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<regulation prefix="Regulation" num=".03" citation="COMAR 10.67.03.03" title_num="10" subtitle_num="67" chapter_num="03" heading="Organization, Operations, and Financing.">
  <text>Except as provided in Regulation .02B of this chapter, an MCO applicant shall include the following information or descriptions in its application:</text>
  <paragraph num="A.">
    <text>An indication whether the applicant is an operating HMO with a certificate of authority from the Maryland Insurance Administration;</text>
  </paragraph>
  <paragraph num="B.">
    <text>A written legal history of the applicant, specific as to dates and parties involved, that includes, but is not limited to:</text>
    <paragraph num="(1)">
      <text>Predecessor corporations;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Mergers;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Reorganizations; and</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Changes of ownership;</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>A copy of the articles of incorporation of the applicant, and any amendments to it, certified by the Maryland Department of Assessments and Taxation;</text>
  </paragraph>
  <paragraph num="D.">
    <text>A copy of the applicant's current bylaws, certified by the appropriate corporate officer;</text>
  </paragraph>
  <paragraph num="E.">
    <text>A written description providing a reason if the applicant has ever defaulted on a contract or otherwise had a contract terminated;</text>
  </paragraph>
  <paragraph num="F.">
    <text>If the applicant is an HMO, the most recent annual loss ratio report provided to the Maryland Insurance Administration pursuant to Insurance Article, §5-605, Annotated Code of Maryland;</text>
  </paragraph>
  <paragraph num="G.">
    <text>A copy of the applicant's business plan provided to the Maryland Insurance Administration pursuant to Insurance Article, §5-605, Annotated Code of Maryland.</text>
  </paragraph>
  <paragraph num="H.">
    <text>Evidence of compliance with Maryland Workers' Compensation Law, as follows:</text>
    <paragraph num="(1)">
      <text>Except as provided in §H(2) of this regulation, the applicant shall submit:</text>
      <paragraph num="(a)">
        <text>The policy number of its Workers' Compensation insurance coverage; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The name of its Workers' Compensation insurance carrier; or</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>If self-insured, the applicant shall submit a certificate of compliance evidencing employee coverage under Workers' Compensation Law, as provided in Labor and Employment Article, Title 9, Annotated Code of Maryland;</text>
    </paragraph>
  </paragraph>
  <paragraph num="I.">
    <text>The names, addresses, and official capacities of the managing employees or other individuals responsible for the conduct of the affairs of the applicant, including concise position descriptions and background, citing education, training, and experience, for, but not limited to, the applicant's:</text>
    <paragraph num="(1)">
      <text>Chief Executive Officer;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Chief Medical Officer;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Chief Information Officer;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Chief Financial Officer;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Chief Quality Officer;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Clinical Operations Manager;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Chief Operating Officer;</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Marketing Director;</text>
    </paragraph>
    <paragraph num="(9)">
      <text>Program Integrity Director;</text>
    </paragraph>
    <paragraph num="(10)">
      <text>Health Equity Director;</text>
    </paragraph>
    <paragraph num="(11)">
      <text>Chief Compliance Officer;</text>
    </paragraph>
    <paragraph num="(12)">
      <text>Appeals and Grievances Manager;</text>
    </paragraph>
    <paragraph num="(13)">
      <text>Provider Relations Manager;</text>
    </paragraph>
    <paragraph num="(14)">
      <text>Special Needs Coordinator, as defined in COMAR 10.67.04.04; and</text>
    </paragraph>
    <paragraph num="(15)">
      <text>Newborn Coordinator, as defined in COMAR 10.67.04.27;</text>
    </paragraph>
  </paragraph>
  <paragraph num="J.">
    <text>A full disclosure of the extent and nature of any contracts or arrangements, including any possible conflicts of interest between the applicant and any individual specified in §I of this regulation;</text>
  </paragraph>
  <paragraph num="K.">
    <text>The name and address of each person with a 5 percent or more ownership or controlling interest in the applicant or in any subcontractor or supplier in which the applicant has direct or indirect ownership of 5 percent or more, including identifying whether any person named is related to any other named person as either spouse, parent, child, or sibling;</text>
  </paragraph>
  <paragraph num="L.">
    <text>A list of any subcontractors or suppliers owned by the applicant, indicating the percent of financial interest held;</text>
  </paragraph>
  <paragraph num="M.">
    <text>A history of any subcontractors with whom the applicant has had business transactions totaling more than $25,000 during the 12-month period ending on the date of application;</text>
  </paragraph>
  <paragraph num="N.">
    <text>A description of the applicant's corporate and organizational structure, and an organizational chart, with detailed lines of authority indicating the relationships among the board of directors, the administrative component, and the medical and health service delivery component of the applicant including, but not limited to, staff positions responsible for the plan's key management functions enumerated in §I of this regulation;</text>
  </paragraph>
  <paragraph num="O.">
    <text>A description of all current contractual relationships between the applicant and subcontractors for administrative/management, health, and marketing services, including the subcontractors' names;</text>
  </paragraph>
  <paragraph num="P.">
    <text>A description of any contracts the applicant intends to enter into before beginning operation as an MCO;</text>
  </paragraph>
  <paragraph num="Q.">
    <text>The name of any person or persons holding an ownership or controlling interest in excess of 5 percent in the applicant, or who is an agent or managing employee of the applicant, who has been subject to a conviction as defined at 42 U.S.C. §1320a-7(i), or a sanction for a Program-related offense;</text>
  </paragraph>
  <paragraph num="R.">
    <text>Copies of all standard subcontracts with service and administrative providers who are not salaried employees of the applicant, including identification of any provision in subcontracts which differ from the standard subcontract;</text>
  </paragraph>
  <paragraph num="S.">
    <text>A description of the method by which the applicant will accomplish cost avoidance or recovery in the case of third-party liability; and</text>
  </paragraph>
  <paragraph num="T.">
    <text>Copies of the applicant’s written Medicaid marketing plan including:</text>
    <paragraph num="(1)">
      <text>A description of how the applicant plans to address the special access provisions in COMAR 10.67.05.01D; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Sample version of all material and communication the applicant would like to distribute to potential enrollees, including but not limited to:</text>
      <paragraph num="(a)">
        <text>Brochures;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Fact sheets; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Posters.</text>
      </paragraph>
    </paragraph>
  </paragraph>
</regulation>