Maryland Administrative Code

.02 Hospital Evaluation — Data Collection and Reporting Requirements. A. Each hospital shall file with the Commission data on measures to be included in the Commission's comparative quality and performance evaluation system and the Health Services Cost Review Commission's quality…

.03 Summary Studies, Reports, and Compilations. A. Subject to §B of this regulation, summary studies, reports, or other compilations of data developed by the Commission from the data submitted in accordance with this chapter are public information. B. Disclosure under §A of this …

.04 Extension of Time. A. A hospital may request an extension of time of up to 30 days for submission of data required in Regulation .02 of this chapter. B. The hospital shall: (1) Submit the request to the Executive Director of the Commission not later than 30 days before the da…

.05 Penalty for Failure to File Reports. A hospital that does not timely file data may be subject to penalties described in COMAR 10.25.12.

.01 Scope and Purpose. A. This chapter addresses the requirements, parameters, administrative process, and procedures for submission, review, approval, and disapproval of requests for data from the Maryland Medical Care Data Base, any other information collected and stored in the…

.02 Definitions. A. In this chapter, the following terms have the meanings indicated. B. Terms Defined. (1) “All-payor claims database” or “APCD” means a large-scale database that systematically collects and aggregates enrollment, claims, and provider information from private and…

.03 Types of Data Available for Release. A. The types of data specified in §C of this regulation may be released to an applicant whose application has been approved in accordance with the requirements of this chapter. B. The availability of the types of data specified in §C of th…

.04 Requests for Medicaid Data. A. An application submitted to the Commission that includes a request for Medicaid data shall be referred to Medicaid for review after Commission staff has reviewed the application and determined the application to be complete in accordance with Re…

.05 Requests for Data from Governmental Entities. A. A governmental entity requesting data shall submit a written data request in the form and manner specified by the Commission that shall: (1) Be signed by the agency head or chief executive officer of a governmental entity; and …

.06 Requests for Data from Nongovernmental Entities. A. Submission of Applications. (1) An applicant shall complete and submit a written application in the form and manner specified by the Commission. (2) An applicant shall disclose on an application all potential or approved fun…

.07 Transparency of Data Request and Data Release Process. A. Except for applications submitted by governmental entities pursuant to an express state or federal statutory or regulatory mandate, all completed applications shall be published on the Commission’s website during the p…

.08 Data Release Advisory Committee. A. The Commission shall establish a Data Release Advisory Committee (DRAC) that meets the membership composition requirements and performs the review functions of a privacy board as described in 45 CFR §164.512. B. The Commission shall appoint…

.09 Data Release Advisory Committee Review. A. The following data requests are not subject to review by the DRAC: (1) Those categories of data requests and data release described in Regulation .01D(1)—(5) of this chapter; (2) Requests for data submitted by a governmental entity t…

.10 Executive Director Review and Decision on Requests for Data. A. Before making a decision on an application requesting data, the Executive Director shall: (1) Review and consider the DRAC’s written report and recommendation; (2) Review all public comment received; (3) Determin…

.11 Review of Decisions on Requests for Data. A. Request for Further Review of Decisions on Requests for Data. (1) An applicant may submit a written request for full Commission review of a written decision issued by the Executive Director or a review panel, as applicable, under R…

.12 Fees. A. The Commission may charge fees to an applicant and data recipient for: (1) Submission of an application; and (2) The cost of accessing data, which may include but is not limited to the costs of producing and releasing data to a data recipient. B. A list of fees to be…

.13 Data Use Agreement. A. An approved applicant shall enter into and sign a data use agreement prior to receipt of the requested data. If an approved applicant does not sign a data use agreement within 30 days of the date of written notification of application approval, the appl…

.14 Compliance and Enforcement. A. If a data recipient fails to comply with any of the terms and conditions of a data use agreement, or it becomes known after execution of a data use agreement that a data recipient provided false information during the application process, the Co…

.01 Scope and Purpose. These regulations establish appropriate methods for collecting and compiling Statewide data on selected health care services provided either under a Maryland contract or to Maryland residents by health care practitioners and facilities: A. From payors; B. F…

.02 Definitions. A. In this chapter, the following terms have the meanings indicated. B. Terms Defined. (1) “Adjudicated” means paid, resolved, or settled. (2) “Behavioral health care services” means procedures or services rendered by a health care practitioner for the treatment …

.03 Persons Designated to Provide Data to the Commission. A. Reporting Entities. By December 31 of each year, the Commission shall make available a list of each payor, third-party administrator, pharmacy benefit manager, and managed behavioral health care organization meeting the…

.04 Process for Submitting Data. A. The Commission shall provide each reporting entity with an annual update to the MCDB Submission Manual, and each current Manual update available, as specified in Regulation .15 of this chapter. B. Each reporting entity shall provide each of the…

.05 Time Period for Submitting Data Reports. A. Unless a different reporting time period is specified in the MCDB Submission Manual pursuant to §B of this regulation, each reporting entity shall submit to the Commission a complete set of the entity’s data for claims paid during e…

.06 Protection of Confidential Information in Submissions. A. To assure that confidential records or information are protected, each reporting entity shall encrypt each of the following data elements in such a manner that each unique value for a data element produces an identical…

.07 Professional Services Data Report Submission. A. Each reporting entity shall submit a professional services data report that provides the data for each fee-for-service and capitated encounter, including fee-for-service equivalents prices for capitated services, provided by a …

.08 Pharmacy Data Report Submission. A. Each reporting entity shall submit a pharmacy data report for each prescription drug encounter for services provided by a pharmacy located in or out of the State. This report shall include all pharmacy services provided to each Maryland res…

.09 Provider Directory Report Submission. A. Each reporting entity shall submit a provider directory report detailing each health care practitioner or supplier that provided services to any enrollee of that reporting entity during the reporting period. This report shall contain i…

.10 Institutional Services Data Report Submission. A. Each reporting entity shall submit an institutional services data report that reports all institutional health care services provided to each Maryland resident insured under a fully insured contract or self-insured contract, a…

.11 Eligibility Data Report Submission. A. Each reporting entity shall submit an eligibility data report that provides information on the characteristics of each enrollee that is a Maryland resident insured under a fully insured contract or a self-insured contract, and each enrol…

.12 Plan Benefit Design Report. Each plan benefit design report shall contain the information specified by the Commission in its annual update to the MCDB Submission Manual and be filed in a form and manner specified in the Manual.

.13 Dental Services Data Report. Each dental services data report shall contain the information specified by the Commission in its annual update to the MCDB Submission Manual and be filed in a form and manner specified in the Manual.

.14 Non-Fee-for-Service Expenses Report. Each non-fee-for-service expenses report shall contain the information specified by the Commission in its annual update to the MCDB Submission Manual and be filed in a form and manner specified in the Manual. Cross References 10.25.06.05A …

.15 Report Submission Methods. A. When a reporting entity collects more granular information than required under this chapter, the reporting entity shall provide a conversion table that describes how internal values are mapped to each required category. B. The MCDB Submission Man…

.16 Request for an Extension of Time. A. A reporting entity may request an extension of an additional 30 days time to provide the required data report. B. For a 30-day extension request to be considered by Commission staff, the reporting entity shall submit a written request to t…

.17 Request for an Annual Waiver or Format Modification. A. Annual Waiver Request. (1) When a reporting entity is not able to submit a data report as set forth in this chapter, the reporting entity shall file with the Commission by March 15 of the year for which a waiver is sough…

.18 Failure to File Data Reports. A. A reporting entity that does not timely file a data report in compliance with the MCDB Submission Manual may be subject to monetary penalties as provided in COMAR 10.25.12. B. In accordance with COMAR 10.25.12.01C, a data report that is substa…

.19 Summaries and Compilations. The Commission shall develop public-use data, summaries, and compilations for public disclosure, pursuant to Health-General Article, §§19-103(c)(3), 19-109(a)(6), and 19-134, Annotated Code of Maryland, in compliance with all applicable federal and…

.01 Scope. A. This chapter provides for the certification of electronic health networks and medical care electronic claims clearinghouses that operate in Maryland. Payors that accept electronic health care transactions originating in Maryland may only accept electronic health car…

.02 Definitions. 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 w…

.03 Duration of Certification. A certification is valid for a 2-year period from the date of certification unless withdrawn by the Commission prior to the end of the 2-year period.

.04 Procedure to Obtain Certification. A. Application for Certification. An EHN seeking Commission certification shall: (1) Complete and submit an application for MHCC Electronic Health Network Certification in the form and manner specified by the Commission; (2) Provide evidence…

.05 Standards for Certification. A. In order to obtain certification, an applicant shall: (1) Provide evidence that the applicant is accredited or certified by a qualified accreditation or certification organization; and (2) Meet the following standards for certification: (a) Dem…

.06 Candidacy Status. A. Subject to the provisions of this section, the Commission shall issue candidacy status to an applicant that: (1) Has been granted candidacy status by a qualified accreditation or certification organization; (2) Has submitted an application for certificati…

.07 Notice Required. A. Within 30 days after the closure, sale, lease, assignment, or transfer of an MHCC-certified EHN to any person or entity, the MHCC-certified EHN and the other party to the transaction shall notify the Commission of that event. Upon such notice, the Commissi…

.08 Renewal of Certification. A. Application for renewal of certification shall be made at least 60 days before the expiration of the certification in a form and manner specified by the Commission. B. A recertification fee shall be paid to the Commission at the time the MHCC Elec…

.09 Electronic Health Network Transaction Submission. A. An MHCC-certified EHN shall submit electronic health care transactions information in accordance with this regulation to the State-designated HIE for public health and clinical purposes to facilitate: (1) A State health imp…

.10 Withdrawal of Certification and Other Penalties. A. The Commission may withdraw certification from an MHCC-certified EHN if the Commission finds that: (1) The MHCC-certified EHN fails to meet the certification standards set forth in Regulation .05 of this chapter; (2) A princ…