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10.37.03.00.htm 10.37.03.00. Title 10 MARYLAND DEPARTMENT OF HEALTH Subtitle 37 HEALTH SERVICES COST REVIEW COMMISSION Chapter 03 Types and Classes of Charges Which Cannot Be Changed Without Prior Commission Approval Authority: Health-General Article, §9-207, 19-210, 19-212, 19-215, 19-217, 19-219, and 19-220, Annotated Code of Maryland
10.37.03.01.htm 10.37.03.01. 01 Changes in Rates.. A hospital may not increase any existing rate or charge of any class or type or impose any new rate or charge of any class or type without the approval of the Commission, except for those changes specifically excepted by regulation or order of the Commission.
10.37.03.02.htm 10.37.03.02. 02 Changes in Unit Rates.. A. A hospital may vary its unit rates within any 100 percent inpatient patient care center without prior Commission approval, if the variation does not change the average charge per unit of service as prescribed in the Commission's Rate Review System.B. A hospital may not vary its unit rates within any ancillary or ambulatory center without prior Commission approval if the Commission's Rate Review System prescribes a unit of service for that center.
10.37.03.03.htm 10.37.03.03. 03 Rates for Auxiliary Enterprises in Other Institutional Program.. Any hospital may change without prior approval of the Commission its unit rate or rates in any auxiliary enterprise or other institutional program as these centers are defined in the Commission's Uniform Accounting and Reporting System and the Commission's Rate Review System.
10.37.03.04.htm 10.37.03.04. 04 Rates for New Services.. Any hospital may institute a rate for a new patient care service if the rate is less than $100 and does not change the average charge per unit of service for the patient care area in which the new patient care service is being provided.
10.37.03.05.htm 10.37.03.05. 05 Overcharges and Undercharges by Hospitals.. A. For purposes of this regulation, the following definitions apply:. 1) "Overcharge" means any charge for a hospital service under the jurisdiction of the Commission that is in excess of its approved rate.2) "Undercharge" means any charge for a hospital service under the jurisdiction of the Commission that is less than its approved rate.B. When any hospital overcharges by more than the allowed corridors, as defined in §G of this regula
10.37.03.06.htm 10.37.03.06. 06 Change in Hospital-Based Physician Compensation Source.. A. Each hospital shall promptly submit a rate application to the Commission for a change in rates whenever the source of a hospital-based physician's or physician support personnel's compensation has been modified (for example, a hospital-based physician previously compensated by the hospital commences billing fee for service or CRNA's previously compensated by the hospital are replaced by physicians billing fee for servi
10.37.03.07.htm 10.37.03.07. 07 Change in Education Programs.. A. Each hospital shall promptly submit a rate application to the Commission for a change in rates whenever an educational program conducted by the hospital has been modified (for example, the loss of a school of nursing program, the loss of resident/intern program, or a decrease in the number of students enrolled in the program)B. Any rate application submitted under the requirements of §A, of this regulation, shall relate onl
10.37.03.08.htm 10.37.03.08. 08 Rates for Identified Physician Cost.. A. Any hospital which incurs or accrues costs as a result of professional medical services which are personally rendered for an individual patient by a physician, and which contribute to the diagnosis or treatment of an individual patient, shall account for those costs as an Identified Physician Cost in accordance with the "Accounting and Reporting System for Hospitals" manual which is incorporated by reference in COMAR 10.37.01.02A(2)
10.37.03.09.htm 10.37.03.09. 09 Rates for Non-Physician Services Provided to Hospital Inpatients by Third-Party Contractors.. A. A non-physician inpatient service is defined as a hospital service under the jurisdiction of the Commission provided by a third-party contractor to a hospital inpatient off-site of the hospital. The charge for this service shall be billed by the hospital.B. The allowable rate shall be equal to or less than the Statewide median or price standard as developed by staff.
10.37.03.10.htm 10.37.03.10. 10 Rates for Services with Revenues Exempt from Commission Jurisdiction.. A. Generally. The Commission may, on its own or upon application from a hospital, permit charges for services to be changed without its prior approval in those cases when 66-2/3 percent or more of the annual gross patient revenue attributable to the services is derived from either Medicaid or Medicare patients, or both, who are not required by State law or by the terms of the Medicare Waiver to pa
10.37.03.9999.htm 10.37.03.9999. Administrative History Effective date: June 14, 1975 (2:15 Md. R. 1066; 2:20 Md. R. 1298) ―. Chapter revised effective August 18, 1976 (3:17 Md. R. 915). Regulation .02 amended effective October 6, 2008 (35:20 Md. R. 1775). Regulation .05 adopted effective July 28, 1978 (5:15 Md. R. 1189). Regulation .05 amended effective August 31, 1992 (19:17 Md. R. 1607). Regulation .05F amended effective April 15, 1991 (18:7 Md. R. 773).
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