.11 - Completion of Research Activities

Current through Register Vol. 51, No. 14, July 12, 2024
Upon completion of research conducted with data released
					 under this chapter, the applicant, at the IRB's discretion, shall:
A. Destroy or return to the Commission all
				  data and copies of data obtained from the Commission; and
B. Provide to the Commission and the IRB a
				  copy of any report, article, paper, or other document prepared by the applicant
				  with use of the released data.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.11 - Institutional Review Board › Section 10.25.11.12 - Contract Provisions and Penalties

Current through Register Vol. 51, No. 14, July 12, 2024
As a prerequisite for release of any information under this
					 chapter, the applicant shall enter into an agreement with the Commission
					 which:
A. Defines the scope of the use
				  to be made of the released information;
B. Provides for safeguards for protecting the
				  identity of data;
C. States that a
				  breach of any condition of the agreement is a breach of contract;
D. Provides for the return or destruction of
				  data upon a determination of breach of contract by the Commission;
				  and
E. Authorizes the Commission to
				  seek all other appropriate remedies for breach of contract.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.12 - Imposition of Fines › Section 10.25.12.01 - Assessment of Fines

Current through Register Vol. 51, No. 14, July 12, 2024
A. Except
				  as provided in §B of this regulation and unless the Executive Director or
				  the Executive Director's designee has granted an extension of time, a party
				  that fails to timely file a report or other information required by the
				  Commission may be liable for a monetary penalty, not to exceed $1,000 per day,
				  for each day the filing of the report is past due.
B. For information required by the Commission
				  pursuant to Health-General Article, §19-116(b), Annotated Code of
				  Maryland, and unless the Executive Director or the Executive Director's
				  designee has granted an extension of time, a party that fails to timely file a
				  report or other information required by the Commission may be liable for a
				  monetary penalty, not to exceed $100 per day, for each day the filing of the
				  report is past due.
C. A data
				  report that is substantially incomplete or inaccurate is not timely
				  filed.
D. The filing of a written
				  petition for review of a denial of an extension of time stays the accrual of
				  the monetary penalty levied under §§A and B of this
				  regulation.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.12 - Imposition of Fines › Section 10.25.12.02 - Process for Levying and Appealing an Assessment

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Executive Director shall determine the
				  amount assessed pursuant to this chapter by considering the factors set forth
				  in Regulation .03.
B. The Executive
				  Director shall issue a notice of assessment to a party found to have filed
				  untimely or inaccurate information, explaining the basis for the
				  assessment.
C. A party assessed a
				  fine has 10 business days from the date of receipt of the assessment to appeal
				  the assessment to the Commission.
D. Upon receipt of an appeal, the Chairman of
				  the Commission may:
(1) Schedule a date for
				  hearing the appeal before the full Commission; or
(2) Appoint a commissioner to act as a
				  hearing officer.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.12 - Imposition of Fines › Section 10.25.12.03 - Factors Considered in the Assessment of Penalties

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Commission shall consider the
				  following factors in determining whether to impose a fine and the amount of any
				  fine:
(1) The willfulness of the improper
				  conduct;
(2) The extent of actual
				  or potential public harm caused by the violation;
(3) The cost of auditing or investigating the
				  matter; and
(4) The party's history
				  of any previous violation.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.13 - Health Information Technology Funding Applications › Section 10.25.13.01 - Applicability

Current through Register Vol. 51, No. 14, July 12, 2024
This chapter applies to the consideration, by the Maryland
					 Health Care Commission, of an application seeking approval for funding that is
					 responsive to an announcement posted by the Maryland Health Care Commission
					 that it will accept applications regarding one or more specified areas of
					 health information technology.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.13 - Health Information Technology Funding Applications › Section 10.25.13.02 - 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) "Applicant" means a person, partnership,
				  firm, association, institution, limited liability company, limited liability
				  partnership, public or private corporation or agency, and shall include at
				  least one rate-regulated hospital, or combination of them.
(2) "Approval for funding" means a
				  determination made by the Health Services Cost Review Commission that it will
				  approve an adjustment to hospital rates based on review of an application and
				  recommendation for funding made by the Maryland Health Care Commission for an
				  activity or program proposed by an applicant.
(3) "Maryland Health Care Commission (MHCC)"
				  means the agency established by Health-General Article, Title 19, Subtitle 1,
				  Annotated Code of Maryland.
(4)
				  "Health Services Cost Review Commission (HSCRC)" means the agency established
				  by Health-General Article, Title 19, Subtitle 2, Annotated Code of
				  Maryland.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.13 - Health Information Technology Funding Applications › Section 10.25.13.03 - Notice of Acceptance of Applications for Funding for Health Information Technology Initiative

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  Maryland Health Care Commission shall inform potential applicants that it will
				  accept applications seeking approval for funding regarding one or more
				  specified areas of health information technology, by posting an announcement on
				  the MHCC website that includes, but is not limited to, the following:
A. Each specific topic to be
				  addressed;
B. Required
				  elements;
C. Application
				  deadline;
D. Application review
				  criteria;
E. Method of
				  review;
F. Available funding for
				  each application; and
G. The
				  maximum number of applications for which funding will be recommended.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.13 - Health Information Technology Funding Applications › Section 10.25.13.04 - Review of Applications

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  executive director of the Maryland Health Care Commission:
(1) Shall review each application submitted
				  pursuant to this chapter; and
(2)
				  May seek the assistance of others in the review.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.13 - Health Information Technology Funding Applications › Section 10.25.13.05 - MHCC Recommendation to the HSCRC; Action by the HSCRC

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Maryland
				  Health Care Commission shall:
(1) Determine
				  which applications merit consideration of approval for funding by the Health
				  Services Cost Review Commission; and
(2) For each application recommended for
				  consideration, send to the HSCRC appropriate information that may include the
				  following:
(a) A summary of the review
				  criteria and scoring for each recommended application; and
(b) A recommended priority order for
				  funding.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.14 - Health Care Data Collection from Maryland Health Care Practitioners › Section 10.25.14.01 - Applicability

Current through Register Vol. 51, No. 14, July 12, 2024
This chapter applies to the collection of health care data,
					 by the Maryland Health Care Commission, from health care practitioners in the
					 State.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.14 - Health Care Data Collection from Maryland Health Care Practitioners › Section 10.25.14.02 - 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) "Health care" means any care treatment,
				  or procedure by a healthcare practitioner:
(a) To diagnose, evaluate, rehabilitate,
				  manage, treat, or maintain the physical or mental condition of a patient;
				  or
(b) That affects the structure
				  or any function of the human body.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.14 - Health Care Data Collection from Maryland Health Care Practitioners › Section 10.25.14.03 - Information to be Collected

Current through Register Vol. 51, No. 14, July 12, 2024
The Commission may collect the following data from a health
					 care practitioner:
A. Data that
				  indicate the nature of the health care practice in which the health care
				  practitioner is engaged;
B. Data
				  that indicate whether the health care practitioner is actively engaged in the
				  practice of health care;
C. Data
				  that indicate whether the health care practitioner is currently engaged in
				  direct patient care in the State;
D. Data that indicate the health care
				  practitioner's primary language, race, and ethnicity;
E. Data that describe the health care
				  practitioner's areas of specialty, including:
(1) Specialty qualifications or
				  training;
(2) Specialty
				  certification, licensure, or status; and
(3) Current areas of concentration;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.14 - Health Care Data Collection from Maryland Health Care Practitioners › Section 10.25.14.04 - Confidentiality of Information Collected

Current through Register Vol. 51, No. 14, July 12, 2024
Information collected by the Commission that is required by
					 law to be held confidential may not be disclosed by the Commission to other
					 persons or entities.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.15 - Management Service Organization State Designation › Section 10.25.15.01 - Scope

Current through Register Vol. 51, No. 14, July 12, 2024
This chapter applies to the State designation of management
					 service organizations. Only a management service organization that is awarded
					 State Designation status by the Maryland Health Care Commission pursuant to
					 this chapter may represent itself as a State-Designated management service
					 organization.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.15 - Management Service Organization State Designation › Section 10.25.15.02 - 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) "Commission" or "MHCC" means the Maryland
				  Health Care Commission.
(2)
				  "Electronic health record" or "EHR" means a complete electronic record system
				  that:
(a) Contains health-related information
				  on one or more individuals; and
(b)
				  Is certified by an authorized testing and certification body designated by the
				  Office of the National Coordinator for Health Information Technology.
(3) "Entity" means an individual,
				  trust or estate, general or limited partnership, joint stock company,
				  unincorporated association or society, municipal or other corporation,
				  incorporated association, limited liability partnership, limited liability
				  company, the State, an agency or political subdivision of the State, a court,
				  and any other governmental body.
(4) "Executive Director" means the Executive
				  Director of the Commission.
(5)
				  "Management service organization" or "MSO" means an entity that provides
				  technology and consultative services to health care providers, and makes
				  available one or more hosted electronic health records systems and other health
				  information technology solutions.
(6) "MSO State Designation certificate" means
				  a certificate provided to the MSO by the Commission that documents award of
				  State Designation.
(7) "MSO State
				  Designation criteria" means the standards published by the Commission on its
				  website and by notice in the Maryland Register that an MSO must meet to qualify
				  for State Designation.
(8) "State
				  Designation" or "State-Designated" means the status awarded by the Commission
				  to an MSO that has met the MSO State Designation criteria required under this
				  chapter.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.15 - Management Service Organization State Designation › Section 10.25.15.03 - Procedure for Initial State Designation

Current through Register Vol. 51, No. 14, July 12, 2024
A.Application.
(1) An entity seeking MSO State Designation
				  shall submit an application in a form and manner specified by the
				  Commission.
(2) The application
				  shall be signed by an individual authorized by the entity submitting the
				  application.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.15 - Management Service Organization State Designation › Section 10.25.15.04 - Procedure for Renewal of State Designation

Current through Register Vol. 51, No. 14, July 12, 2024
A. An application for renewal of State
				  Designation shall:
(1) Be made at least 30
				  days before the expiration of the State Designation in a form and manner
				  specified by the Commission; and
(2) Demonstrate compliance with the MSO State
				  Designation criteria in effect at the date of application for
				  renewal.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.15 - Management Service Organization State Designation › Section 10.25.15.05 - Denial of an Initial or Renewal Application

Current through Register Vol. 51, No. 14, July 12, 2024
A. An MSO whose initial or renewal
				  application was denied may seek Commission review of the denial.
B. A written request for Commission review of
				  the denial of an application shall:.
(1) Be
				  filed within 20 days of the receipt of the denial;
(2) State with particularity the grounds and
				  factual basis for the applicant's disagreement with the denial; and
(3) Be supported by relevant documentation
				  and affidavits.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.15 - Management Service Organization State Designation › Section 10.25.15.06 - Nontransferability of Designation

Current through Register Vol. 51, No. 14, July 12, 2024
State Designation issued pursuant to this chapter may not
					 be sold, assigned, leased, or transferred in any way.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.15 - Management Service Organization State Designation › Section 10.25.15.07 - Closure, Sale, or Transfer of All or Part of a State-Designated MSO

Current through Register Vol. 51, No. 14, July 12, 2024
A. At least 60 days
				  before the closure, sale, lease, assignment, or transfer of all or part of a
				  State-Designated MSO to any person or entity that was not identified as an
				  owner of the MSO at the time of the most recent certification by the
				  Commission, the State-Designated MSO shall notify the Commission of the
				  impending closure, sale, lease, assignment, or transfer of the State-Designated
				  MSO and timely provide information required or requested by the
				  Commission.
B. If all or part of a
				  State-Designated MSO is closed, sold, leased, assigned, or transferred in any
				  person or entity that was not identified as an owner of the MSO at the time of
				  the most recent certification by the Commission, the Commission shall review
				  current State Designation status pursuant to the renewal requirements set forth
				  in Regulation .04 of this chapter.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.15 - Management Service Organization State Designation › Section 10.25.15.08 - Commission Oversight of State-Designated MSOs

Current through Register Vol. 51, No. 14, July 12, 2024
A. Commission staff may, on its own
				  initiative or in response to information provided to the Commission,
				  investigate any State-Designated MSO or applicant for State
				  Designation.
B. Following an
				  investigation, the Executive Director may issue a notice of proposed action,
				  which may include the following:
(1) A
				  time-limited opportunity to correct deficiencies identified by the
				  investigation;
(2) Suspension of
				  the State Designation of an MSO for a definite period of time after which,
				  depending upon the circumstances of the case and completion of appropriate
				  corrective actions, the MSO may seek reinstatement of its State Designation;
				  or
(3) Revocation of State
				  Designation.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.16 - Electronic Health Record Incentives › Section 10.25.16.01 - Scope

Current through Register Vol. 51, No. 14, July 12, 2024
A. This chapter
				  applies to each payor that is required to provide an incentive payment to each
				  primary care practice, including a practice owned by a hospital, that adopts
				  and reaches an approved level of use of electronic health records.
B. Only a primary care practice that meets
				  the requirements established in this chapter may receive an adoption incentive
				  for electronic health record adoption under this program.
C. Adoption incentives under this chapter are
				  available through December 31, 2018.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.16 - Electronic Health Record Incentives › Section 10.25.16.03 - Program Description

Current through Register Vol. 51, No. 14, July 12, 2024
A. An EHR
				  adoption incentive shall be available to a primary care practice that meets the
				  requirements set forth in Regulation .04 of this chapter.
B. A payor may exclude from a primary care
				  practice's EHR adoption incentive calculation the payor's patient members who
				  were previously included in another primary care practice's EHR adoption
				  incentive calculation.
C. A payor
				  may, upon notification to a primary care practice:
(1) Request additional information from a
				  primary care practice to validate the primary care practice's EHR adoption
				  incentive request; and
(2) Reduce a
				  remaining EHR adoption incentive to a primary care practice if the payor
				  determines that a duplicate payment or an overpayment has been made under this
				  chapter.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.16 - Electronic Health Record Incentives › Section 10.25.16.04 - Participation Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. To
				  be eligible for an EHR adoption incentive under this chapter, a primary care
				  practice shall:
(1) Adopt a certified
				  EHR;
(2) Complete and submit an EHR
				  adoption incentive request to each appropriate payor from which the practice
				  desires an incentive award; and
(3)
				  Demonstrate that the primary care practice has either:
(a) Attested to the current meaningful use
				  requirements under the Medicare or Medicaid EHR Incentive Program; or
(b) Participates in any MHCC approved
				  patient-centered medical home program and has achieved NCQA level two
				  recognition.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.16 - Electronic Health Record Incentives › Section 10.25.16.05 - Incentive Payment Calculation by Payor

Current through Register Vol. 51, No. 14, July 12, 2024
A. An EHR adoption incentive is calculated at
				  $25 per member, up to a maximum of $15,000, and limited to the payor's patient
				  members on the practice panel.
B.
				  Upon request by a primary care practice, a payor shall provide the practice, in
				  a timely manner, with an accounting of its EHR adoption incentive including the
				  names of each patient included in the EHR adoption incentive
				  calculation.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.16 - Electronic Health Record Incentives › Section 10.25.16.06 - Reporting

Current through Register Vol. 51, No. 14, July 12, 2024
A. A payor shall
				  submit:
(1) An annual report to the MHCC for
				  calendar years 2011-2018 no later than 90 days after the end of each calendar
				  year; and
(2) At the request of the
				  MHCC, a payor shall submit an interim report within 30 days of the Commission's
				  request.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.16 - Electronic Health Record Incentives › Section 10.25.16.07 - Incentive Program Transition

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  A payor has until the end of the implementation period to implement this
				  chapter's requirements.
B. Except
				  as provided in §E of this regulation, a primary care practice that
				  received an incentive under earlier incentive program requirements is not
				  eligible to receive an incentive under the requirements of this replacement
				  chapter.
C. A primary care practice
				  may be eligible to receive an incentive provided under the requirements of an
				  earlier EHR adoption incentive regulation if the practice, under an earlier EHR
				  adoption incentive regulation:
(1) Did not
				  receive an incentive payment; and
(2) Prior to the effective date of this
				  chapter:
(a) Submitted an incentive
				  application and payment request; or
(b) Submitted an incentive application but
				  not an incentive payment request.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.17 - Benchmarks for Preauthorization of Health Care Services › Section 10.25.17.01 - Scope

Current through Register Vol. 51, No. 14, July 12, 2024
A. This chapter
				  applies to a payor that:
(1) Requires
				  preauthorization for health care services; and
(2) Is required to report to the Maryland
				  Health Care Commission on its attainment and plans for attainment of certain
				  preauthorization benchmarks.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.17 - Benchmarks for Preauthorization of Health Care Services › Section 10.25.17.02 - 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) "Commission" means the Maryland Health
				  Care Commission.
(2) "Executive
				  Director" means the Executive Director of the Commission or the Executive
				  Director's designee.
(3) "Health
				  Care Service" has the meaning stated in Insurance Article, §15-10 A-01,
				  Annotated Code of Maryland.
(4)
				  "Payor" means one of the following State-regulated entities that require
				  preauthorization for a health care service:
(a) An insurer or nonprofit health service
				  plan that provides hospital, medical, or surgical benefits to individuals or
				  groups on an expense-incurred basis under health insurance policies or
				  contracts that are issued or delivered in the State;
(b) A health maintenance organization that
				  provides hospital, medical, or surgical benefits to individuals or groups under
				  contracts that are issued or delivered in the State; or
(c) A pharmacy benefits manager that is
				  registered with the Maryland Insurance Commissioner, except for a pharmacy
				  benefits manager that only provides services for:
(i) Workers' compensation claims pursuant to
				  Labor and Employment Article, Title 9, Annotated Code of Maryland; or
(ii) Personal injury protection
				  claims pursuant to Insurance Article, Title 19, Annotated Code of
				  Maryland.
(5)
				  "Preauthorization" means the process of obtaining approval from a payor by
				  meeting certain criteria before a certain health care service can be rendered
				  by the health care provider.
(6)
				  "Prescriber" means a health care practitioner who has the required license and,
				  if necessary, scope of practice or delegation agreement that permits the health
				  care practitioner to prescribe drugs to treat medical conditions or
				  diseases.
(7) "Step therapy or
				  fail-first protocol" is a protocol established by an insurer, a nonprofit
				  health service plan, a health maintenance organization, or a pharmacy benefits
				  manager that requires a certain prescription drug or sequence of prescription
				  drugs to be used by an insured individual or an enrollee before another
				  specific prescription drug ordered by a prescriber is covered
(8) "Supporting medical information" means:
(a) A paid claim from a payor that requires a
				  step therapy or fail-first protocol for an insured or an enrollee;
(b) A pharmacy record that documents that a
				  prescription has been filled and delivered to an insured or enrollee, or to a
				  representative of an insured or enrollee; or
(c) Other information mutually agreed to that
				  constitutes sufficient supporting medical information by an insured's or
				  enrollee's prescriber and a payor that requires a step therapy or fail-first
				  protocol
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.17 - Benchmarks for Preauthorization of Health Care Services › Section 10.25.17.03 - Benchmarks

Current through Register Vol. 51, No. 14, July 12, 2024
A. Each payor
				  shall establish and maintain online access for a provider to the following:
(1) A list of each health care service that
				  requires preauthorization by the payor; and
(2) Key criteria used by the payor for making
				  a determination on a preauthorization request.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.17 - Benchmarks for Preauthorization of Health Care Services › Section 10.25.17.04 - Reporting

Current through Register Vol. 51, No. 14, July 12, 2024
A. A payor that
				  becomes authorized to provide benefits or services within the State of Maryland
				  after October 1, 2012, shall report to the Commission in a form and manner
				  specified by the Commission on its attainment of each benchmark in Regulation
				  .03 of this chapter within 3 months of the payor's offering of services or
				  benefits within the State.
B. A
				  payor that becomes authorized to provide benefits or services within the State
				  of Maryland after October 1, 2012, shall report to the Commission in a form and
				  manner specified by the Commission on its attainments of each benchmark in
				  Regulation .03 of this chapter within 3 months of the payor's offering of
				  services or benefits within the State.
C. A payor that has been granted a waiver
				  under Regulation .05 of this chapter shall notify the Executive Director if it
				  can no longer demonstrate the extenuating circumstances for which the waiver
				  was granted within 30 days after a payor can no longer demonstrate extenuating
				  circumstances.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.17 - Benchmarks for Preauthorization of Health Care Services › Section 10.25.17.05 - Waiver from Benchmark Requirement

Current through Register Vol. 51, No. 14, July 12, 2024
A. A payor may
				  request that the Commission issue or renew a waiver from the requirement to
				  meet a benchmark in Regulation .03 of this chapter by the demonstration of the
				  following extenuating circumstances:
(1) For
				  an insurer or nonprofit health service plan, a premium volume that is less than
				  $1,000,000 annually in the State;
(2) For a group model health maintenance
				  organization, as defined in Health-General Article, §19-713.6, Annotated
				  Code of Maryland, preauthorizations of health care services requested by
				  providers not employed by the group model health maintenance organization;
				  or
(3) Other circumstances
				  determined by the Executive Director to be extenuating.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.17 - Benchmarks for Preauthorization of Health Care Services › Section 10.25.17.06 - Fines

Current through Register Vol. 51, No. 14, July 12, 2024
A payor that does not meet the reporting requirements of
					 this chapter may be assessed a fine in accordance with COMAR
					 10.25.12.01B, et
					 seq.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.18 - Health Information Exchanges: Privacy and Security of Protected Health Information › Section 10.25.18.01 - Scope and Purpose

Current through Register Vol. 51, No. 14, July 12, 2024
A. This chapter
				  addresses the privacy and security of protected health information maintained
				  by a health information exchange, or obtained or released by any person through
				  a health information exchange by adopting specific requirements:
(1) To assure the privacy and security of
				  protected health information accessed, used, or disclosed through a health
				  information exchange, including protections for the secondary use of protected
				  health information obtained, accessed, or released through a health information
				  exchange;
(2) To govern the access,
				  use, maintenance, and disclosure of protected health information through or by
				  a health information exchange;
(3)
				  To improve access to clinical records by treating clinicians; and
(4) To promote uses of a State-designated HIE
				  that will assist public health agencies in reaching public health
				  goals.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.18 - Health Information Exchanges: Privacy and Security of Protected Health Information › Section 10.25.18.02 - 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) "Adjudication of claims" means the
				  activities necessary for the adjudication or subrogation of a health benefit
				  claim that has been filed or may be filed by a patient, or with the
				  authorization of a patient on the patient's behalf, including:
(a) Determinations of eligibility or
				  coverage, including coordination of benefits or the determination of
				  cost-sharing amounts;
(b)
				  Reasonable prospective, concurrent, or retrospective utilization review or
				  predetermination of benefit coverage;
(c) Review, audit, and investigation of a
				  specific claim for payment of benefits with respect to medical necessity,
				  coverage under a health plan, appropriateness of care, or justification of
				  charges;
(d) Billing, claims
				  management, collection activities, obtaining payment under a contract for
				  reinsurance, and related health care data processing; and
(e) Risk adjustments based on enrollee health
				  status and demographic characteristics.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.18 - Health Information Exchanges: Privacy and Security of Protected Health Information › Section 10.25.18.03 - Rights of a Health Care Consumer Concerning Information Accessed, Used, or Disclosed Through an HIE

Current through Register Vol. 51, No. 14, July 12, 2024
A. A health
				  care consumer has the following rights in accordance with the requirements
				  specified in this section:
(1) The right to
				  have information regarding the health care consumer's rights under these
				  regulations readily available to assist the health care consumer in making an
				  informed decision concerning:
(a) The
				  accessibility of a patient's protected health information electronically
				  through an HIE; and
(b) The risks
				  and benefits of participating in the HIE.