(a) Subject to any limitations under this subtitle or other applicable law, the Board shall have all powers necessary or convenient to carry out the functions authorized by the Affordable Care Act and consistent with the purposes of the Exchange. (b) The enumeration of specific powers in this subtitle is not intended to restrict the Board's power to take any lawful action that the Board determines is necessary or convenient to carry out the functions authorized by the Affordable Care Act and consistent with the purposes of the Exchange. (c) (1) In addition to the powers set forth elsewhere in this subtitle, the Board may: (i) adopt and alter an official seal; (ii) sue, be sued, plead, and be impleaded; (iii) adopt bylaws, rules, and policies; (iv) subject to paragraph (2) of this subsection, adopt regulations to carry out this subtitle: 1. in accordance with Title 10, Subtitle 1 of the State Government Article; and 2. without conflicting with or preventing application of regulations adopted by the Secretary under Title 1, Subtitle D of the Affordable Care Act; (v) maintain an office at the place designated by the Board; (vi) enter into any agreements or contracts and execute the instruments necessary or convenient to manage its own affairs and carry out the purposes of this subtitle; (vii) apply for and receive grants, contracts, or other public or private funding; and (viii) do all things necessary or convenient to carry out the powers granted by this subtitle. (2) Unless waived by the chairs of the committees, at least 30 days before submitting any proposed regulation to the Maryland Register for publication, the Board shall submit the proposed regulation to the Senate Finance Committee and the House Health and Government Operations Committee. (d) (1) To carry out the purposes of this subtitle or perform any of its functions under this subtitle, the Board may contract or enter into memoranda of understanding with eligible entities, including: (i) the Maryland Medical Assistance Program; (ii) the family investment unit of the Department of Human Services; (iii) insurance producers and third party administrators registered in the State; and (iv) any other entities that have experience in individual and small group public and private health insurance plans or facilitating enrollment in those plans. (2) The operations of the Exchange are subject to the provisions of this subtitle whether the operations are performed directly by the Exchange or through an entity under a contract with the Exchange. (3) The Board shall ensure that any entity under a contract with the Exchange complies with the provisions of this subtitle when performing services that are subject to this subtitle on behalf of the Exchange. (e) (1) The Board may enter into information-sharing agreements with federal and state agencies, and other state health insurance exchanges, to carry out the provisions of this subtitle. (2) An information-sharing agreement entered into under paragraph (1) of this subsection shall: (i) include adequate protections with respect to the confidentiality of information; and (ii) comply with all State and federal laws and regulations. (f) (1) The Board, in accordance with Title 12, Subtitle 4 of the State Finance and Procurement Article, shall adopt written policies and procedures governing all procurements of the Exchange. (2) To the fullest extent practicable, and in a manner that does not impair the Exchange's ability to carry out the purposes of this subtitle, the Board's procurement policies and procedures shall establish an open and transparent process that: (i) promotes public confidence in the procurements of the Exchange; (ii) ensures fair and equitable treatment of all persons and entities that participate in the procurement system of the Exchange; (iii) fosters appropriate competition and provides safeguards for maintaining a procurement system of quality and integrity; (iv) promotes increased economic efficiency and responsibility on the part of the Exchange; (v) achieves the maximum benefit from the purchasing power of the Exchange; and (vi) provides clarity and simplicity in the rules and procedures governing the procurements of the Exchange. (g) (1) To carry out the purposes of this subtitle, the Board shall: (i) create and consult with ad hoc advisory committees; and (ii) appoint to the ad hoc advisory committees representatives of: 1. insurers or health maintenance organizations offering health benefit plans in the State; 2. nonprofit health service plans offering health benefit plans in the State; 3. licensed health insurance producers and advisers; 4. third-party administrators; 5. health care providers, including: A. hospitals; B. long-term care facilities; C. mental health providers; D. developmental disability providers; E. substance abuse treatment providers; F. Federally Qualified Health Centers; G. physicians; H. nurses; I. experts in services and care coordination for criminal and juvenile justice populations; J. licensed hospice providers; and K. other health care professionals; 6. managed care organizations; 7. employers, including large, small, and minority- owned employers; 8. public employee unions, including public employee union members who are caseworkers in local departments of social services with direct knowledge of information technology systems used for Medicaid eligibility determination; 9. consumers, including individuals who: A. reside in lower-income and racial or ethnic minority communities; B. have chronic diseases or disabilities; or C. belong to other hard-to-reach or special populations; 10. individuals with knowledge and expertise in advocacy for consumers described in item 9 of this item; 11. public health researchers and other academic experts with knowledge and background relevant to the functions and goals of the Exchange, including knowledge of the health needs and health disparities among the State's diverse communities; and 12. any other stakeholders identified by the Exchange as having knowledge or representing interests relevant to the functions and duties of the Exchange. (2) In addition to the ad hoc advisory committees created under paragraph (1) of this subsection, the Board, on or before March 15, 2014, shall create a standing advisory committee that: (i) consists of members who, to the extent practicable: 1. reflect the gender, racial, ethnic, and geographic diversity of the State; 2. constitute a diverse cross-section of stakeholders broadly representative of the individuals and entities described in paragraph (1)(ii) of this subsection; and 3. are appointed by the Board for a term of no more than 3 years in a manner that provides continuity and rotation; (ii) has a liaison to the Board who is a member of the Board and is appointed by the chair of the Board; and (iii) is charged with the responsibility of addressing the broad range of policy issues: 1. on which the Board may seek its input and advice; and 2. that may be proposed by the liaison to the Board, in consultation with the standing advisory committee chair and members. §31-107. ** CONTINGENCY - IN EFFECT - CHAPTER 468 OF 2025 ** (a) There is a Maryland Health Benefit Exchange Fund. (b) (1) The purpose of the Fund is to: (i) provide funding for the operation and administration of the Exchange in carrying out the purposes of the Exchange under this subtitle; (ii) provide funding for the establishment and operation of the State Reinsurance Program authorized under this subtitle; (iii) provide funding for the Medical Assistance Program and the Senior Prescription Drug Assistance Program; (iv) provide funding for the establishment and operation of Health Equity Resource Communities under Title 20, Subtitle 14 of the Health - General Article; (v) provide funding for the establishment and operation of the State-Based Young Adult Health Insurance Subsidies Program authorized under this subtitle; and (vi) provide funding for the establishment of State-based health insurance subsidies to mitigate the impact of a reduction in federal advance premium tax credits under 26 U.S.C. § 36B(b)(3)(A)(iii). (2) The operation and administration of the Exchange, the State Reinsurance Program, the State-Based Young Adult Health Insurance Subsidies Program, and the Qualified Resident Enrollment Program may include functions delegated by the Exchange to a third party under law or by contract. (c) The Exchange shall administer the Fund. (d) (1) The Fund is a special, nonlapsing fund that is not subject to § 7- 302 of the State Finance and Procurement Article. (2) The State Treasurer shall hold the Fund separately, and the Comptroller shall account for the Fund. (e) The Fund consists of: (1) any user fees or other assessments collected by the Exchange; (2) all revenue deposited into the Fund that is received from the distribution of the premium tax under § 6-103.2 of this article; (3) income from investments made on behalf of the Fund; (4) interest on deposits or investments of money in the Fund; (5) money collected by the Board as a result of legal or other actions taken by the Board on behalf of the Exchange or the Fund; (6) money donated to the Fund; (7) money awarded to the Fund through grants; (8) any pass-through funds received from the federal government under a waiver approved under § 1332 of the Affordable Care Act; (9) any funds designated by the federal government to provide reinsurance to carriers that offer individual health benefit plans in the State; (10) any funds designated by the State to provide reinsurance to carriers that offer individual health benefit plans in the State; (11) any funds designated by the State to provide State-based health insurance subsidies to young adults in the State; (12) any funds designated by the State to provide State-based health insurance subsidies to individuals in the State to mitigate the impact of a reduction in federal advance premium tax credits under 26 U.S.C. § 36B(b)(3)(A)(iii); (13) any federal funds received in accordance with § 31-121 of this subtitle for the administration of small business tax credits; and (14) any other money from any other source accepted for the benefit of the Fund. (f) (1) The Fund may be used only: (i) 1. for the operation and administration of the Exchange in carrying out the purposes authorized under this subtitle; 2. for the establishment and operation of the State Reinsurance Program; and 3. for appropriations to the Health Equity Resource Community Reserve Fund under § 20-1407 of the Health - General Article; (ii) in fiscal years 2021 and 2022, for the Medical Assistance Program within the Medical Care Programs Administration of the Maryland Department of Health; (iii) in fiscal year 2022, for the Senior Prescription Drug Assistance Program established under Title 15, Subtitle 10 of the Health - General Article; (iv) for the establishment and operation of the State-Based Young Adult Health Insurance Subsidies Program; and (v) in fiscal years 2026 through 2028, for the establishment of State-based health insurance subsidies to mitigate the impact of a reduction in federal advance premium tax credits under 26 U.S.C. § 36B(b)(3)(A)(iii). (2) In each of fiscal years 2023 through 2025, the Governor shall: (i) transfer $15,000,000 to the Health Equity Resource Community Reserve Fund; and (ii) include the funds transferred in accordance with item (i) of this paragraph in the annual budget bill as an appropriation to the Health Equity Resource Community Reserve Fund under § 20-1407 of the Health - General Article. (g) (1) The Board shall maintain separate accounts within the Fund for Exchange operations, for the State Reinsurance Program, and for the State-Based Young Adult Health Insurance Subsidies Program. (2) Accounts within the Fund shall contain the money that is intended to support the purpose for which each account is designated. (3) Funds received from the distribution of the premium tax under § 6-103.2 of this article shall be placed in the account for Exchange operations and may be used only for the purpose of funding the operation and administration of the Exchange. (4) The following funds may be used only for the purposes of funding the State Reinsurance Program: (i) any pass-through funds received from the federal government under a waiver approved under § 1332 of the Affordable Care Act to provide reinsurance to carriers that offer individual health benefit plans in the State; (ii) any funds designated by the federal government to provide reinsurance to carriers that offer individual health benefit plans in the State; and (iii) any funds designated by the State to provide reinsurance to carriers that offer individual health benefit plans in the State. (5) Except as provided in subsection (f) of this section, funds received from the distribution of the assessment under § 6-102.1 of this article may be used only for purposes of funding the State Reinsurance Program and the State-Based Health Insurance Subsidies Program. (h) (1) Expenditures from the Fund for the purposes authorized by this subtitle may be made only: (i) with an appropriation from the Fund approved by the General Assembly in the State budget; or (ii) by the budget amendment procedure provided for in Title 7, Subtitle 2 of the State Finance and Procurement Article. (2) Notwithstanding § 7-304 of the State Finance and Procurement Article, if the amount of the distribution from the premium tax under § 6-103.2 of this article exceeds in any State fiscal year the actual expenditures incurred for the operation and administration of the Exchange, funds in the Exchange operations account from the premium tax that remain unspent at the end of the State fiscal year shall revert to the General Fund of the State. (3) If operating expenses of the Exchange may be charged to either State or non-State fund sources, the non-State funds shall be charged before State funds are charged. (i) (1) The State Treasurer shall invest the money of the Fund in the same manner as other State money may be invested. (2) Any investment earnings of the Fund shall be credited to the Fund. (3) Except as provided in subsection (h)(2) of this section, no part of the Fund may revert or be credited to the General Fund or any special fund of the State. (j) A debt or an obligation of the Fund is not a debt of the State or a pledge of credit of the State. §31-107. ** CONTINGENCY - NOT IN EFFECT - CHAPTER 468 OF 2025** (a) There is a Maryland Health Benefit Exchange Fund. (b) (1) The purpose of the Fund is to: (i) provide funding for the operation and administration of the Exchange in carrying out the purposes of the Exchange under this subtitle; (ii) provide funding for the establishment and operation of the State Reinsurance Program authorized under this subtitle; (iii) provide funding for the Medical Assistance Program and the Senior Prescription Drug Assistance Program; (iv) provide funding for the establishment and operation of Health Equity Resource Communities under Title 20, Subtitle 14 of the Health - General Article; and (v) provide funding for the establishment and operation of the State-Based Young Adult Health Insurance Subsidies Program authorized under this subtitle. (2) The operation and administration of the Exchange, the State Reinsurance Program, the State-Based Young Adult Health Insurance Subsidies Program, and the Qualified Resident Enrollment Program may include functions delegated by the Exchange to a third party under law or by contract. (c) The Exchange shall administer the Fund. (d) (1) The Fund is a special, nonlapsing fund that is not subject to § 7- 302 of the State Finance and Procurement Article. (2) The State Treasurer shall hold the Fund separately, and the Comptroller shall account for the Fund. (e) The Fund consists of: (1) any user fees or other assessments collected by the Exchange; (2) all revenue deposited into the Fund that is received from the distribution of the premium tax under § 6-103.2 of this article; (3) income from investments made on behalf of the Fund; (4) interest on deposits or investments of money in the Fund; (5) money collected by the Board as a result of legal or other actions taken by the Board on behalf of the Exchange or the Fund; (6) money donated to the Fund; (7) money awarded to the Fund through grants; (8) any pass-through funds received from the federal government under a waiver approved under § 1332 of the Affordable Care Act; (9) any funds designated by the federal government to provide reinsurance to carriers that offer individual health benefit plans in the State; (10) any funds designated by the State to provide reinsurance to carriers that offer individual health benefit plans in the State; (11) any funds designated by the State to provide State-based health insurance subsidies to young adults in the State; (12) any federal funds received in accordance with § 31-121 of this subtitle for the administration of small business tax credits; and (13) any other money from any other source accepted for the benefit of the Fund. (f) (1) The Fund may be used only: (i) 1. for the operation and administration of the Exchange in carrying out the purposes authorized under this subtitle; 2. for the establishment and operation of the State Reinsurance Program; and 3. for appropriations to the Health Equity Resource Community Reserve Fund under § 20-1407 of the Health - General Article; (ii) in fiscal years 2021 and 2022, for the Medical Assistance Program within the Medical Care Programs Administration of the Maryland Department of Health; (iii) in fiscal year 2022, for the Senior Prescription Drug Assistance Program established under Title 15, Subtitle 10 of the Health - General Article; and (iv) for the establishment and operation of the State-Based Young Adult Health Insurance Subsidies Program. (2) In each of fiscal years 2023 through 2025, the Governor shall: (i) transfer $15,000,000 to the Health Equity Resource Community Reserve Fund; and (ii) include the funds transferred in accordance with item (i) of this paragraph in the annual budget bill as an appropriation to the Health Equity Resource Community Reserve Fund under § 20-1407 of the Health - General Article. (g) (1) The Board shall maintain separate accounts within the Fund for Exchange operations, for the State Reinsurance Program, and for the State-Based Young Adult Health Insurance Subsidies Program. (2) Accounts within the Fund shall contain the money that is intended to support the purpose for which each account is designated. (3) Funds received from the distribution of the premium tax under § 6-103.2 of this article shall be placed in the account for Exchange operations and may be used only for the purpose of funding the operation and administration of the Exchange. (4) The following funds may be used only for the purposes of funding the State Reinsurance Program: (i) any pass-through funds received from the federal government under a waiver approved under § 1332 of the Affordable Care Act to provide reinsurance to carriers that offer individual health benefit plans in the State; (ii) any funds designated by the federal government to provide reinsurance to carriers that offer individual health benefit plans in the State; (iii) any funds designated by the State to provide reinsurance to carriers that offer individual health benefit plans in the State; and (iv) except as provided in subsection (f) of this section, funds received from the distribution of the assessment under § 6-102.1 of this article. (h) (1) Expenditures from the Fund for the purposes authorized by this subtitle may be made only: (i) with an appropriation from the Fund approved by the General Assembly in the State budget; or (ii) by the budget amendment procedure provided for in Title 7, Subtitle 2 of the State Finance and Procurement Article. (2) Notwithstanding § 7-304 of the State Finance and Procurement Article, if the amount of the distribution from the premium tax under § 6-103.2 of this article exceeds in any State fiscal year the actual expenditures incurred for the operation and administration of the Exchange, funds in the Exchange operations account from the premium tax that remain unspent at the end of the State fiscal year shall revert to the General Fund of the State. (3) If operating expenses of the Exchange may be charged to either State or non-State fund sources, the non-State funds shall be charged before State funds are charged. (i) (1) The State Treasurer shall invest the money of the Fund in the same manner as other State money may be invested. (2) Any investment earnings of the Fund shall be credited to the Fund. (3) Except as provided in subsection (h)(2) of this section, no part of the Fund may revert or be credited to the General Fund or any special fund of the State. (j) A debt or an obligation of the Fund is not a debt of the State or a pledge of credit of the State.
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