<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".03" citation="COMAR 14.35.15.03" title_num="14" subtitle_num="35" chapter_num="15" heading="Carrier Conditions for Participation and Certification — Generally.">
  <paragraph num="A.">
    <text>In order to participate in the Exchanges, carriers must hold a current certificate of authorization issued by the Exchange.</text>
  </paragraph>
  <paragraph num="B.">
    <text>To receive a certificate of authorization from the Exchange, carriers shall:</text>
    <paragraph num="(1)">
      <text>Possess a certificate of authority to:</text>
      <paragraph num="(a)">
        <text>Act as an insurer and engage in the business of health insurance under Insurance Article, Title 4, Subtitle 1, Annotated Code of Maryland;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Operate a health maintenance organization under Health-General Article, §19-707, Annotated Code of Maryland;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Operate as a dental plan organization under Insurance Article, Title 14, Subtitle 4, Annotated Code of Maryland; or</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Operate as a nonprofit health service plan under Insurance Article, §14-108, Annotated Code of Maryland;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>If offering health plans, demonstrate evidence that the carrier:</text>
      <paragraph num="(a)">
        <text>Is accredited by the National Committee for Quality Assurance (NCQA) or the Utilization Review Accreditation Commission (URAC); and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Meets data sharing requirements with the Exchange under the federal accreditation standard at 45 CFR §156.275(c)(5);</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>Have a current active carrier business agreement in place, in the form designated by the Exchange;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Have a current active non-Exchange entity agreement in place, in the form designated by the Exchange; and</text>
    </paragraph>
    <paragraph num="(5)">
      <text>By submitting its application, agree that it will:</text>
      <paragraph num="(a)">
        <text>Retain records related to participation in the Exchange for a period of 10 years after participation in the Exchange has ceased; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Allow reasonable inspection by the Exchange and, to the extent required by law, other governmental entities including HHS.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>The carrier shall remain an authorized carrier until:</text>
    <paragraph num="(1)">
      <text>The certificate of authorization expires;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The Exchange suspends or revokes the authorized carrier’s certification;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The authorized carrier discontinues offering health benefit plans in the Exchange under Insurance Article, §§15-1212 and 15-1308, Annotated Code of Maryland; or</text>
    </paragraph>
    <paragraph num="(4)">
      <text>The authorized carrier loses its certificate of authority to act as a carrier in the State of Maryland.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>When an authorized carrier that offers one or more qualified plans in the Exchange merges into or is acquired by another entity and the merger or acquisition is approved by the Commissioner, the authorized carrier shall:</text>
    <paragraph num="(1)">
      <text>Notify the Exchange of the change in a manner to be specified by the Exchange;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Provide the legal name and Taxpayer Identification Number of the new entity and the effective date of the change at least 30 days prior to the effective date of the merger or acquisition;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Be deemed to adhere to the requirements of this chapter for the remainder of the affected benefit year; and</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Complete any required modifications to interfaces with the Exchange without undue delay such that operations with the Exchange are not affected or interrupted.</text>
    </paragraph>
  </paragraph>
</regulation>