Md. Code Regs. 10.25.06.03

Current through Register Vol. 51, No. 22, November 1, 2024

Section 10.25.06.03 - 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 criteria for designation as a reporting entity and who shall file the reports under this chapter in the following year.

(1) The Commission shall designate as a reporting entity each payor and third-party administrator whose total lives covered exceeds 1,000, as reported to the Maryland Insurance Administration.

(2) The Commission shall designate as a reporting entity each payor offering a qualified health plan, qualified dental plan, or qualified vision plan certified by the Maryland Health Benefit Exchange, under Insurance Article, §31-115, Annotated Code of Maryland.

(3) The Commission shall designate as a reporting entity each payor that is a managed care organization participating in the Maryland Medical Assistance Program in connection with the enrollment of an individual in the Maryland Medical Assistance Program or the Maryland Children's Health Program.

(4) The Commission may conduct surveys as needed to fulfill the purposes of the MCDB.

(a) The Commission may conduct a survey of any reporting entity to determine if the reporting entity is required to report data or for other purposes consistent with this chapter.

(b) If necessary, the Commission may institute an annual survey to obtain information needed to determine and designate a third-party administrator whose annual covered lives report filed with the Maryland Insurance Administration does not delineate the number of covered lives for the following:

(i) A behavioral health services plan; or

(ii) A pharmacy benefit management services plan.

(c) A reporting entity shall timely report information sought by the Commission in a survey.

B. Data Otherwise Collected by the Commission from Reporting Entities or Providers.

(1) A reporting entity's reports are considered submitted to the Commission if the reports are contained within the submission of another reporting entity.

(2) For purposes of supplementing the MCDB, the Commission may include information that the Commission has otherwise received regarding providers and services.

C. Data Collected from other State or Federal Agencies. The Commission designates and selects any data obtained from a state or federal agency to be a part of the MCDB for use consistent with this chapter.

Md. Code Regs. 10.25.06.03

Regulations .03 adopted effective August 21, 2000 (27:16 Md. R. 1525)
Regulations .03 adopted effective April 19, 2010 (37:8 Md. R. 617)
Regulations .03 adopted as an emergency provision effective January 9, 2014 (41:3 Md. R. 200); adopted permanently effective 41:5 Md. R. 344, eff.3/17/2014 ; amended effective 48:21 Md. R. 889, eff. 10/18/2021