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<regulation prefix="Regulation" num=".03" citation="COMAR 31.10.51.03" title_num="31" subtitle_num="10" chapter_num="51" heading="Definitions.">
  <paragraph num="A.">
    <text>In this chapter, the following terms have the meaning indicated.</text>
  </paragraph>
  <paragraph num="B.">
    <text>Terms Defined.</text>
    <paragraph num="(1)">
      <text>“Analysis report” means the report required by Insurance Article, §15-144(c)(2), Annotated Code of Maryland.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>“As written” means the written policies, procedures, and related documents, including medical necessity criteria or guidelines, used in the development and description of a NQTL and the decision whether to apply a NQTL to a particular benefit by the carrier or any entity delegated by the carrier to manage mental health, substance use disorder, or medical/surgical benefits on behalf of the carrier.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>“Evidentiary standards” has the meaning stated in 45 C.F.R. §146.136(a).</text>
    </paragraph>
    <paragraph num="(4)">
      <text>“Factor” has the meaning stated in 45 C.F.R. §146.136(a).</text>
    </paragraph>
    <paragraph num="(5)">
      <text>“In operation” means as used in the implementation and application of NQTLs, including the administration of benefits.</text>
    </paragraph>
    <paragraph num="(6)">
      <text>“Medical/surgical benefits” has the meaning stated in Insurance Article, §15-144(a)(4), Annotated Code of Maryland, and may be abbreviated as “med/surg benefits” or “M/S benefits”.</text>
    </paragraph>
    <paragraph num="(7)">
      <text>“Medical Necessity” means medical necessity as determined by the definition, criteria, or guidelines used by the carrier or its private review agent to determine what is necessary, efficient, or appropriate for purposes of coverage of a service or benefit. Insurance Article, §15-802, Annotated Code of Maryland, requires use of the criteria published by the American Society of Addiction Medicine for the evaluation of the medical necessity, efficiency, or appropriateness of services to treat a substance use disorder.</text>
    </paragraph>
    <paragraph num="(8)">
      <text>“Mental health benefits” has the meaning stated in Insurance Article, §15-144(a)(5), Annotated Code of Maryland.</text>
    </paragraph>
    <paragraph num="(9)">
      <text>“MH/SUD” means mental health benefits and substance use disorder benefits as a combined category.</text>
    </paragraph>
    <paragraph num="(10)">
      <text>“NQTL” means a nonquantitative treatment limitation as defined in Insurance Article, §15-144(a)(6), Annotated Code of Maryland.</text>
    </paragraph>
    <paragraph num="(11)">
      <text>“Parity Act” has the meaning stated in Insurance Article, §15-144(a)(7), Annotated Code of Maryland.</text>
    </paragraph>
    <paragraph num="(12)">
      <text>“Parity Act classification” has the meaning stated in Insurance Article, §15-144(a)(8), Annotated Code of Maryland.</text>
    </paragraph>
    <paragraph num="(13)">
      <text>“Process” has the meaning stated in 45 C.F.R. §146.136(a).</text>
    </paragraph>
    <paragraph num="(14)">
      <text>“Product” has the meaning stated in Insurance Article, §15-1309(a)(3), Annotated Code of Maryland.</text>
    </paragraph>
    <paragraph num="(15)">
      <text>“Provider” means:</text>
      <paragraph num="(a)">
        <text>A physician;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Hospital;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Facility;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Practitioner; or</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Other person who is licensed or otherwise authorized to provide healthcare services.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(16)">
      <text>“Source” means the data, analyses, recommendation, requirement, meeting, or other information upon which a factor is based or from which a factor is derived or arises.</text>
    </paragraph>
    <paragraph num="(17)">
      <text>“Strategy” has the meaning stated in 45 C.F.R. §146.136(a).</text>
    </paragraph>
    <paragraph num="(18)">
      <text>“Substance use disorder benefits” has the meaning stated in Insurance Article, §15-144(a)(9), Annotated Code of Maryland.</text>
    </paragraph>
    <paragraph num="(19)">
      <text>“Summary form” means the form required by Insurance Article, §15-144(g)(5), Annotated Code of Maryland.</text>
    </paragraph>
  </paragraph>
</regulation>