Maine Revised Statutes > Title 22 > Subtitle 6 > Chapter 1683 – Maine Health Data Organization

		Sections
Subchapter 1	General Provisions	8701 – 8719
Subchapter 3	Prescription Drug Pricing for Purchasers	8731 – 8737
Subchapter 4	International Referenced Rate Pricing for Prescription Drugs	8741

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Terms Used In Maine Revised Statutes > Title 22 > Subtitle 6 > Chapter 1683 - Maine Health Data Organization

Actuary: means a member of the American Academy of Actuaries who is also a member of the Society of Actuaries or the Casualty Actuarial Society and is qualified to sign a statement of actuarial opinion. See Maine Revised Statutes Title 24-A Sec. 6201
Adjourn: A motion to adjourn a legislative chamber or a committee, if passed, ends that day's session.
Adjusted risk-based capital report: means a risk-based capital report that has been adjusted by the superintendent in accordance with section 6452, subsection 3. See Maine Revised Statutes Title 24-A Sec. 6451
Adult: means a person who has attained the age of 18 years. See Maine Revised Statutes Title 1 Sec. 72
Affidavit: A written statement of facts confirmed by the oath of the party making it, before a notary or officer having authority to administer oaths.
Agricultural products: include floricultural, horticultural, viticultural, forestry, nut, dairy, livestock, poultry, bee and any farm products. See Maine Revised Statutes Title 13 Sec. 1774
Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
Annuity: A periodic (usually annual) payment of a fixed sum of money for either the life of the recipient or for a fixed number of years. A series of payments under a contract from an insurance company, a trust company, or an individual. Annuity payments are made at regular intervals over a period of more than one full year.
Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
Association: means a corporation organized under this subchapter, or a similar domestic corporation, or a foreign association or corporation if authorized to do business in this State, organized under any general or special Act as a cooperative association for the mutual benefit of its members, as agricultural producers, and which confines its operations to purposes authorized by this subchapter and restricts the return on the stock or membership capital and the amount of its business with nonmembers to the limits placed thereon by this subchapter for associations organized hereunder. See Maine Revised Statutes Title 13 Sec. 1774
Attachment: A procedure by which a person's property is seized to pay judgments levied by the court.
Authorized control level risk-based capital: means the number determined under the risk-based capital formula in accordance with the risk-based capital instructions; and [PL 1993, c. See Maine Revised Statutes Title 24-A Sec. 6451
Bankruptcy: Refers to statutes and judicial proceedings involving persons or businesses that cannot pay their debts and seek the assistance of the court in getting a fresh start. Under the protection of the bankruptcy court, debtors may discharge their debts, perhaps by paying a portion of each debt. Bankruptcy judges preside over these proceedings.
Board: means the Board of Directors of the Maine Health Data Organization established pursuant to section 8703. See Maine Revised Statutes Title 22 Sec. 8702
Board: means the board of trustees, established under section 12004?F, subsection 9, to administer the Maine Public Employees Retirement System. See Maine Revised Statutes Title 5 Sec. 17001
Brand-name drug: means a prescription drug marketed under a proprietary name or registered trademark name, including a biological product. See Maine Revised Statutes Title 22 Sec. 8731
Carrier: means an insurance company licensed in accordance with Title 24?A, including a health maintenance organization, a multiple employer welfare arrangement licensed pursuant to Title 24?A, chapter 81, a preferred provider organization, a fraternal benefit society or a nonprofit hospital or medical service organization or health plan licensed pursuant to Title 24. See Maine Revised Statutes Title 22 Sec. 8702
Clinical data: includes but is not limited to the data required to be submitted by providers and payors pursuant to sections 8708 and 8711. See Maine Revised Statutes Title 22 Sec. 8702
Commissioner: means the Commissioner of Health and Human Services. See Maine Revised Statutes Title 22 Sec. 1-A
Company action level risk-based capital: means , with respect to any insurer, the product of 2. See Maine Revised Statutes Title 24-A Sec. 6451
Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
Continuing care: means furnishing shelter for the life of the individual or for a period in excess of one year and either health care, supportive services, or both, under an agreement requiring prepayment as defined in subsection 12, whether or not the shelter and services are provided at the same location, to 3 or more older individuals not related by blood or marriage to the providers. See Maine Revised Statutes Title 24-A Sec. 6201
Contract: A legal written agreement that becomes binding when signed.
Conviction: A judgement of guilt against a criminal defendant.
Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
Corrective order: means an order issued by the superintendent specifying corrective actions that the superintendent has determined are required. See Maine Revised Statutes Title 24-A Sec. 6451
Counterclaim: A claim that a defendant makes against a plaintiff.
Creditable service: means a person's membership service, the person's prior service and service for which credit is allowable under sections 17755 and 17756; section 17760, subsection 3; section 18258; sections 18355 and 18356; and section 18360, subsection 2. See Maine Revised Statutes Title 5 Sec. 17001
Damages: Money paid by defendants to successful plaintiffs in civil cases to compensate the plaintiffs for their injuries.
Defendant: In a civil suit, the person complained against; in a criminal case, the person accused of the crime.
Department: means the Department of Health and Human Services. See Maine Revised Statutes Title 24-A Sec. 6201
Department: means the Department of Health and Human Services and its agents and authorized representatives. See Maine Revised Statutes Title 19-A Sec. 101
Department: means the Department of Health and Human Services. See Maine Revised Statutes Title 22 Sec. 1-A
Department: means any department, commission, institution or agency of State Government including the Maine Community College System. See Maine Revised Statutes Title 5 Sec. 17001
Deposition: An oral statement made before an officer authorized by law to administer oaths. Such statements are often taken to examine potential witnesses, to obtain discovery, or to be used later in trial.
division: means the Department of Health and Human Services, Division of Licensing and Regulatory Services. See Maine Revised Statutes Title 22 Sec. 7701
Domestic insurer: means any insurance company domiciled in this State. See Maine Revised Statutes Title 24-A Sec. 6451
Drug product family: means a group of one or more prescription drugs that share a unique generic drug description and drug form. See Maine Revised Statutes Title 22 Sec. 8731
Employee: means :

A. See Maine Revised Statutes Title 5 Sec. 17001

Entrance fee: means an initial payment of a sum of money or any other consideration that assures a subscriber a place in a facility for a term of years or for life. See Maine Revised Statutes Title 24-A Sec. 6201

Equitable: Pertaining to civil suits in "equity" rather than in "law." In English legal history, the courts of "law" could order the payment of damages and could afford no other remedy. See damages. A separate court of "equity" could order someone to do something or to cease to do something. See, e.g., injunction. In American jurisprudence, the federal courts have both legal and equitable power, but the distinction is still an important one. For example, a trial by jury is normally available in "law" cases but not in "equity" cases. ^{Source: U.S. Courts}

Escrow: Money given to a third party to be held for payment until certain conditions are met.

Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.

Executor: A male person named in a will to carry out the decedent

Facility: means a physical plant in which continuing care is provided in accordance with this chapter. See Maine Revised Statutes Title 24-A Sec. 6201

facility: means any of the places defined in section 8001, 8101, 8201 or 8301?A, subsection 1?A, paragraph B. See Maine Revised Statutes Title 22 Sec. 7701

federal Affordable Care Act: means the federal Patient Protection and Affordable Care Act, Public Law 111-148, as amended by the federal Health Care and Education Reconciliation Act of 2010, Public Law 111-152, and any amendments to or regulations or guidance issued under those acts. See Maine Revised Statutes Title 24-A Sec. 14

Federal Reserve System: The central bank of the United States. The Fed, as it is commonly called, regulates the U.S. monetary and financial system. The Federal Reserve System is composed of a central governmental agency in Washington, D.C. (the Board of Governors) and twelve regional Federal Reserve Banks in major cities throughout the United States. ^{Source: OCC}

Fiduciary: A trustee, executor, or administrator.

Financial data: includes but is not limited to financial information required to be submitted pursuant to section 8709. See Maine Revised Statutes Title 22 Sec. 8702

Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.

Fiscal year: means the provider's fiscal year. See Maine Revised Statutes Title 24-A Sec. 6201

Foreign insurer: means any insurance company that is authorized to do business in this State under section 404 but is not domiciled in this State. See Maine Revised Statutes Title 24-A Sec. 6451

Fraud: Intentional deception resulting in injury to another.

Generic drug: includes a biosimilar product. See Maine Revised Statutes Title 22 Sec. 8731

Health care: means the provision of any one or more of the following services:

A. See Maine Revised Statutes Title 24-A Sec. 6201

Health care facility: means a public or private, proprietary or not-for-profit entity or institution providing health services, including, but not limited to, a radiological facility licensed under chapter 160, a health care facility licensed under chapter 405, an independent radiological service center, a federally qualified health center certified by the United States Department of Health and Human Services, Health Resources and Services Administration, a rural health clinic or rehabilitation agency certified or otherwise approved by the Division of Licensing and Regulatory Services within the Department of Health and Human Services, a home health care provider licensed under chapter 419, an assisted living facility or a residential care facility licensed under chapter 1663, a hospice provider licensed under chapter 1681, a state institution as defined under Title 34?B, chapter 1 and a mental health facility licensed under Title 34?B, chapter 1. See Maine Revised Statutes Title 22 Sec. 8702

Health care practitioner: has the meaning provided in Title 24, section 2502, subsection 1?A. See Maine Revised Statutes Title 22 Sec. 8702

health insurance: means insurance of human beings against bodily injury, disablement or death by accident or accidental means, or the expense thereof, or against disablement or expense resulting from sickness, and every insurance appertaining thereto, including provision for the mental and emotional welfare of human beings by defraying the costs of legal services only to the extent provided for in chapter 38. See Maine Revised Statutes Title 24-A Sec. 704

HIPAA: means the federal Health Insurance Portability and Accountability Act of 1996. See Maine Revised Statutes Title 22 Sec. 8702

in writing: include printing and other modes of making legible words. See Maine Revised Statutes Title 1 Sec. 72

Interest rate: The amount paid by a borrower to a lender in exchange for the use of the lender's money for a certain period of time. Interest is paid on loans or on debt instruments, such as notes or bonds, either at regular intervals or as part of a lump sum payment when the issue matures. ^{Source: OCC}

Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.

Lease: A contract transferring the use of property or occupancy of land, space, structures, or equipment in consideration of a payment (e.g., rent). ^{Source: OCC}

Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity.

Life or health insurer: means any insurance company described in section 409, subsection 3 and authorized to do business in this State under section 410, or a licensed property and casualty insurer writing only accident and health insurance. See Maine Revised Statutes Title 24-A Sec. 6451

Majority: when used in reference to age shall mean the age of 18 and over. See Maine Revised Statutes Title 1 Sec. 72

Managed care organization: means an organization that manages and controls medical services, including but not limited to a health maintenance organization, a preferred provider organization, a competitive medical plan, a managed indemnity insurance program and a nonprofit hospital and medical service organization, licensed in the State. See Maine Revised Statutes Title 22 Sec. 8702

Mandatory control level risk-based capital: means the product of . See Maine Revised Statutes Title 24-A Sec. 6451

Manufacturer: means an entity that manufactures or repackages, and sets the wholesale acquisition cost for, prescription drugs that are distributed in the State. See Maine Revised Statutes Title 22 Sec. 8731

Medicare health plan sponsor: means a health insurance carrier or other private company authorized by the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services to administer Medicare Part C and Part D benefits under a health plan or prescription drug plan. See Maine Revised Statutes Title 22 Sec. 8702

Month: means a calendar month. See Maine Revised Statutes Title 1 Sec. 72

Mortgage: The written agreement pledging property to a creditor as collateral for a loan.

Mortgagee: The person to whom property is mortgaged and who has loaned the money.

Municipality: includes cities, towns and plantations, except that "municipality" does not include plantations in Title 10, chapter 110, subchapter IV; or Title 30?A, Part 2. See Maine Revised Statutes Title 1 Sec. 72

National Association of Insurance Commissioners: means the National Association of Insurance Commissioners or its successor organization of insurance regulators. See Maine Revised Statutes Title 24-A Sec. 15

Negative trend: means :

A. See Maine Revised Statutes Title 24-A Sec. 6451

Nonlicensed carrier: means a health insurance carrier that is not required to obtain a license in accordance with Title 24?A and pays health care claims on behalf of residents of this State. See Maine Revised Statutes Title 22 Sec. 8702

Organization: means the Maine Health Data Organization established under this chapter. See Maine Revised Statutes Title 22 Sec. 8702

Outpatient services: means all therapeutic or diagnostic health care services rendered to a person who has not been admitted to a hospital as an inpatient. See Maine Revised Statutes Title 22 Sec. 8702

Oversight: Committee review of the activities of a Federal agency or program.

Payor: means a 3rd-party payor, 3rd-party administrator, Medicare health plan sponsor, pharmacy benefits manager or nonlicensed carrier. See Maine Revised Statutes Title 22 Sec. 8702

Person: means an individual, trust, estate, partnership, association, company, corporation, political subdivision of the State, instrumentality of the State or other entity. See Maine Revised Statutes Title 19-A Sec. 101

Personal property: All property that is not real property.

Pick-up contributions: means member contributions to the retirement system which are assumed and paid by the employer through a reduction of members' salaries for services rendered, in accordance with the United States Internal Revenue Code, Section 414(h), in lieu of employee contributions. See Maine Revised Statutes Title 5 Sec. 17001

Plaintiff: The person who files the complaint in a civil lawsuit.

Plan sponsor: means any person, other than an insurer, who establishes or maintains a plan covering residents of this State, including, but not limited to, plans established or maintained by 2 or more employers or jointly by one or more employers and one or more employee organizations or the association, committee, joint board of trustees or other similar group of representatives of the parties that establish or maintain the plan. See Maine Revised Statutes Title 22 Sec. 8702

Pleadings: Written statements of the parties in a civil case of their positions. In the federal courts, the principal pleadings are the complaint and the answer.

Prescription drug: means a drug, as defined in 21 United States Code § 321(g) or a biological product as defined in 42 United States Code § 262(i)(1) that:

A. See Maine Revised Statutes Title 22 Sec. 8731

Pricing component data: means data unique to each manufacturer, wholesale drug distributor or pharmacy benefits manager subject to this subchapter that evidences the cost to each manufacturer, wholesale drug distributor or pharmacy benefits manager to make a prescription drug available to consumers and the payments received by each manufacturer, wholesale drug distributor or pharmacy benefits manager to make a prescription drug available to consumers, taking into account any price concessions, and that is measured uniformly among the entities, as determined by rules adopted by the organization pursuant to section 8737. See Maine Revised Statutes Title 22 Sec. 8731

Pricing unit: means the smallest dispensable amount of a prescription drug that could be dispensed. See Maine Revised Statutes Title 22 Sec. 8731

Probate: Proving a will

Producers: includes independent agricultural contractors. See Maine Revised Statutes Title 13 Sec. 1774

Property and casualty insurer: means any insurance company authorized to do business in this State under section 410 except a life or health insurer or single line mortgage guaranty insurer, financial guaranty insurer or title insurer. See Maine Revised Statutes Title 24-A Sec. 6451

Prosecute: To charge someone with a crime. A prosecutor tries a criminal case on behalf of the government.

Protected health information: includes :

A. See Maine Revised Statutes Title 22 Sec. 8702

Provider: means the owner of an institution, building, residence or other place, whether operated for profit or not, in which the owner undertakes to provide continuing care. See Maine Revised Statutes Title 24-A Sec. 6201

Provider: means a health care facility, health care practitioner, health product manufacturer or health product vendor but does not include a retail pharmacy. See Maine Revised Statutes Title 22 Sec. 8702

Quality data: means information on health care quality required to be submitted pursuant to section 8708?A. See Maine Revised Statutes Title 22 Sec. 8702

Quorum: The number of legislators that must be present to do business.

Records: means the financial and other information and personnel data maintained by the provider for the proper operation of the facility pursuant to this chapter. See Maine Revised Statutes Title 24-A Sec. 6201

registered mail: when used in connection with any requirement for notice by mail shall mean either registered mail or certified mail. See Maine Revised Statutes Title 1 Sec. 72

Regulatory action level risk-based capital: means the product of 1. See Maine Revised Statutes Title 24-A Sec. 6451

Remainder: An interest in property that takes effect in the future at a specified time or after the occurrence of some event, such as the death of a life tenant.

Restructuring data: means reports, charts and information required to be submitted pursuant to section 8710. See Maine Revised Statutes Title 22 Sec. 8702

Retirement: means termination of membership with a retirement allowance granted under this chapter. See Maine Revised Statutes Title 5 Sec. 17001

Risk-based capital instructions: means the risk-based capital instructions adopted by the NAIC, as such risk-based capital instructions may be amended by the NAIC from time to time in accordance with the procedures adopted by the NAIC. See Maine Revised Statutes Title 24-A Sec. 6451

Risk-based capital level: means an insurer's company action level risk-based capital, regulatory action level risk-based capital, authorized control level risk-based capital or mandatory control level risk-based capital where:

A. See Maine Revised Statutes Title 24-A Sec. 6451

Risk-based capital plan: means a comprehensive financial plan containing the elements specified in section 6453, subsection 2. See Maine Revised Statutes Title 24-A Sec. 6451

Risk-based capital report: means the report required in section 6452. See Maine Revised Statutes Title 24-A Sec. 6451

Service: means service as an employee for which compensation was paid. See Maine Revised Statutes Title 5 Sec. 17001

Service credit: means credit received for creditable service as defined under subsection 10. See Maine Revised Statutes Title 5 Sec. 17001

Settlement: Parties to a lawsuit resolve their difference without having a trial. Settlements often involve the payment of compensation by one party in satisfaction of the other party's claims.

state: means any state, territory or possession of the United States, the Commonwealth of Puerto Rico and the District of Columbia. See Maine Revised Statutes Title 19-A Sec. 101

Statute: A law passed by a legislature.

Statute of limitations: A law that sets the time within which parties must take action to enforce their rights.

Subpoena: A command to a witness to appear and give testimony.

Summons: Another word for subpoena used by the criminal justice system.

Superintendent: means the Superintendent of Insurance. See Maine Revised Statutes Title 24-A Sec. 6201

Supportive services: means providing assistance in the activities of daily living or other social services, or both. See Maine Revised Statutes Title 24-A Sec. 6201

Teacher: includes a person who is on a one-year leave of absence from a position as a teacher and is participating in the education of prospective teachers by teaching and supervising students enrolled in college-level teacher preparation programs in this State. See Maine Revised Statutes Title 5 Sec. 17001

Testify: Answer questions in court.

Third-party administrator: means any person who, on behalf of a plan sponsor, health care service plan, nonprofit hospital or medical service organization, health maintenance organization or insurer, receives or collects charges, contributions or premiums for, or adjusts or settles claims on, residents of this State. See Maine Revised Statutes Title 22 Sec. 8702

Third-party payor: means a health insurer, carrier, including a carrier that provides only administrative services for plan sponsors, nonprofit hospital, medical services organization or managed care organization licensed in the State. See Maine Revised Statutes Title 22 Sec. 8702

Total adjusted capital: means the sum of:

A. See Maine Revised Statutes Title 24-A Sec. 6451

Town: includes cities and plantations, unless otherwise expressed or implied. See Maine Revised Statutes Title 1 Sec. 72

Trial: A hearing that takes place when the defendant pleads "not guilty" and witnesses are required to come to court to give evidence.

Trustee: A person or institution holding and administering property in trust.

United States: includes territories and the District of Columbia. See Maine Revised Statutes Title 1 Sec. 72

User fees: Fees charged to users of goods or services provided by the government. In levying or authorizing these fees, the legislature determines whether the revenue should go into the treasury or should be available to the agency providing the goods or services.

Wholesale acquisition cost: means a manufacturer's listed price for sale to a wholesale drug distributor or other entity that purchases a prescription drug directly from the manufacturer, not including any price concessions. See Maine Revised Statutes Title 22 Sec. 8731

Year: means a calendar year, unless otherwise expressed. See Maine Revised Statutes Title 1 Sec. 72