Annual Provider Rate Schedule Certification

BETH SAMMIS, Ph.D. Acting Commissioner KAREN STAKEM HORNIG Deputy Commissioner MARTIN O’MALLEY Governor ANTHONY G. BROWN Lt. Governor 200 St. Paul Place, Suite 2700, Baltimore, Maryland 21202 1-800-492-6116 TTY: 1-800-735-2258 www.mdinsurance.state.md.us BULLETIN 11-01 Date: January 7, 2011 To: Health Maintenance Organizations Participating in the Individual or Group Markets in Maryland Re: Annual Provider Rate Schedule Certification—COMAR 31.12.08.04D The purpose of this bulletin is to remind HMOs participating in the individual or group markets in Maryland of the annual certification that is required to be filed with the Commissioner each year. The annual certification filing does not apply to HMOs that participate only in the MCO market in Maryland. COMAR 31.12.08 was adopted as an emergency provision effective January 1, 2010, and was adopted permanently, effective March 8, 2010. This chapter requires HMOs to establish a rate schedule for each geographic area for each year beginning with January 1, 2010. The rate schedule is used for the payment for services rendered to nonparticipating providers, but is based on payments made to participating providers, as described in COMAR 31.12.08.04C. COMAR 31.12.08.04D requires an annual written certification, “not later than December 31 of each year, signed by an individual with the authority to bind the health maintenance organization that the: (1) Annual rating schedule applicable to the year in which the certification is made is, to the best of that individual’s knowledge, information, and belief, compliant with this regulation; and (2) Individual making the certification has undertaken an adequate inquiry to make the required certification.” Since the first report was due December 31, 2010 and many HMOs have failed to make the required filing, we are extending this deadline until January 31, 2011 this one time to assist in this first year of certification. The certifications should be directed to Ellen Woodall, Chief Administrator, Life/Health Section, Maryland Insurance Administration, 200 St. Paul Place, Baltimore, Maryland, 21202 or to ewoodall@mdinsurance.state.md.us. Questions about this bulletin may be directed to the Life/Health Section of the Maryland Insurance Administration at 410-468-2170. Brenda A. Wilson Associate Commissioner Life and Health Section Signature on file with original