Maryland Code § IN-31-106

Section IN-31-106
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(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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