Code of Maine Rules
90 - INDEPENDENT AGENCIES
590 - MAINE HEALTH DATA ORGANIZATION
Chapter 10 - DETERMINATION OF ASSESSMENTS
Section 590-10-1 - Definitions

A. Carrier. "Carrier" means an insurance company licensed in accordance with Title 24-A M.R.S.A., including a health maintenance organization, a multiple employer welfare arrangement licensed pursuant to Title 24-A M.R.S.A., chapter 81, a preferred provider organization, a fraternal benefit society, or a nonprofit hospital or medical service organization or health plan licensed pursuant to 24 M.R.S.A. An employer exempted from the applicability of 24-A M.R.S.A., chapter 56-A under the federal Employee Retirement Income Security Act of 1974, 29 United States Code, Sections 1001 to 1461(1988) is not considered a carrier.

B. Health Care Claims Processed or Paid. "Health care claims processed or paid" by third-party administrators or carriers that provide administrative services only do not include claims for specified disease, accident, injury, hospital indemnity, long term care, disability income, or other limited benefits.

C. Health Care Premiums. "Health care premiums" means the dollar amount charged for any policies offered by health insurance entities which partially or fully cover the cost of health care services but do not include policies issued for specified disease, accident, injury, hospital indemnity, long term care, disability income, or other limited benefit health insurance policies.

D. Health Care Provider. "Health care provider" is a hospital or a non-hospital health care facility. Riverview Psychiatric Center and Dorothea Dix Psychiatric Center are excluded.

E. Health Insurance Entity. "Health insurance entity" means a health insurance company, a health maintenance organization, or a nonprofit hospital or medical services organization with greater than $ 500,000 of premiums written per year in Maine that is licensed by the Maine Bureau of Insurance under Title 24-A M.R.S.A. All preferred payor organizations licensed by the Maine Bureau of Insurance under Title 24-A M.R.S.A. are excluded.

F. Hospital. "Hospital" means any acute care institution required to be licensed pursuant to 22 M.R.S.A., chapter 405.

G. MHDO. "MHDO" means the Maine Health Data Organization.

H. M.R.S.A. " M.R.S.A. " means Maine Revised Statutes Annotated.

I. Non-Hospital Health Care Facility. "Non-hospital health care facility" means a public or private, proprietary or not-for-profit entity or institution providing health services licensed or certified under Title 22 M.R.S.A., including, but not limited to, a radiological facility licensed under chapter 160, a health care facility licensed under chapter 405, an independent radiological service center, a federally qualified health center certified by the United States Department of Health and Human Services, Health Resources Service Administration, a rural health clinic, or rehabilitative agency, certified, or otherwise approved by the Division of Licensing within the Department of Health and Human Services, a home health care provider licensed under chapter 419, a residential care facility licensed under chapter 1663, a hospice provider licensed under chapter 1681, a state institution as defined under Title 34-B M.R.S.A., chapter 1 and a mental health facility licensed under Title 34-B M.R.S.A., chapter 1, and a retail store drug outlet licensed under Title 32 M.R.S.A., chapter 117.

J. Pharmacy Benefits Manager. "Pharmacy benefits manager" means an entity that performs pharmacy benefits management as defined in 24-A MRSA §1913.

K. Plan Sponsor. "Plan sponsor" means any person, other than an insurer, who establishes or maintains a plan covering residents of this State, including, but not limited to, plans established or maintained by 2 or more employers or jointly by one or more employers and one or more employee organizations, the association, committee, joint board of trustees or other similar group of representatives of the parties that establish or maintain the plan.

L. Retail Store Drug Outlet. "Retail store drug outlet" means any pharmacy located in a retail store in this state which is engaged in dispensing, delivering, or distributing prescription drugs.

M. Third-Party Administrator. "Third-party administrator" means any person licensed by the Maine Bureau of Insurance under Title 24-A M.R.S.A., chapter 18 who, on behalf of a plan sponsor, health care service plan, nonprofit hospital or medical service organization, health maintenance organization or insurer, receives or collects charges, contributions or premiums for, or adjusts or settles claims on residents of this State that in aggregate exceeds $500,000 per year in Maine.

N. Total Net Patient Service Revenue. "Total net patient service revenue" means gross charges for patient services less contractual adjustments, charity care and bad debt costs as provided in the standardized accounting templates submitted in accordance the requirements of 90-590 CMR, Chapter 300: Uniform Reporting System for Hospital Financial Data.