Skip to Main Content
<< Back | Return to Main COMAR Search Page

8 records match your request.

FileAbstract
10.25.17.00.htm 10.25.17.00. Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 25 MARYLAND HEALTH CARE COMMISSION Chapter 17 Benchmarks for Preauthorization of Health Care Services Authority: Health-General Article, §19-101 and 19-108.2, Annotated Code of Maryland
10.25.17.01.htm 10.25.17.01. 01 Scope.. 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 (Commission) on or before certain dates on its attainment and plans for attainment of certain preauthorization benchmarks.B. This chapter does not apply to a pharmacy benefits manager that only provides services for workers’ compensation claims pursuant to Labor and Employment Article, §9-101, et
10.25.17.02.htm 10.25.17.02. 02 Definitions.. 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, §15-10A-01, Annotated Code of Maryland.4) “Payor” means one of the following State-regulated entities that require preauthorization for a h
10.25.17.03.htm 10.25.17.03. 03 Benchmarks.. 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.. B. Each payor shall establish and maintain an online process for:. 1) Accepting electronically a preauthorization request from a provider; and. 2) Assigning to a preauthorization request a uniqu
10.25.17.04.htm 10.25.17.04. 04 Reporting.. A. On or before August 1, 2015, a payor that requires a step therapy or fail-first protocol shall report to the Commission in a form and manner specified by the Commission on its attainment of the benchmark in Regulation .03D of this chapter.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
10.25.17.05.htm 10.25.17.05. 05 Waiver from Benchmark Requirement.. 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 extenuating circumstances, including: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 Mary
10.25.17.06.htm 10.25.17.06. 06 Fines.. A payor that does not meet the reporting requirements of this chapter may be assessed a fine in accordance with COMAR 10.25.12.01, et seq.
10.25.17.9999.htm 10.25.17.9999. Administrative History Effective date: February 18, 2013 (40:3 Md. R. 218). Regulation .02B amended effective October 12, 2015 (42:20 Md. R. 1265). Regulation .03 amended effective October 12, 2015 (42:20 Md. R. 1265). Regulation .04 amended effective October 12, 2015 (42:20 Md. R. 1265). Regulation .05 amended effective October 12, 2015 (42:20 Md. R. 1265).
<< Back | Return to Main COMAR Search Page