<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".17" citation="COMAR 10.25.06.17" title_num="10" subtitle_num="25" chapter_num="06" heading="Request for an Annual Waiver or Format Modification.">
  <paragraph num="A.">
    <text>Annual Waiver Request.</text>
    <paragraph num="(1)">
      <text>When a reporting entity is not able to submit a data report as set forth in this chapter, the reporting entity shall file with the Commission by March 15 of the year for which a waiver is sought a written request for an annual waiver that shall include an explanation of why the reporting entity is not able to provide the data report, including any extraordinary circumstances.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Supporting Documentation Required for an Annual Waiver Request.</text>
      <paragraph num="(a)">
        <text>A general health benefit plan shall include an affidavit from an officer of the organization stating that its total lives covered does not exceed 1,000, as reported to the Maryland Insurance Administration.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A qualified health benefit plan, a qualified vision plan or a qualified dental plan shall include a relevant document from the Health Benefit Exchange indicating that the entity’s filing of the data is not required.</text>
      </paragraph>
      <paragraph num="(c)">
        <text>A third party administrator shall include an affidavit from an officer of the organization stating that its total lives covered does not exceed 1,000, as reported to the Maryland Insurance Administration.</text>
      </paragraph>
      <paragraph num="(d)">
        <text>A behavioral health care services organization shall include an affidavit from an officer of the organization stating that its total lives covered does not exceed 1,000, as reported to the Maryland Insurance Administration.</text>
      </paragraph>
      <paragraph num="(e)">
        <text>A pharmacy benefit manager shall include an affidavit from an officer of the organization stating that its total lives covered does not exceed 1,000.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Format Modification Request. When a reporting entity is not able to provide all the information required in Regulations .07—.14 of this chapter, the reporting entity shall file with the Commission a written request for a format modification at least 30 days before the applicable submission date that shall include:</text>
    <paragraph num="(1)">
      <text>The extraordinary circumstances surrounding the reporting entity’s inability to submit values for a specific data element;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>An explanation of each reason why a format modification is necessary; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>A detailed description of the reporting entity’s proposed layout or submission method, or both, when applicable.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>The Executive Director shall provide the reporting entity with a written decision within 30 days of the filing of a completed request.</text>
  </paragraph>
  <paragraph num="D.">
    <text>Appeal of the Executive Director’s Decision. The aggrieved party may file a written request for Commission review of the Executive Director’s written decision within 14 days of the decision.</text>
    <paragraph num="(1)">
      <text>The Commission may provide an opportunity for the reporting entity to present argument to the Commission.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The Commission may affirm, reverse, or modify the decision of the Executive Director.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The decision by the Commission shall be by a majority of the quorum present and voting.</text>
    </paragraph>
  </paragraph>
</regulation>