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<section article="gin" article_name="Insurance" number="31-119" title_number="31" title_name="Maryland Health Benefit Exchange" subtitle_number="1" subtitle_name="Maryland Health Benefit Exchange">
  <level label="a">
    <text>The Exchange shall be administered in a manner designed to:</text>
    <level label="1">
      <text>prevent discrimination on the basis of race, color, national origin, disability, age, sex, gender identity, or sexual orientation;</text>
    </level>
    <level label="2">
      <text>streamline enrollment and other processes to minimize expenses and achieve maximum efficiency;</text>
    </level>
    <level label="3">
      <text>prevent waste, fraud, and abuse; and</text>
    </level>
    <level label="4">
      <text>promote financial integrity.</text>
    </level>
  </level>
  <level label="b">
    <level label="1">
      <text>The Exchange shall establish a full–scale fraud, waste, and abuse detection and prevention program designed to:</text>
      <level label="i">
        <text>ensure the Exchange’s compliance with federal and State laws for the detection and prevention of fraud, waste, and abuse, including whistleblower and confidentiality protections and federal anti–kickback prohibitions; and</text>
      </level>
      <level label="ii">
        <text>promote transparency, credibility, and trust on the part of the public in the integrity of its operations.</text>
      </level>
    </level>
    <level label="2">
      <text>The fraud, waste, and abuse detection and prevention program shall:</text>
      <level label="i">
        <text>establish a framework for internal controls;</text>
      </level>
      <level label="ii">
        <text>identify control cycles;</text>
      </level>
      <level label="iii">
        <text>conduct risk assessments;</text>
      </level>
      <level label="iv">
        <text>document processes; and</text>
      </level>
      <level label="v">
        <text>implement controls.</text>
      </level>
    </level>
    <level label="3">
      <text>The Exchange:</text>
      <level label="i">
        <text>shall, in accordance with § 2–1257 of the State Government Article, submit its plan for the fraud, waste, and abuse detection and prevention program to the Senate Finance Committee and the House Health and Government Operations Committee; and</text>
      </level>
      <level label="ii">
        <text>shall allow the committees 60 days for review and comment before establishing the program.</text>
      </level>
    </level>
  </level>
  <level label="c">
    <text>The Exchange shall keep an accurate accounting of all its activities, expenditures, and receipts.</text>
  </level>
  <level label="d">
    <level label="1">
      <text>On or before December 1 of each year, the Board shall forward to the Secretary, the Governor, and, in accordance with § 2–1257 of the State Government Article, the General Assembly, a report on the activities, expenditures, and receipts of the Exchange.</text>
    </level>
    <level label="2">
      <text>The report shall:</text>
      <level label="i">
        <text>be in the standardized format required by the Secretary;</text>
      </level>
      <level label="ii">
        <text>include data regarding:</text>
        <level label="1">
          <text>health plan participation, ratings, coverage, price, quality improvement measures, and benefits;</text>
        </level>
        <level label="2">
          <text>consumer choice, participation, and satisfaction information to the extent the information is available;</text>
        </level>
        <level label="3">
          <text>financial integrity, fee assessments, and status of the Fund; and</text>
        </level>
        <level label="4">
          <text>any other appropriate metrics related to the operation of the Exchange that may be used to evaluate Exchange performance, assure transparency, and facilitate research and analysis;</text>
        </level>
      </level>
      <level label="iii">
        <text>assess and, to the extent feasible and permitted by law, include data to identify disparities related to gender, race, ethnicity, geographic location, language, disability, gender identity, sexual orientation, or other attributes of special populations; and</text>
      </level>
      <level label="iv">
        <text>include information on its fraud, waste, and abuse detection and prevention program.</text>
      </level>
    </level>
  </level>
  <level label="e">
    <level label="1">
      <text>The Board shall cooperate fully with any investigation into the affairs of the Exchange, including making available for examination the records of the Exchange, conducted by:</text>
      <level label="i">
        <text>the Secretary under the Secretary’s authority under the Affordable Care Act; and</text>
      </level>
      <level label="ii">
        <text>the Commissioner under the Commissioner’s authority under this article.</text>
      </level>
    </level>
    <level label="2">
      <text>The Commissioner may adopt regulations establishing the minimum length of time for which, and the manner in which, the Exchange is required to maintain records of insurance transactions conducted by the Exchange.</text>
    </level>
  </level>
</section>
