Md. Code Regs. 31.10.22.02

Current through Register Vol. 51, No. 21, October 18, 2024

Section 31.10.22.02 - Definitions

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

B. Terms Defined.

(1) "Commissioner" means the Maryland Insurance Commissioner.

(2) "Contract" means the contractual agreement for the provision of health care services on a prepaid, capitated basis entered into between a provider-sponsored organization and the Health Care Finance Administration to provide health care benefits to medicare program beneficiaries.

(3) "Enrollee" means an individual who is enrolled in a provider-sponsored organization.

(4) Health Care Delivery Assets.

(a) "Health care delivery assets" means any tangible asset that is part of a provider-sponsored organization operation.

(b) "Health care delivery assets" includes:

(i) Hospitals, medical facilities, and their ancillary equipment; and

(ii) Property as may reasonably be required for a provider-sponsored organization's principal office or for such purposes as may be necessary in the transaction of the business of a provider-sponsored organization.

(5) "Health Care Finance Administration" means the Health Care Finance Administration of the federal Department of Health and Human Services.

(6) "Health care services" means a health or medical procedure or service rendered by a health care provider that:

(a) Provides testing, diagnosis, or treatment of a human disease or dysfunction; or

(b) Dispenses drugs, medical devices, medical appliances, or medical goods for the treatment of a human disease or dysfunction.

(7) "Insolvent" means the condition of having been:

(a) Declared as not meeting the fiscal requirements for continued licensing; or

(b) Placed under an order of liquidation by a court of competent jurisdiction.

(8) "Leasehold estate improvements" means improvements made to property that is leased by a provider-sponsored organization and used by it to provide health care services directly.

(9) "Net worth" means the excess of total admitted assets over liabilities, but the liabilities may not include fully subordinated debt.

(10) "Provider" means a physician, hospital, or other person licensed or otherwise authorized to provide health care services.

(11) "Provider-sponsored organization" has the meaning stated in Health-General Article, § 19-7 A-01(f), Annotated Code of Maryland.

(12) "Subordinated debt" means a surplus account item derived from the subordination of provider-sponsored organization debts to owners, medical providers, or other creditors.

Md. Code Regs. 31.10.22.02

Regulations .02 adopted as an emergency provision effective June 29, 1999 (26:15 Md. R. 1146); emergency status extended at 27:3 Md. R. 326; emergency status expired April 17, 2000; adopted permanently effective May 15, 2000 (27:9 Md. R. 860)