Md. Code Regs. 10.25.08.02

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

Section 10.25.08.02 - Definitions

In this chapter, the following terms have the meanings indicated.

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 accordance with Insurance Article, Annotated Code of Maryland, or a health maintenance organization that holds a certificate of authority in the State.

(2) "Commission" means the Maryland Health Care Commission.

(3) Health Benefit Plan.

(a) "Health benefit plan" means a hospital or medical policy, contract, or certificate issued by a carrier.

(b) "Health benefit plan" does not include:

(i) Coverage for accident or disability income insurance;

(ii) Coverage issued as a supplement to liability insurance;

(iii) Liability insurance, including general liability insurance and automobile liability insurance;

(iv) Workers' compensation or similar insurance;

(v) Automobile or property medical payment insurance;

(vi) Credit-only insurance;

(vii) Coverage for on"site medical clinics;

(viii) Dental or vision insurance;

(ix) Long-term care insurance or benefits for nursing home care, home health care, community-based care, or any combination of these;

(x) Coverage only for a specified disease or illness;

(xi) Hospital indemnity or other fixed indemnity insurance or a hospital or medical policy, contract, or certificate issued by a carrier; or

(xii) If offered as a separate insurance policy, Medicare supplemental health insurance, as defined in § 1882(g)(1) of the Social Security Act, coverage supplemental to the coverage provided under Chapter 55 of Title 10 of the United States Code, or similar supplemental coverage provided under an employer sponsored plan.

(4) "HEDIS" means the Healthcare Effectiveness Data and Information Set published by the National Committee for Quality Assurance.

(5) "Measurement year" means the calendar year in which services take place and that precedes the reporting period in which the quality and performance measures report is submitted to the Commission or its contractor.

(6) "Performance measures report" means the report that a carrier submits to the Commission or its contractor that includes the performance measures calculated in accordance with the HEDIS and other applicable performance measure specifications.

(7) "Proprietary information" means information that would put a carrier at a competitive disadvantage if such information were disclosed.

(8) "Quality and performance evaluation system" means the process by which the Commission carries out its responsibilities related to the evaluation and reporting of quality and performance of health benefit plans.

(9) "Reporting period" means the year in which a carrier submits HEDIS and other performance measures to the Commission or its contractor and which follows the measurement year.

Md. Code Regs. 10.25.08.02