The Maryland Health Care Commission (MHCC) is releasing COMAR 10.25.06 for informal comment. MHCC currently collects data on paid commercial claims from Maryland payors for inclusion in the Medical Care Data Base (MCDB), Maryland’s All-Payer Claims Database (APCD). Although nearly half of states with similar databases currently collect information about denied claims, MHCC does not. The Maryland Health Care Commission (MHCC) is in ongoing discussions with the Maryland Insurance Administration (MIA), the Health Services Cost Review Commission (HSCRC), the Maryland Department of Health (MDH), the Prescription Drug Affordability Board (PDAB), and the Health Education and Advocacy Unit (HEAU) about the value that data on denied claims would add to a variety of public health initiatives. While Maryland collects some information on insurance denials, the State lacks individual service-level information regarding denials. The current data that the state receives on prior authorization is typically organized into broad service categories, such as “Durable Medical Equipment,” but not the level of specificity to comprehensively identify individual denied services, such as “Continuous Glucose Monitors.” Collecting denied claims will provide insights into payors operating in the state, utilization management procedures and identify patterns in health services that are routinely denied. MHCC is collaborating with other states regarding the collection of denied claims in their APCDs. Eleven of the twenty-five APCD states are currently collecting denied claims.

The draft regulations require payors to begin reporting denied claims in 2027.

Notice of Proposed Action [24-165-R] Volume 52 Issue 15 Maryland Register August 8, 2025

The Maryland Health Care Commission proposes to amend Regulations .01, .02 and .05, adopt new Regulation .09, amend and recodify existing Regulations .09 and .10 to be Regulations .10 and .11, and recodify existing Regulation .11 to be Regulation .12 under COMAR 10.25.07 Certification of Electronic Health Networks and Medical Care Electronic Claims Clearinghouses. This action was considered by the Commission at an open meeting held on June 12, 2025, notice of which was given through publication in the Maryland Register, in accordance with General Provisions Article, §3-302(c), Annotated Code of Maryland. Because substantive changes have been made to the original proposal as published in 51:24 Md. R. 1086 - 1088 (December 2, 2024), this action is being re-proposed at this time.  Comments will be accepted through September 8, 2025. A public hearing has not been scheduled.

Statement of Purpose

The purpose of this action is to re-propose amendments and a new regulation to COMAR 10.25.07 Certification of Electronic Health Networks and Medical Care Electronic Claims Clearinghouses.

Legislation passed by the Maryland General Assembly in 2021 (Chapter 790/House Bill 1022 and Chapter 791/Senate Bill 748, Public Health—State Designated Exchange—Clinical Information) requires the Maryland Health Care Commission (MHCC) to adopt regulations to support a State health improvement program, mitigate a public health emergency, and improve patient safety by requiring MHCC-certified electronic health networks (EHNs) to provide electronic health care transaction information to the State-designated health information exchange (HIE) for clinical and public health purposes. 

Legislation passed by the Maryland General Assembly in 2025 (Chapter 615/House Bill 1104, Maryland Department of Health—AHEAD Model Implementation—Electronic Health Care Transactions and Population Health Improvement Fund) clarifies that electronic health care transaction information may be used to support the State’s participation in the Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model and any successor models, among other things. 

The re-proposed amendments clarify and build upon proposed regulations published in Volume 51, Issue 24 of the Maryland Register on December 2, 2025 based on certain public comments received and new legislation passed during the 2025 Maryland legislative session pertaining to the AHEAD Model.

Re-proposed amendments

1. Adds EHNs and the State-designated HIE to the scope of the chapter;
2. Modifies when EHNs must demonstrate compliance with Health-General Article, §4-302.5, Annotated Code of Maryland;
3. Allows electronic healthcare transaction information to be used for public health and clinical purposes to facilitate the State’s participation in the AHEAD Model;
4. Clarifies required components and processes for the State-designated HIE in developing the Electronic Health Care Transactions Technical Submission Guidance;
5. Extends the implementation timeline for the State-designated HIE and EHNs; and
6. Adds requirements for the State-designated HIE and EHNs to report to MHCC on their implementation of the regulations.

Re-proposed amendments build upon previous amendments that:

1.  Add definitions for improvement of patient safety, mitigation of a public health emergency, State-designated HIE, and state health improvement program;
2. Adds a regulation requiring MHCC-certified EHNs to submit certain electronic health care transactions to the State-designated HIE for public health and clinical purposes;
3. Requires the State-designated HIE to develop and publish Electronic Health Care Transactions Technical Submission Guidance;
4. Prohibits EHNs from charging a fee for providing electronic health care transaction information; and
5. Allows EHNs to request a one-year exemption from certain reporting requirements.

The Maryland Health Care Commission proposes to amend Regulations .01-.17 and .19 under COMAR 10.25.10 Maryland Trauma Physician Services Fund. This action was considered at an open meeting held by the Commission on September 19, 2024. This action was printed in the Maryland Register published November 1, 2024, Volume 51, Issue 22, Pages 969-975.

Comments may be sent to Jason Caplan, Chief, Special Projects, Maryland Health Care Commission, 4160 Patterson Avenue, Baltimore, MD 21215, or call 410-764-3579, or email Jason.caplan3@maryland.gov. Comments will be accepted through December 2, 2024. A public hearing has not been scheduled.

Final action on the proposal will be considered by the Maryland Health Care Commission during a public meeting to be held on December 19, 2024 at 1:00 pm, at 4160 Patterson Avenue, Baltimore, Maryland.

In accordance with the Nursing Home Acquisition legislation (SB 1000, Chapter 816 and HB 1122, Chapter 817) that passed in the 2024 General Assembly session, Maryland Health Care Commission staff has prepared updates of COMAR 10.24.20, the Nursing Home Chapter of the State Health Plan and COMAR 10.24.01, the Procedural Regulations. The legislation specifically requires the Commission to adopt the regulations required under § 19–120.2(j) of the Health – General Article on or before January 1, 2025, to be applicable to acquisitions executed after the adoption of the regulations.

We have prepared the attached DRAFT proposed revisions to the existing regulations and would request comments be submitted by COB, Monday, August 19, 2024. Please submit all comments to mhcc_regs.comment@maryland.gov. Many amendments were derived from the Nursing Home Acquisitions Transparency Workgroup’s Recommendations and Report. Depending on the volume and substance of comments, the Commission may convene a short webinar to discuss the comments and respond to any questions from stakeholders.

When submitting written comments, it is important to begin each comment in your letter by adhering to the COMAR Codification System. Comments should not be embedded in an email; rather, submitted as an attachment in an email to mhcc_regs.comment@maryland.gov. Respondents are encouraged to submit comments by close of business on August 19, 2024. The MHCC cannot ensure that comments received after the due date will be considered.

The Maryland Health Care Commission seeks feedback on certain provisions to an informal draft version of amendments to COMAR 10.25.18, Health Information Exchanges: Privacy and Security of Protected Health Information and COMAR 10.25.07 Certification of Electronic Health Networks and Medical Care Electronic Claims Clearinghouses. The draft amendments focus on legislation passed by the Maryland General Assembly during the 2021 and 2022 legislative sessions.

Informal Draft Amendments to COMAR 10.25.07, Certification of Electronic Health Networks and Medical Care Electronic Claims Clearinghouses - For Informal Public Comment
Informal Draft Amendments to COMAR 10.25.18, Health Information Exchanges: Privacy and Security of Protected Health Information - For Informal Public Comment

When submitting written comments, it is important to begin each comment in your letter adhering to the COMAR Codification System. Comments should not be embedded in an email; rather, submitted as an attachment in an email to mhcc_regs.comment@maryland.gov. Respondents are encouraged to submit comments by close of business on May 29, 2024. The MHCC cannot ensure that comments received after the due date will be considered.