Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 4
Subtitle 25 - MARYLAND HEALTH CARE COMMISSION
Chapter 10.25.16 - Electronic Health Record Incentives
Section 10.25.16.02 - Definitions
Universal Citation: MD Code Reg 10.25.16.02
Current through Register Vol. 51, No. 19, September 20, 2024
A. In this chapter, the following terms have the meanings indicated.
B. Terms Defined.
(1) "Achieved NCQA level two recognition"
means a primary care practice has received recognition from NCQA for meeting
NCQA's 2011 or later standards for a level two patient-centered medical
home.
(2) "Attested to meaningful
use" means a physician or nurse practitioner within a primary care practice has
achieved the meaningful use requirements under either the Medicaid or Medicare
EHR Incentive Program and has received confirmation of the attestation from:
(a) The Centers for Medicare and Medicaid
Services; or
(b) The Maryland
Medical Assistance Program (Medicaid).
(3) "EHR adoption incentive" means a payment
that an eligible primary care practice can receive from a payor to assist the
primary care practice in adopting an electronic health record and attaining a
required use level that:
(a) Consists of a
one-time cash payment not to exceed $15,000 or an incentive of equivalent value
agreed upon by the primary care practice and payor; and
(b) Is based on a $25 per-patient payment
applied to the total number of patients on the practice panel who are Maryland
residents.
(4)
"Electronic health record" or "EHR" means a complete electronic record system
that is certified by an authorized testing and certification body designated by
the Office of the National Coordinator for Health Information Technology and
that contains health-related information on an individual.
(5) Fully Insured Health Benefit Plan.
(a) "Fully insured health benefit plan" means
a medical policy, contract, or certificate for which an:
(i) Employer pays a per-employee premium to a
payor and the payor assumes the risk of providing health coverage for insured
events and incurred administrative costs; or
(ii) Individual pays a premium to a
payor.
(b) "Fully
insured health benefit plan" does not include a self-insured health plan or a
health plan for which a payor is acting only as a third-party
administrator.
(6)
Health Care Provider.
(a) "Health care
provider" means a person who is licensed, certified, or otherwise authorized
under Health Occupations Article, Annotated Code of Maryland, to provide health
care services in the ordinary course of business or practice of a profession or
in an approved education or training program.
(b) "Health care provider" includes a
facility where health care is provided to patients or recipients, including:
(i) A facility, as defined in Health-General
Article, §10-101(e), Annotated Code of Maryland;
(ii) A hospital, as defined in Health-General
Article, §19-301, Annotated Code of Maryland;
(iii) A related institution, as defined in
Health-General Article, §19-301, Annotated Code of Maryland;
(iv) An outpatient clinic;
(v) A freestanding medical facility, as
defined in Health-General Article, § 19-3 A-01, Annotated Code of
Maryland;
(vi) An ambulatory
surgical facility, as defined in Health-General Article, § 19-3 B-01,
Annotated Code of Maryland; and
(vii) A nursing home, as defined in
Health-General Article, §19-1401, Annotated Code of Maryland.
(c) For purposes of this chapter,
"health care provider" does not include a health maintenance organization as
defined in Health-General Article, §19-701, Annotated Code of
Maryland.
(7)
"Implementation period" means the first 120 days after the effective date of
this chapter.
(8) "Incentive of
equivalent value" means:
(a) Specific
services;
(b) A gain-sharing
arrangement;
(c) Rewards for
quality and efficiency;
(d) In-kind
payment; or
(e) Other items or
services that can be assigned a specific monetary value.
(9) "Meaningful use" means the criteria and
requirements established by the Centers for Medicare and Medicaid Services as
detailed under 42 CFR 142, 143, 422, et al. (2010) and subsequent
regulations.
(10) "Medicare and
Medicaid EHR Incentive Programs" means the programs described at 42 CFR 412,
413, 422, and 495 (2010) and 42 CFR 412, 413, and 495 (2012), adopted by the
Centers for Medicare and Medicaid Services (CMS) to implement provisions of the
American Recovery and Reinvestment Act of 2009, the Medicare EHR Incentive
Program as administered by CMS, and the Medicaid EHR Incentive Program as
administered by Medicaid.
(11)
"MHCC" or "Commission" means the Maryland Health Care Commission.
(12) "NCQA" means the National Committee for
Quality Assurance, a health care quality accreditation, certification, and
recognition body.
(13) "NPI" or
"national provider identifier" means the unique individual identification
number issued by the National Provider System to a health care provider
typically used in administrative and financial transactions.
(14) Payor.
(a) "Payor" means a State-regulated carrier
that issues or delivers health benefit plans in the State and includes:
(i) Aetna, Inc;
(ii) CareFirst BlueCross
BlueShield;
(iii) CIGNA HealthCare
Mid-Atlantic;
(iv) Coventry Health
Care;
(v) Kaiser Permanente;
and
(vi) United Healthcare,
Mid-Atlantic Region.
(b)
"Payor" does not include a managed care organization as defined in
Health-General Article, Title 15, Subtitle 1, Annotated Code of
Maryland.
(15) "Practice
panel" means:
(a) The patients who are
Maryland residents and enrolled in a fully insured health benefit plan assigned
by a payor to a provider within a primary care practice at the time the primary
care practice requests an EHR incentive payment; or
(b) When a payor does not assign patients
enrolled in a fully insured health benefit plan to a provider within a primary
care practice, the patients who are Maryland residents and enrolled with that
payor in a fully insured health benefit plan who have been treated by the
primary care practice within the 24 months preceding a primary care practice's
request for an EHR adoption incentive payment.
(16) "Primary care practice" means a medical
practice located in the State that is composed of:
(a) One or more physicians who provide health
care in family practice, general practice, geriatric medicine, internal
medicine, pediatric medicine, or gynecologic practice and that uses one of the
following CMS specialty codes in claims submissions:
(i) Family practice (08);
(ii) General practice (01);
(iii) Geriatric medicine (38);
(iv) Internal medicine (11);
(v) Pediatric medicine (37); or
(vi) Obstetrics & Gynecology (16);
or
(b) One or more nurse
practitioners who provide health care in family practice, general practice,
geriatric medicine, internal medicine, pediatric medicine, or gynecologic
practice and that uses CMS taxonomy code in claims submissions:
(i) Adult Health (363LA2100X);
(ii) Family (363LF0000X);
(iii) Gerontology (363LG0600X);
(iv) Obstetrics & Gynecology
(363LX0001X);
(v) Pediatric
(363LP0200X);
(vi) Primary Care
(363LP2300X); or
(vii) Women's
Health (363LW0102X).
(17) "State" means the State of
Maryland.
(18) "Third-party
administrator" means a person that is registered as an administrator under
Insurance Article, Title 8, Subtitle 3, Annotated Code of Maryland.
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