In this chapter, the following terms have the meanings indicated. Terms Defined. Annual Letter to Issuers. “Annual Letter to Issuers” means a written communication, issued by the Exchange, which should be interpreted in the same manner as the Annual Letter to Issuers that is distributed by the federally facilitated Exchange. “Annual Letter to Issuers” includes instruction on how issuers shall meet compliance with QHP certification standards, establishes timelines on implementation, details Exchange expectations of issuer compliance with such certification standards, and alerts issuers of policy developments. “Essential community provider” means: An essential community provider as defined in 45 CFR §156.235(c); A local health department; An outpatient mental health center, as described in COMAR 10.21.20, or a substance use disorder treatment provider, as described in COMAR 10.09.80.03B(1) and (3), that is licensed or approved by the State Department of Health and Mental Hygiene as a program or facility; or A school-based health center. “Similarly situated” means alike in all relevant ways.