Md. Code Regs. 14.35.15.03

Current through Register Vol. 51, No. 24, December 2, 2024

Section 14.35.15.03 - Carrier Conditions for Participation and Certification- Generally

A. In order to participate in the Exchanges, carriers must hold a current certificate of authorization issued by the Exchange.

B. To receive a certificate of authorization from the Exchange, carriers shall:

(1) Possess a certificate of authority to:

(a) Act as an insurer and engage in the business of health insurance under Insurance Article, Title 4, Subtitle 1, Annotated Code of Maryland;

(b) Operate a health maintenance organization under Health-General Article, § 19-707 ', Annotated Code of Maryland;

(c) Operate as a dental plan organization under Insurance Article, Title 14, Subtitle 4, Annotated Code of Maryland; or

(d) Operate as a nonprofit health service plan under Insurance Article, 14 - 108, Annotated Code of Maryland;

(2) If offering health plans, demonstrate evidence that the carrier:

(a) Is accredited by the National Committee for Quality Assurance (NCQA) or the Utilization Review Accreditation Commission (URAC); and

(b) Meets data sharing requirements with the Exchange under the federal accreditation standard at 45 CFR § 156.275(c)(5);

(3) Have a current active carrier business agreement in place, in the form designated by the Exchange;

(4) Have a current active non-Exchange entity agreement in place, in the form designated by the Exchange; and

(5) By submitting its application, agree that it will:

(a) Retain records related to participation in the Exchange for a period of 10 years after participation in the Exchange has ceased; and

(b) Allow reasonable inspection by the Exchange and, to the extent required by law, other governmental entities including HHS.

C. The carrier shall remain an authorized carrier until:

(1) The certificate of authorization expires;

(2) The Exchange suspends or revokes the authorized carrier's certification;

(3) The authorized carrier discontinues offering health benefit plans in the Exchange under Insurance Article, §§ 15 - 1212 and 15 - 1308, Annotated Code of Maryland ; or

(4) The authorized carrier loses its certificate of authority to act as a carrier in the State of Maryland

D. When an authorized carrier that offers one or more qualified plans in the Exchange merges into or is acquired by another entity and the merger or acquisition is approved by the Commissioner, the authorized carrier shall:

(1) Notify the Exchange of the change in a manner to be specified by the Exchange;

(2) Provide the legal name and Taxpayer Identification Number of the new entity and the effective date of the change at least 30 days prior to the effective date of the merger or acquisition;

(3) Be deemed to adhere to the requirements of this chapter for the remainder of the affected benefit year; and

(4) Complete any required modifications to interfaces with the Exchange without undue delay such that operations with the Exchange are not affected or interrupted.

Md. Code Regs. 14.35.15.03

Regulation .03 adopted effective 46:5 Md. R. 308, eff. 3/11/2019