<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".03" citation="COMAR 10.25.06.03" title_num="10" subtitle_num="25" chapter_num="06" heading="Persons Designated to Provide Data to the Commission.">
  <paragraph num="A.">
    <text>Reporting Entities. By December 31 of each year, the Commission shall make available a list of each payor, third-party administrator, pharmacy benefit manager, and managed behavioral health care organization meeting the criteria for designation as a reporting entity and who shall file the reports under this chapter in the following year.</text>
    <paragraph num="(1)">
      <text>The Commission shall designate as a reporting entity each payor and third-party administrator whose total lives covered exceeds 1,000, as reported to the Maryland Insurance Administration.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The Commission shall designate as a reporting entity each payor offering a qualified health plan, qualified dental plan, or qualified vision plan certified by the Maryland Health Benefit Exchange, under Insurance Article, §31-115, Annotated Code of Maryland.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The Commission shall designate as a reporting entity each payor that is a managed care organization participating in the Maryland Medical Assistance Program in connection with the enrollment of an individual in the Maryland Medical Assistance Program or the Maryland Children's Health Program.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>The Commission may conduct surveys as needed to fulfill the purposes of the MCDB.</text>
      <paragraph num="(a)">
        <text>The Commission may conduct a survey of any reporting entity to determine if the reporting entity is required to report data or for other purposes consistent with this chapter.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>If necessary, the Commission may institute an annual survey to obtain information needed to determine and designate a third-party administrator whose annual covered lives report filed with the Maryland Insurance Administration does not delineate the number of covered lives for the following:</text>
        <paragraph num="(i)">
          <text>A behavioral health services plan; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>A pharmacy benefit management services plan.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(c)">
        <text>A reporting entity shall timely report information sought by the Commission in a survey.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Data Otherwise Collected by the Commission from Reporting Entities or Providers.</text>
    <paragraph num="(1)">
      <text>A reporting entity’s reports are considered submitted to the Commission if the reports are contained within the submission of another reporting entity.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>For purposes of supplementing the MCDB, the Commission may include information that the Commission has otherwise received regarding providers and services.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Data Collected from other State or Federal Agencies. The Commission designates and selects any data obtained from a state or federal agency to be a part of the MCDB for use consistent with this chapter.</text>
  </paragraph>
</regulation>