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Maryland Code, Insurance § 31-119

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(a) The Exchange shall be administered in a manner designed to:

(1) prevent discrimination on the basis of race, color, national origin, disability, age, sex, gender identity, or sexual orientation;

(2) streamline enrollment and other processes to minimize expenses and achieve maximum efficiency;

(3) prevent waste, fraud, and abuse;  and

(4) promote financial integrity.

(b)(1) The Exchange shall establish a full-scale fraud, waste, and abuse detection and prevention program designed to:

(i) ensure the Exchange's compliance with federal and State laws for the detection and prevention of fraud, waste, and abuse, including whistleblower and confidentiality protections and federal anti-kickback prohibitions;  and

(ii) promote transparency, credibility, and trust on the part of the public in the integrity of its operations.

(2) The fraud, waste, and abuse detection and prevention program shall:

(i) establish a framework for internal controls;

(ii) identify control cycles;

(iii) conduct risk assessments;

(iv) document processes;  and

(v) implement controls.

(3) The Exchange:

(i) shall, in accordance with § 2-1257 of the State Government Article, submit its plan for the fraud, waste, and abuse detection and prevention program to the Senate Finance Committee and the House Health and Government Operations Committee;  and

(ii) shall allow the committees 60 days for review and comment before establishing the program.

(c) The Exchange shall keep an accurate accounting of all its activities, expenditures, and receipts.

(d)(1) On or before December 1 of each year, the Board shall forward to the Secretary, the Governor, and, in accordance with § 2-1257 of the State Government Article, the General Assembly, a report on the activities, expenditures, and receipts of the Exchange.

(2) The report shall:

(i) be in the standardized format required by the Secretary;

(ii) include data regarding:

1. health plan participation, ratings, coverage, price, quality improvement measures, and benefits;

2. consumer choice, participation, and satisfaction information to the extent the information is available;

3. financial integrity, fee assessments, and status of the Fund;  and

4. any other appropriate metrics related to the operation of the Exchange that may be used to evaluate Exchange performance, assure transparency, and facilitate research and analysis;

(iii) assess and, to the extent feasible and permitted by law, include data to identify disparities related to gender, race, ethnicity, geographic location, language, disability, gender identity, sexual orientation, or other attributes of special populations;  and

(iv) include information on its fraud, waste, and abuse detection and prevention program.

(e)(1) The Board shall cooperate fully with any investigation into the affairs of the Exchange, including making available for examination the records of the Exchange, conducted by:

(i) the Secretary under the Secretary's authority under the Affordable Care Act;  and

(ii) the Commissioner under the Commissioner's authority under this article.

(2) The Commissioner may adopt regulations establishing the minimum length of time for which, and the manner in which, the Exchange is required to maintain records of insurance transactions conducted by the Exchange.

Cite this article: - Maryland Code, Insurance § 31-119 - last updated December 31, 2021 |

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