5. Voluntary File Submissions Any self-funded employee benefit plan by ERISA may voluntarily submit completed healthcare data sets for Maine residents. The MHDO shall collect such data sets in accordance with the provisions of this chapter for uniform reporting system for health care claims data sets. Any such data shall be subject to the same laws as other MHDO data. 5 6. Public Access Information collected, processed and/or analyzed under this rule shall be subject to release to the public or retained as confidential information in accordance with 22 M.R.S.A. Chapter 1683 and 90-590, Chapter 120, unless prohibited by state or federal law. Code of Maine Rules 6 7. Extensions or Waivers to Data Submission Requirements If a health care claims processor due to circumstances beyond its control is temporarily unable to meet the terms and conditions of this Chapter, a written request must be made to the Compliance Officer of the MHDO as soon as it is practicable after the health care claims processor has determined that an extension or waiver is required. The written request shall include: the specific requirement to be extended or waived; an explanation of the cause; the methodology proposed to eliminate the necessity of the extension or waiver; and the time frame required to come into compliance. If the Compliance Officer does not approve the requested extension or waiver, the health claims processor making the request may submit a written request appealing the decision to the MHDO Board. The appeal shall be heard by the MHDO Board at the next regularly scheduled meeting following receipt of the request at the MHDO. 7 8. Compliance The failure to file, report, or correct health care claims data sets when required in accordance with the provisions of this Chapter may be considered a violation under 22 M.R.S.A. Sec. 8705-A and Code of Maine Rules 90-590, Chapter 100: Enforcement Procedures. STATUTORY AUTHORITY: 22 M.R.S.A. §§ 8703(1), 8704(4), 8708(6-A) and 8712(2) EFFECTIVE DATE: July 29, 2002 AMENDED: June 2, 2003 filing 2003-173 – NON-SUBSTANTIVE CORRECTIONS: September 8, 2003 formatting only – AMENDED:
5. Voluntary File Submissions Any self-funded employee benefit plan by ERISA may voluntarily submit completed healthcare data sets for Maine residents. The MHDO shall collect such data sets in accordance with the provisions of this chapter for uniform reporting system for health care claims data sets. Any such data shall be subject to the same laws as other MHDO data. 5 6. Public Access Information collected, processed and/or analyzed under this rule shall be subject to release to the public or retained as confidential information in accordance with 22 M.R.S.A. Chapter 1683 and Code of Maine Rules 90-590, Chapter 120, unless prohibited by state or federal law. 6 7. Extensions or Waivers to Data Submission Requirements If a health care claims processor due to circumstances beyond its control is temporarily unable to meet the terms and conditions of this Chapter, a written request must be made to the Compliance Officer of the MHDO as soon as it is practicable after the health care claims processor has determined that an extension or waiver is required. The written request shall include: the specific requirement to be extended or waived; an explanation of the cause; the methodology proposed to eliminate the necessity of the extension or waiver; and the time frame required to come into compliance. If the Compliance Officer does not approve the requested extension or waiver, the health claims processor making the request may submit a written request appealing the decision to the MHDO Board. The appeal shall be heard by the MHDO Board at the next regularly scheduled meeting following receipt of the request at the MHDO. 7 8. Compliance The failure to file, report, or correct health care claims data sets when required in accordance with the provisions of this Chapter may be considered a violation under 22 M.R.S.A. Sec. 8705-A and Code of Maine Rules 90-590, Chapter 100: Enforcement Procedures. STATUTORY AUTHORITY: 22 M.R.S.A. §§ 8703(1), 8704(4), 8708(6-A) and 8712(2) EFFECTIVE DATE: July 29, 2002 AMENDED: June 2, 2003 – filing 2003-173 NON-SUBSTANTIVE CORRECTIONS: September 8, 2003 – formatting only AMENDED:
Chapter%20243_Proposed%20Rule_V4_12_15_16%20AAG%20edits.docx