Maryland Administrative Code

.03 Notice of Acceptance of Applications for Funding for Health Information Technology Initiative. 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 i…

.04 Review of Applications. 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. B. The executive director shall forward the results of the …

.05 MHCC Recommendation to the HSCRC; Action by the HSCRC. 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 consid…

.01 Applicability. This chapter applies to the collection of health care data, by the Maryland Health Care Commission, from health care practitioners in the State.

.02 Definitions. 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 menta…

.03 Information to be Collected. 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 practitione…

.04 Confidentiality of Information Collected. 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.

.01 Scope. 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…

.02 Definitions. 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 healt…

.03 Procedure for Initial State Designation. 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 appl…

.04 Procedure for Renewal of State Designation. 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 Stat…

.05 Denial of an Initial or Renewal Application. 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 th…

.06 Nontransferability of Designation. State Designation issued pursuant to this chapter may not be sold, assigned, leased, or transferred in any way.

.07 Closure, Sale, or Transfer of All or Part of a State-Designated MSO. 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…

.08 Commission Oversight of State-Designated MSOs. 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 Direct…

.01 Scope. 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 practic…

.02 Definitions. A. In this chapter, the following terms have the meanings indicated. B. Terms Defined. (1) “Achieved NCQA level two recognition” means a primary care practice has received recognition from NCQA for meeting NCQA’s 2011 or later standards for a level two patient-ce…

.03 Program Description. 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 patien…

.04 Participation Requirements. 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 inc…

.05 Incentive Payment Calculation by Payor. 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, …

.06 Reporting. 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…

.07 Incentive Program Transition. 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…

.01 Scope. A. This chapter applies to: (1) A payor that requires preauthorization or step therapy for health care services; and (2) A health care provider. B. This chapter does not apply to a pharmacy benefits manager that only provides services for: (1) Workers’ compensation cla…

.02 Definitions. A. In this chapter, the following terms have the meanings indicated. B. Terms Defined. (1) “Carrier” has the meaning stated in Insurance Article, §15-1301, Annotated Code of Maryland. (2) “Commission” means the Maryland Health Care Commission. (3) “Executive Dire…

.03 Online Process Requirements. A. A 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 preau…

.04 Reporting. A. If requested by the Commission, a payor shall demonstrate continued compliance with the preauthorization requirements in Regulation .03 of this chapter. B. A payor that has been granted a waiver under Regulation .05 of this chapter shall notify the Executive Dir…

.05 Payor Waiver from Requirement. A. A payor may request that the Commission issue or renew a waiver from the requirement to meet a preauthorization requirement in Regulation .03 of this chapter by the demonstration of the following extenuating circumstances: (1) For an insurer …

.06 Provider Requirements and Waiver. A. On or before July 1, 2026, a health care provider shall ensure that each e-Prescribing system or electronic health record system owned or contracted for by the health care provider to maintain a health record of an insured or enrollee has …

.07 Fines. A. A payor that becomes authorized to provide services within the State after the effective date of a requirement in this chapter shall meet each requirement within this chapter within 3 months of offering services. B. A person that fails to meet a requirement of this …

.01 Scope and Purpose. 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 …

.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 Rights of a Health Care Consumer Concerning Information Accessed, Used, or Disclosed Through an HIE. 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 c…

.04 Access, Use, or Disclosure of Sensitive Health Information. A. Consistency with Disclosure Requirements Under Federal and State Law. (1) A person shall comply with all relevant State and federal laws, including 42 CFR Part 2, and Health-General Article, §4-302.5, Annotated Co…

.05 Requirements for Accessing, Using, or Disclosing Health Information Through an HIE. A. As a requirement of participation in an HIE, the HIE shall require each participating organization to enter into a binding participation agreement that: (1) Requires the participating organ…

.06 Auditing Requirements. A. In order to ensure that only an authorized user who is appropriately authenticated is granted access to HIE information, an HIE shall: (1) Develop and implement protocols, methodologies, and a monitoring approach designed to discover any unusual find…

.07 Remedial Actions to Be Taken by an HIE. A. An HIE shall immediately suspend a person's access to the HIE when it is necessary to avoid serious harm to the privacy or security of health information accessed, used, or disclosed through or from the HIE. (1) An HIE may, in its so…

.08 Notice of Breach and non-HIPAA Violation. A. Notification of a breach shall be required consistent with notification requirements of applicable federal and State laws, including HIPAA and the HITECH Act. B. When federal or State law does not require an HIE or other entity to …

.09 Registration and Enforcement. A. To operate an HIE in the State, a person shall be recognized by the Commission as having met requirements for registration. (1) A person shall complete an application for registration in a form and manner specified by the Commission that shall…

.10 Requirements for Accessing, Using, or Disclosing of Data Through an HIE for Secondary Use. A. An HIE may not use or disclose a patient’s sensitive health information for secondary use unless permitted by applicable federal or State laws and regulations. B. Population Health M…

.11 Requirements for Accessing, Using, or Disclosing of Data Through an HIE in an Emergency. A. An HIE shall develop and implement emergency access policies and procedures that satisfy the following requirements: (1) The policies and procedures shall be included in the HIEs healt…

.12 Requirements for Providing Health Care Consumers Electronic Access to Their Health Information. A. An HIE or its third party that offers health care consumers electronic access to view, download, transmit, submit, or control their health information shall: (1) Appropriately v…

.13 Noncontrolled Prescription Drugs Dispenser Reporting. A. For each noncontrolled prescription drug dispensed, the dispenser shall report drug information to the State-designated HIE in accordance with this regulation. B. MHCC Noncontrolled Prescription Drugs Dispenser Data Sub…

.14 Operation of the State-designated HIE as a Health Data Utility. A. The State-designated HIE shall operate as a health data utility for the State. B. The State-designated HIE shall implement a consent management application in accordance with Regulation .03D of this chapter. C…

.01 Scope. This chapter applies to the State Recognition of an electronic advance directives service. Only an electronic advance directives service that is awarded State Recognition status by the Maryland Health Care Commission pursuant to this chapter may represent itself as a S…

.02 Definitions. A. In this chapter, the following terms have the meanings indicated. B. Terms Defined. (1) “Advance Care Planning” means a process through which an individual considers and documents in a formal manner the individual’s preferences for the receipt of health care, …

.03 Criteria for State Recognition of an Electronic Advance Directives Service. A. The Commission will assess the application of an electronic advance directives service for State Recognition in accordance with criteria approved by the Commission in accordance with the process se…

.04 Procedure for Initial State Recognition. A. Application. (1) An electronic advance directives service seeking State Recognition shall submit an application in the form and manner specified by the Commission. (2) The application, and all information supplementing the applicati…