Md. Code Regs. 14.35.11.02

Current through Register Vol. 51, No. 24, December 2, 2024

Section 14.35.11.02 - Definitions

A. In this chapter, the following terms have the meanings indicated

B. Terms Defined.

(1) "Administrative law judge" means an individual appointed by the Chief Administrative Law Judge under State Government Article, § 9-1604, Annotated Code of Maryland, or designated by the Chief Administrative Law Judge under State Government Article, § 9-1607, Annotated Code of Maryland, to adjudicate contested cases at the Maryland Office of Administrative Hearings.

(2) "Affordable Care Act" means the Patient Protection and Affordable Care Act of 2010 (Pub.L. 111-148), as amended by the Health Care and Education Reconciliation Act of 2010 (Pub.L. 111-152), as amended by the Three Percent Withholding Repeal and Job Creation Act (Pub.L. 112-56).

(3) "Appellant" means any individual who requests a fair hearing for the reasons specified in Regulation .03 of this chapter or that individual's authorized representative, whether regarding an initial determination or a redetermination.

(4) "Authorized representative" has the same meaning as in Regulation .14 of this chapter

(5) "Catastrophic plan" means a plan established under § 1302(e) of the Affordable Care Act

(6) "Consolidated Services Center" means the call center operated by the Maryland Health Benefit Exchange to assist consumers who apply for, or participate in, a qualified health plan or the insurance affordability programs offered through the Maryland Health Connection.

(7) "Delegate agency" means the Department of Human Resources and its affiliate local departments which, under contractual agreements with the Department, determine initial and continuing eligibility in the Program.

(8) "Department" means the Department of Health and Mental Hygiene, the single State agency which, pursuant to Title XIX of the Social Security Act, implements fair hearing requirements for Program applicants and recipients.

(9) "Individual Exchange " has the meaning stated in Insurance Article, § 31-101(h), Annotated Code of Maryland

(10) "Insurance affordability program" means a program that is one of the following:

(a) The Maryland State Medicaid program;

(b) The Maryland Children's Health Insurance Program (CHIP), including the program known as Maryland Children's Health Program (MCHP) Premium;

(c) A State basic health program established under § 1331 of the Affordable Care Act;

(d) A program that makes available to eligible individuals coverage in a qualified health plan through the Maryland Health Benefit Exchange with advance payments of the premium tax credit established under § 36B of the Internal Revenue Code;

(e) A program that makes available to eligible individuals coverage in a qualified health plan through the Maryland Health Benefit Exchange with cost-sharing reductions established under § 1402 of the Affordable Care Act; or

(f) The State-Based Young Adult Health Insurance Subsidies Program established under Insurance Article, § 31-122, Annotated Code of Maryland.

(11) "MAGI" means modified adjusted gross income, as calculated for purposes of determining or redetermining eligibility for insurance affordability programs under the Affordable Care Act, as defined in 26 CFR § 1.36 B- 1(e)(2).

(12) "Maryland Health Benefit Exchange" or "Exchange" means the unit of State government that determines initial and continuing eligibility for the MAGI-based insurance affordability programs, including, by delegation, certain eligibility in the Program.

(13) "Maryland Health Connection" means the electronic eligibility system maintained by the Maryland Health Benefit Exchange.

(14) "Program" means the Department's Medical Assistance Program.

(15) Qualified Health Plan.

(a) "Qualified health plan" means a health benefit plan that has been certified by the Maryland Health Benefit Exchange to meet the criteria for certification described in § 1311(c) of the Affordable Care Act and Insurance Article, §31-115, Annotated Code of Maryland.

(b) "Qualified health plan" includes a catastrophic plan.

Md. Code Regs. 14.35.11.02

Regulation .02 adopted effective 42:11 Md. R. 726, eff.6/8/2015; amended effective 48:24 Md. R.1025, eff. 11/29/2021