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10.25.10.00.htm 10.25.10.00. Title 10 MARYLAND DEPARTMENT OF HEALTH Subtitle 25 MARYLAND HEALTH CARE COMMISSION Chapter 10 Maryland Trauma Physician Services Fund Authority: Health-General Article, §19-103(c) 19-130, and 19-207, Annotated Code of Maryland
10.25.10.01.htm 10.25.10.01. 01 Scope.. A. This chapter applies to trauma physicians and Maryland Institute for Emergency Medical Services Systems designated trauma centers, Maryland Trauma Specialty Referral Centers, and rehabilitation hospitals that are affiliated with Maryland Institute for Emergency Medical Services Systems designated trauma centers by common ownership, as defined in Health-General Article, §19-130(a)3) and (4) Annotated Code of Maryland, that provide trauma care.B. Reimbursement..
10.25.10.02.htm 10.25.10.02. 02 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) "Applicant" means a person or entity eligible to file a claim to receive reimbursement from the Fund.2) "Commission" means the Maryland Health Care Commission.. 3) "Faculty practice plan" means a professional services organization that:. a) Includes physicians; and. b) Is formed to carry out, improve, and supplement the medical education, research, and clinical ser
10.25.10.03.htm 10.25.10.03. 03 Fund Administration.. A. The Fund is a special, nonlapsing interest bearing fund that is not subject to State Finance and Procurement Article, §7-302, Annotated Code of Maryland.B. The purpose of the Fund is to subsidize the documented costs:. 1) Of uncompensated care incurred by a trauma physician in providing trauma services to a trauma patient on the Maryland Trauma Registry;2) Of undercompensated care incurred by a trauma physician in providing trauma services to an enroll
10.25.10.04.htm 10.25.10.04. 04 Source of Fund Revenue.. A. The Fund consists of motor vehicle registration surcharges paid into the Fund in accordance with Transportation Article, §13-954(b) Annotated Code of Maryland, and regulations promulgated under that authority.B. The Commission shall make reimbursement from the Fund for:. 1) On-call costs;. 2) Uncompensated care costs;. 3) Medicaid differential payments;. 4) Standby expenses to an out-of-State pediatric trauma center that has ent
10.25.10.05.htm 10.25.10.05. 05 Who May Request Payment.. A. A trauma physician as defined in Regulation .02 of this chapter may request payment under this chapter.B. Medicaid and Uncompensated Care Reimbursement.. 1) Trauma Physician Services. A faculty practice plan, a physician practice, a trauma center on behalf of the trauma physician, or an individual trauma physician may submit requests for payment for trauma services provided to a Medicaid trauma patient or for uncompensated care trauma services if:
10.25.10.06.htm 10.25.10.06. 06 Payments for Medicaid Trauma Patients.. A. A trauma physician:. 1) Is eligible for payment from the Fund for trauma services provided to a Medicaid trauma patient on the Maryland Trauma Registry on or after July 1, 2006; and2) May seek reimbursement in accordance with this regulation.. B. A trauma physician providing trauma services to a Medicaid trauma patient during the service period shall be reimbursed at the greater of:1) The Medicaid routine payment rate; or.
10.25.10.07.htm 10.25.10.07. 07 Payments for Uncompensated Care Patients.. A. A trauma physician:. 1) Is eligible for payment from the Fund for trauma services provided to uncompensated trauma care patients with an admission date on the Maryland Trauma Registry beginning on or after July 1, 2006; and2) May seek reimbursement in accordance with this regulation.. B. The cost of uncompensated care incurred by a trauma physician in providing trauma care to a trauma patient as defined in this chapter shall be reim
10.25.10.08.htm 10.25.10.08. 08 On-Call Payment.. A. Eligibility. The Fund will reimburse trauma centers' on-call costs to maintain surgeons on-call in conformance with MIEMSS' regulations at COMAR 30.08.05―30.08.14 for the minimum number of trauma physicians required to be on-call. Trauma centers are eligible for on-call payments as follows:1) The Level I trauma center and pediatric trauma center are eligible for on-call payments for on-call hours provided by trauma specialties designated
10.25.10.09.htm 10.25.10.09. 09 Payment for Standby Costs at an Out-of-State Pediatric Center.. A. An out-of-State pediatric trauma center that has entered into an agreement with the Maryland Institute for Emergency Medical Services Systems shall be eligible for an annual grant of up to $590,000 for standby expenses related to the provision of trauma care to Maryland residents.B. An out-of-State pediatric trauma center shall submit an application for standby expenses incurred in the previous fiscal y
10.25.10.10.htm 10.25.10.10. 10 Trauma Equipment Grants.. A. Eligibility.. 1) The Commission, in consultation with the Health Services Cost Review Commission and the Maryland Institute for Emergency Medical Services Systems, shall develop a process for the award of grants to Level II and Level III trauma centers in the State to be used for equipment primarily used in the delivery of trauma care.2) The process developed by the Commission for the award of grants shall include:.
10.25.10.11.htm 10.25.10.11. 11 Equitable Payment Under the Fund.. A. Disbursement from the Fund is subject to the availability of funds.. B. The Commission shall adjust reimbursement formulas used for Medicaid trauma services, uncompensated care trauma services, on-call payments, and standby payments to an out-of-State pediatric trauma center to preserve the distribution of monies in the Fund.C. Revenue; Payments.. 1) On or before May 1 of each year, the Commission shall determine appropri
10.25.10.12.htm 10.25.10.12. 12 Filing of On-call Applications and Uncompensated Care Claims.. A. In order to receive a payment from the Fund, a faculty practice plan, a physician practice plan, a trauma physician, or a trauma center on behalf of a trauma physician shall submit a timely and complete on-call services application or an uncompensated services claim that includes the information required in this regulation on a form and in a manner approved by the Commission as indicated in the application.
10.25.10.13.htm 10.25.10.13. 13 Audits.. A. The Commission, or its designee, may audit to verify the information submitted by faculty practice plans, physician practice plans, trauma physicians, and trauma centers applying for reimbursement from the Fund.B. The Commission, or its designee, may perform on-site audits.. C. Information discovered by the audit process indicating that an application for payment from the Fund was improperly paid may result in remedial action being taken, includin
10.25.10.14.htm 10.25.10.14. 14 Appeals.. A. The Commission's executive director, or designee, shall review any appeal from an audit finding, a denial, or partial denial, of an uncompensated care shortfall payment, or an on-call payment.B. To secure review of an audit finding, denial, or partial denial, an applicant shall file a written appeal of the denial with the Commission, together with any supporting memoranda and documentation, within 15 days of the date of receipt of audit finding, the denial, or th
10.25.10.15.htm 10.25.10.15. 15 Annual Reconciliation Reporting Requirements.. A. On or before January 31 of each year, trauma physicians who have received uncompensated care reimbursement from the Fund during the prior calendar year shall file an annual reconciliation report with the Commission.B. The annual reconciliation report shall include:. 1) The name, address, and telephone number of the physician, practice, or center;. 2) The name, address, and telephone number of the physician, practice, or c
10.25.10.16.htm 10.25.10.16. 16 Prohibited Acts.. A. An applicant for payment from the Fund may not:. 1) Make, or cause to be made, a false statement or false claim; or. 2) Engage in fraud in submitting a claim or application.. B. Violation of §A of this regulation may result in:. 1) Referral to the appropriate Medicaid fraud administrative and prosecutorial authorities, to the Office of the State's Attorney, or both; and2) Rescission of, or an action for recovery of, any prior reimbursement imp
10.25.10.17.htm 10.25.10.17. 17 Reporting Requirements to the General Assembly.. On or before November 1 of each year, the Commission and the HSCRC shall report to the General Assembly in accordance with State Government Article, §2-1246, Annotated Code of Maryland, on:A. The amount of money in the Fund on the last day of the previous fiscal year;. B. The amount of payments applied for by trauma physicians and trauma centers during the previous fiscal year;C. The amount of money distributed in the form of
10.25.10.18.htm 10.25.10.18. 18 Expiration of Fund.. A. This chapter remains in effect unless the Fund ceases to be funded or expires by operation of law.B. In the event the Fund ceases to operate, unless otherwise provided by law, the Fund shall make any final disbursements for the current reporting period based upon available funds.
10.25.10.19.htm 10.25.10.19. 19 Effective Date.. Trauma services provided by a trauma physician to a trauma patient on or after July 1, 2008, are eligible for reimbursement pursuant to the provisions set forth in this chapter.
10.25.10.9999.htm 10.25.10.9999. Administrative History Effective date:. Regulations .01―16 adopted as an emergency provision effective July 1, 2003 (30:19 Md. R. 1327) adopted permanently effective December 22, 2003 (30:25 Md. R. 1846) ―Regulations .01―16 repealed and new regulations .01―17 adopted as an emergency provision effective July 1, 2006 (33:21 Md. R. 1672) adopted permanently effective October 23, 2006 (33:21 Md. R. 1676) ―Regulations .01―17 repealed and new regulations .01―19 adopted effective Ju
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