Maryland Administrative Code

.02 Definitions. A. In this chapter, the following terms have the meanings indicated. B. Terms Defined. (1) “Carrier” means an insurer or nonprofit health service plan that holds a certificate of authority and provides health insurance policies or contracts in the State in accord…

.03 Health Benefit Plan Quality and Performance Evaluation System — Implementation. A. Carrier Participation. (1) Each carrier may participate in the health benefit plan quality and performance evaluation system. (2) Each carrier that meets the criteria of Regulation .01B of this…

.04 Audits. A. In order to verify the validity, reliability, and comparability of HEDIS and other performance measures required by the Commission, a carrier shall participate in certified audits as specified by the Commission, which may include: (1) A process audit; (2) One or mo…

.05 Extension of Time. A. A carrier may request an extension of not more than 30 days for submission of the performance measures report. B. A request for an extension of time shall: (1) Be submitted to the Executive Director of the Commission not later than 30 days before the car…

.06 Penalty for Failure to File Reports. A carrier that is required to participate under Regulation .01B of this chapter and that does not timely file a performance measures report may be subject to the penalties provided in COMAR 10.25.12.

.01 Scope. A. This chapter applies to a third-party payer operating in the State of Maryland, as of July 1, 1997, whose premium volume exceeds $1,000,000 as reported in the most recent annual statement in the hands of the Maryland Insurance Administration as of December 1 of each…

.02 Definitions. A. In this chapter, the following terms have the meanings indicated. B. Terms Defined. (1) “Adjudication” means paid, resolved, or settled. (2) “Commission” or “MHCC” means the Maryland Health Care Commission. (3) “HIPAA” means the Health Insurance Portability an…

.03 EHN Designation. A. Payers shall only contract with MHCC-certified EHNs for the exchange of electronic health care transactions that originate in Maryland. B. In the event that a designated EHN loses its MHCC-certified status, the Commission shall provide written notice to th…

.04 Designation Requirements. The payer and its designated EHNs shall enter into a written agreement that shall address at minimum each of the following: A. Transaction format specifications; B. Transmission methods to be used; C. Schedules of events, such as transmission cutoffs…

.05 EDI Progress Report. A. On or before June 30 of each year, each payer shall submit to the Commission an EDI Progress Report Form, describing certain electronic health care transaction activity for the payer's previous calendar year as described in this regulation. B. This rep…

.06 Waiver or Exception Request. A. A payer may submit a written request for waiver or exception of the reporting requirements. B. The payer shall: (1) Submit a written request for a waiver or exception to the Deputy Director not later than 30 days before the due date of meeting …

.07 Extension of Time. A. A payer may request an extension of time of up to 60 days for submission of the EDI information. B. The payer shall: (1) Submit the request in writing to the Deputy Director for Data Systems and Analysis not later than 30 days before the reporting deadli…

.08 Penalties for Failure to File a Report. A. Unless the Deputy Director has granted an extension of time, a payer that does not timely file a report is liable for a monetary penalty of $1,000 per day for each day the filing of the report is delayed. B. A report that is substant…

.09 Penalties for Failure to Contract with a MHCC-Certified EHN. A. Unless the Deputy Director has granted an extension of time, a payer that does not contract with an MHCC-Certified EHN within 60 days of notification by MHCC that the EHN is not certified, is liable for a monetar…

.01 Scope. A. This chapter applies to trauma physicians, trauma health care practitioners, and Maryland Institute for Emergency Medical Services Systems designated trauma centers, Specialty Referral Centers, and rehabilitation hospitals that are affiliated with Maryland Institute…

.02 Definitions. A. In this chapter, the following terms have the meanings indicated. B. Terms Defined. (1) “Applicant” means a person or entity eligible to file a claim to receive reimbursement from the Fund. (2) “Commission” means the Maryland Health Care Commission. (3) “Facul…

.03 Fund Administration. A. The Fund is a special, nonlapsing interest bearing fund that is not subject to State Finance and Procurement Article, §7-302, Annotated Code of Maryland. B. The purpose of the Fund is to subsidize the documented costs: (1) Of uncompensated care incurre…

.04 Source of Fund Revenue. A. The Fund consists of motor vehicle registration surcharges paid into the Fund in accordance with Transportation Article, §§13-954(b), and 21-902, Annotated Code of Maryland, and regulations promulgated under that authority, and any other money trans…

.05 Who May Request Payment. A. A trauma physician or trauma health care practitioner as defined in Regulation .02 of this chapter may request payment under this chapter. B. Medicaid and Uncompensated Care Reimbursement. (1) Trauma Practitioner Services. A faculty practice plan, …

.06 Payments for Medicaid Trauma Patients. A. A trauma physician or trauma health care practitioner: (1) Is eligible for payment from the Fund for trauma services provided to a Medicaid trauma patient on the Maryland Trauma Registry on or after July 1, 2024; and (2) May seek reim…

.07 Payments for Uncompensated Care Patients. A. A trauma physician or trauma health care practitioner: (1) Is eligible for payment from the Fund for trauma services provided to uncompensated trauma care patients with an admission date on the Maryland Trauma Registry beginning on…

.08 On-Call Payment. A. Eligibility. The Fund will reimburse trauma centers' on-call costs to maintain surgeons on-call in conformance with MIEMSS' regulations at COMAR 30.08.05 — 30.08.14 for the minimum number of trauma physicians required to be on-call. Trauma centers are elig…

.09 Payment for Costs at a Pediatric Center. A. The pediatric trauma centers listed below shall be eligible for an annual grant of up to $900,000 for documented expenses related to the provision of trauma care to Maryland residents: (1) Johns Hopkins Children’s Center; and (2) Ch…

.10 Trauma Grants. A. Eligibility. (1) The Commission, in consultation with the Health Services Cost Review Commission and the Maryland Institute for Emergency Medical Services Systems, shall develop a process for the award of grants to Level I, Level II and Level III trauma cent…

.11 Equitable Payment Under the Fund. A. Disbursement from the Fund is subject to the availability of funds. B. The Commission shall adjust reimbursement formulas used for Medicaid trauma services, uncompensated care trauma services, on-call payments, and standby payments to a pe…

.12 Filing of On-call Applications and Uncompensated Care Claims. A. In order to receive a payment from the Fund for uncompensated care, a faculty practice plan, a physician practice, a trauma physician, a trauma health care practitioner, or a trauma center on behalf of a trauma …

.13 Audits. A. The Commission, or its designee, may audit to verify the information submitted by faculty practice plans, physician practices, trauma physicians, trauma health care practitioners, and trauma centers applying for grants or reimbursement from the Fund. B. The Commiss…

.14 Appeals. 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, an on-call payment or grant award. B. To secure review of an audit finding, denial, or partial…

.15 Annual Reconciliation Reporting Requirements. A. On or before January 31 of each year, a trauma physician or trauma health care practitioner who has received uncompensated care reimbursement from the Fund during the prior calendar year shall file an annual reconciliation repo…

.16 Prohibited Acts. 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. B. Violation of §A of this regulation may result in: (1) Referral to the appropria…

.17 Reporting Requirements to the General Assembly. On or before November 1 of each year, the Commission and the HSCRC shall report to the General Assembly in accordance with Health-General Article, §19-130(f) and State Government Article, §2-1246, Annotated Code of Maryland.

.18 Expiration of Fund. 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…

.19 Effective Date. Trauma services provided by a trauma health care practitioner to a trauma patient on or after July 1, 2024, are eligible for reimbursement pursuant to the provisions set forth in this chapter.

.01 Scope. 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 informat…

.02 Definitions. 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” mea…

.03 IRB Membership. 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. C. The IR…

.04 IRB Review of Applications. 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. C. The IRB shall meet as necessary …

.05 Criteria for Approval. 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…

.06 Commission Review of IRB Recommendations. 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 faile…

.07 Expedited Review Procedures. 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;…

.08 Suspension or Termination of IRB Approval. 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;…

.09 Cooperative Research Activities. 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 …

.10 IRB Records. 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) A…

.11 Completion of Research Activities. 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 th…

.12 Contract Provisions and Penalties. 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 fo…

.01 Assessment of Fines. 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 liabl…

.02 Process for Levying and Appealing an Assessment. 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 hav…