Code of Maine Rules
90 - INDEPENDENT AGENCIES
590 - MAINE HEALTH DATA ORGANIZATION
Chapter 100 - ENFORCEMENT PROCEDURES
Section 590-100-2 - DEFINITIONS

A. Carrier. "Carrier" means an insurance company licensed in accordance with 24-A M.R.S., including a health maintenance organization, a multiple employer welfare arrangement licensed pursuant to Title 24-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. An employer exempted from the applicability of 24-A M.R.S., 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. Entity. "Entity" means an assessed, commercial, educational, or non-profit entity as defined by the MHDO Prices for Data Sets, Fees for Programming and Report Generation, and Duplication Rates Rule (90-590 C.M.R. Chapter 50).

C. Health care facility. "Health care facility" means a public or private, proprietary or not-for-profit entity or institution providing health services including, but not limited to an independent radiological services center licensed under 22 M.R.S., chapter 160, a health care facility licensed under 22 M.R.S., chapter 405 or certified under chapter 405-D, a rural health clinic certified by the Division of Licensing and Certification within the Department of Human Services, a home health care provider licensed under 22 M.R.S., chapter 419, a hospice provider licensed under 22 M.R.S., chapter 1681, a community rehabilitation program licensed under 20-A M.R.S., chapter 701, a state institution as defined under 34-B M.R.S., chapter 1 and a mental health facility licensed under 34-B M.R.S., chapter 1.

D. Health care practitioner. "Health care practitioner" means physicians and all others certified, registered or licensed in the healing arts, including but not limited to, nurses, podiatrists, optometrists, chiropractors, physical therapists, dentists, psychologists and physicians' assistants as defined in 24 M.R.S., chapter 21. "Health care practitioner" also includes licensed clinical social workers as defined in 32 M.R.S., chapter 83 and marriage and family therapists and licensed clinical professional counselors as defined in 32 M.R.S., chapter 119.

E. Health care provider. "Health care provider" means a health care facility, health care practitioner, health product manufacturer, health product vendor or pharmacy.

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

G. Manufacturer. "Manufacturer" means an entity that manufactures or repackages, and sets the wholesale acquisition cost for, prescription drugs that are distributed in the State.

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

I. M.R.S. "M.R.S." means Maine Revised Statutes.

J. Parent entity. "Parent entity" means the organization or corporation that has control, directly or indirectly through majority ownership, affiliation, contract or membership of a hospital and/or any affiliated health care facility. A parent entity may be an individual hospital or, as a parent of a health care facility, considered a health care facility.

K. Payor. "Payor" means a third-party payor or third-party administrator.

L. Person. "Person" means an individual, trust, estate, partnership, corporation including associations, joint stock companies and insurance companies, the State or any political subdivision or instrumentality, including a municipal corporation of the State, or any other legal entity recognized by State law.

M. Pharmacy Benefits Manager (PBM). "Pharmacy benefits manager (PBM)" means an entity that performs pharmacy benefits management, as defined in 24-A M.R.S. §4347, sub-section 17.

N. Third-party administrator. "Third-party administrator" means any person 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.

O. Third-party payor. "Third-party payor" means a health insurance carrier, nonprofit hospital, medical services organization, or managed care organization licensed in the State of Maine. "Third-party payor" does not include carriers licensed to issue limited benefit health policies or accident, specified disease, vision, disability, long-term care or nursing home care policies.

P. Wholesale drug distributor. "Wholesale drug distributor" means an entity that