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<chapter num="42" heading="Continuity of Health Care Notice" title_num="31" subtitle_num="10">
  <regulation prefix="Regulation" num=".01" heading="Scope.">
    <text>This chapter applies to each:</text>
    <paragraph num="A.">
      <text>Receiving carrier that issues or delivers individual or group health benefit plans in Maryland; and</text>
    </paragraph>
    <paragraph num="B.">
      <text>Receiving managed care organization that enrolls Program recipients in Maryland.</text>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".02" heading="Definitions.">
    <paragraph num="A.">
      <text>In this chapter, the following terms have the meanings indicated.</text>
    </paragraph>
    <paragraph num="B.">
      <text>Terms Defined.</text>
      <paragraph num="(1)">
        <text>“Carrier” means:</text>
        <paragraph num="(a)">
          <text>An insurer authorized to sell health insurance;</text>
        </paragraph>
        <paragraph num="(b)">
          <text>A nonprofit health service plan;</text>
        </paragraph>
        <paragraph num="(c)">
          <text>A health maintenance organization;</text>
        </paragraph>
        <paragraph num="(d)">
          <text>A dental plan organization; or</text>
        </paragraph>
        <paragraph num="(e)">
          <text>Any other entity providing a plan of health insurance, health benefits, or health services authorized under the Insurance Article of the Annotated Code of Maryland or the Affordable Care Act.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(2)">
        <text>“Enrollee” means a:</text>
        <paragraph num="(a)">
          <text>Person entitled to health care benefits from a carrier; or</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Program recipient who is enrolled in a managed care organization.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(3)">
        <text>“Health benefit plan” has the meaning stated in Insurance Article, §15-140, Annotated Code of Maryland.</text>
      </paragraph>
      <paragraph num="(4)">
        <text>“Managed care organization” means:</text>
        <paragraph num="(a)">
          <text>A certified health maintenance organization that is authorized to receive medical assistance prepaid capitation payments;</text>
        </paragraph>
        <paragraph num="(b)">
          <text>A corporation that:</text>
          <paragraph num="(i)">
            <text>Is a managed care system that is authorized to receive medical assistance prepaid capitation payments;</text>
          </paragraph>
          <paragraph num="(ii)">
            <text>Enrolls only Program recipients or individuals or families served under the Maryland Children’s Health Program; and</text>
          </paragraph>
          <paragraph num="(iii)">
            <text>Is subject to the requirements of Health-General Article, §15-102.4, Annotated Code of Maryland.; or</text>
          </paragraph>
        </paragraph>
        <paragraph num="(c)">
          <text>A prepaid dental plan that receives fees to manage dental services.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(5)">
        <text>“Program recipient” means an individual who receives benefits under the Maryland Medical Assistance Program.</text>
      </paragraph>
      <paragraph num="(6)">
        <text>“Receiving carrier” means the carrier that issues the new health benefit plan when an enrollee transitions from another carrier or a managed care organization.</text>
      </paragraph>
      <paragraph num="(7)">
        <text>“Receiving managed care organization” means the managed care organization that accepts the enrollee when the enrollee transitions from another managed care organization or a carrier.</text>
      </paragraph>
      <paragraph num="(8)">
        <text>“Relinquishing carrier” means a carrier that issued the prior health benefit plan when an enrollee transitions to a new carrier or a managed care organization.</text>
      </paragraph>
      <paragraph num="(9)">
        <text>“Relinquishing managed care organization” means a managed care organization in which an enrollee had been enrolled prior to the enrollee’s transition to a new managed care organization or a carrier.</text>
      </paragraph>
      <paragraph num="(10)">
        <text>“Transitioning enrollee” means an enrollee:</text>
        <paragraph num="(a)">
          <text>Who has an effective date of coverage with a receiving carrier or a receiving managed care organization on or after January 1, 2015, under a contract that is issued or renewed on or after January 1, 2015; and</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Whose coverage under the receiving carrier or receiving managed care organization began within 1 month of the date coverage terminated under the:</text>
          <paragraph num="(i)">
            <text>Health benefit plan with a relinquishing carrier; or</text>
          </paragraph>
          <paragraph num="(ii)">
            <text>Relinquishing managed care organization.</text>
          </paragraph>
        </paragraph>
      </paragraph>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".03" heading="Requirement to Provide Continuity of Health Care Notice.">
    <paragraph num="A.">
      <text>A receiving carrier shall send a transitioning enrollee the Continuity of Health Care Notice set forth in Regulation .04A of this chapter:</text>
      <paragraph num="(1)">
        <text>Except as provided in §A(2) of this regulation, within 30 days of the enrollee’s effective date of coverage; and</text>
      </paragraph>
      <paragraph num="(2)">
        <text>If the enrollee’s coverage is made effective retroactively, within 30 days of the date the receiving carrier is notified of the enrollment.</text>
      </paragraph>
    </paragraph>
    <paragraph num="B.">
      <text>A receiving managed care organization shall send a transitioning enrollee the Continuity of Health Care Notice set forth in Regulation .04B of this chapter:</text>
      <paragraph num="(1)">
        <text>Except as provided in §B(2) of this regulation, within 30 days of the enrollee’s effective date of coverage; and</text>
      </paragraph>
      <paragraph num="(2)">
        <text>If the enrollee’s coverage is made effective retroactively, within 30 days of the date the receiving managed care organization is notified of the enrollment.</text>
      </paragraph>
    </paragraph>
    <paragraph num="C.">
      <text>The Continuity of Health Care Notices shall be in the language and format described in Regulation .04 of this chapter in not less than 12-point type.</text>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".04" heading="Continuity of Health Care Notice.">
    <paragraph num="A.">
      <text>The following form is to be used by receiving carriers as the Continuity of Health Care Notice required by Regulation .03A of this chapter.</text>
    </paragraph>
    <paragraph num="B.">
      <text>The following form is to be used by receiving managed care organizations as the Continuity of Health Care Notice required by Regulation .03B of this chapter.</text>
    </paragraph>
  </regulation>
  <annotations>
    <annotation type="Authority">Insurance Article, §§2-109(a)(1), 15-140, and 15-10D-01, Annotated Code of Maryland and Ch. 159, §3, Acts of 2013</annotation>
    <annotation type="History" subtype="Administrative History">Effective date:</annotation>
    <annotation type="History" subtype="Administrative History">Regulations .01—.04 adopted as an emergency provision effective January 1, 2015 (42:1 Md. R. 16); adopted permanently effective April 27, 2015 (42:8 Md. R. 608)</annotation>
  </annotations>
</chapter>