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10.37.10.00.htm 10.37.10.00. Title 10 MARYLAND DEPARTMENT OF HEALTH Subtitle 37 HEALTH SERVICES COST REVIEW COMMISSION Chapter 10 Rate Application and Approval Procedures Authority: Health-General Article, §15-601 et seq. and 19-201, 19-207, 19-210―19-214, 19-214.1, 19-214.2, 19-214.3, 19-216, 19-217, 19-219, and 19-222; Insurance Article, §14-501, 14-502, and 14-504; State Government Article, §10-304(b) Annotated Code of Maryland
10.37.10.01.htm 10.37.10.01. 01 Definitions.. A. "Burden of proof" means the burden of persuasion by the preponderance of the evidence.. B. "Commission" means the Health Services Cost Review Commission.. C. "Executive Director" means the Executive Director of the Commission, or in his absence, the Commission staff member designated to act in his stead.D. "Opinion" means a written statement setting forth the reasons and grounds why the writer of the statement believes that certain actions should be t
10.37.10.01-1.htm 10.37.10.01-1. 01-1 Incorporation by Reference.. The Alternative Rate Setting Method (ARM) Manual (1998) is hereby incorporated by reference..
10.37.10.02.htm 10.37.10.02. 02 Rate Review System.. A. The rate review system, otherwise known as the Accounting and Budget Manual for Fiscal and Operating Management, shall consist of:1) The rate review forms; and. 2) Instructions for completion of the forms.. B. The rate review system is incorporated by reference in COMAR 10.37.01.02.. C. A hospital's rate review system and a schedule of published rates shall be filed by the last day of the third month after the close of the hospital's fiscal year.
10.37.10.03.htm 10.37.10.03. 03 Regular Rate Applications.. A. A hospital may not file a regular rate application with the Commission until rate efficiency measures are adopted by the Commission which are consistent with the all-payer model contract approved by the Centers for Medicare & Medicaid Services (CMS) During this interim period of time, a hospital may seek a rate adjustment under any other administrative remedy available to it under existing Commission, law, regulation, or policy. The rate effic
10.37.10.03-1.htm 10.37.10.03-1. 03-1 Partial Rate Application.. A. The provisions of Regulation .03B(2) and (3) of this chapter may be waived by staff in the review of a partial rate application.B. A hospital may file a partial rate application with the Commission at any time, consistent with the provisions of Regulation .03A of this chapter. A partial rate application is not a contested case under the provisions of the Administrative Procedure Act.C. The Commission shall act on a docketed partial
10.37.10.04.htm 10.37.10.04. 04 Commission Review of Established Rates.. A. The Commission may order a review of a hospital's established rates at any time, as it deems necessary and proper.B. This order, provided it orders the review of any rate or charge, may constitute a Commission-initiated rate proceeding.
10.37.10.04-1.htm 10.37.10.04-1. 04-1 ICC Methodology.. A. In evaluating the reasonableness of a hospital's permanent rate structure, the Commission may use its Interhospital Cost Comparison (ICC) methodology as a benchmark for reasonableness. Thus, the results of an ICC analysis do not constitute an absolute rule, and the Commission shall consider the individual circumstances of the subject hospital in determining the appropriate rate structure. The ICC methodology begins by establishing costs for th
10.37.10.04-2.htm 10.37.10.04-2. 04-2 Case Target Methodology.. A. Effective July 1, 2000, the Commission shall implement its case target methodology (CTM) for the purpose of establishing reasonable rates for Maryland's general acute hospitals. Effective July 1, 2008, the Commission shall expand its case target methodology to include outpatient services. This methodology is prospective in nature and designates a charge-per-admission target and a charge-per-visit target for each hospital.
10.37.10.04-3.htm 10.37.10.04-3. 04-3 Case Target Update Mechanism.. A. For purposes of this regulation, the following definitions apply:. 1) "Factor cost inflation" means increases in the costs of goods, services, wages, and salaries experienced by the hospitals as calculated by the Commission for the most recent period for which data are available preceding the year for which the Commission calculates case target updates.2) "Hospital update" means the amount by which an individual hospital's cha
10.37.10.05.htm 10.37.10.05. 05 Application for Temporary Change in Rates.. A. The Commission may issue a general notice setting forth circumstances under which a hospital may obtain a temporary change in rates. The rates, if approved or modified, shall be effective before the rate review procedure set forth in these regulations, but not before the date of application.B. A hospital may apply at any time for a temporary change in rates provided that one of the following conditions is satisfied:
10.37.10.06.htm 10.37.10.06. 06 Application for Alternative Method of Rate Determination.. A. At any time on or after July 1, 1974, a hospital may file a written application with the Commission requesting an alternative method for submitting or reviewing any or all of its rates and charges, specifying the reasons for and details of the alternative methods.B. If warranted by the circumstances set forth in the application, the Executive Director may grant a temporary approval of an alternative method of r
10.37.10.07.htm 10.37.10.07. 07 Rate Applications by New Hospitals or Existing Hospitals with Expanded Facilities or New Revenue Centers.A. At least 60 days before the operational opening of a new hospital, a revenue center, or a new service within a hospital whose projected annual operating cost exceeds $100,000, the hospital shall file a rate application for the requested rates. This application shall be supported by financial data presented in the format of the Commission's rate B. If an existing hospita
10.37.10.07-1.htm 10.37.10.07-1. 07-1 Outpatient Services ― At the Hospital Determination.. A. Definition. In this regulation, "at the hospital" means a service provided in a building on the campus of a hospital in which hospital services are provided.B. A service at the hospital is:. 1) Presumed to be an outpatient service; and. 2) Subject to rate regulation.. C. In accordance with Health-General Article, §19-201, Annotated Code of Maryland, the Commission’s rate-setting jurisdiction extends to outpatient se
10.37.10.07-2.htm 10.37.10.07-2. 07-2 Outpatient Services ― Freestanding Medical Facility.. A. Definition. In this regulation, “freestanding medical facility” means a freestanding medical facility licensed under Health-General Article, Title 19, Subtitle 3A, Annotated Code of Maryland.B. The following outpatient services provided at a freestanding medical facility are considered hospital services under Health-General Article, §19-201, Annotated Code of Maryland:1) Emergency Services;.
10.37.10.08.htm 10.37.10.08. 08 Content.. Each rate application shall include a list of services for which new rates are being requested, a list of the present and requested rates, and shall be based on the currently filed or required rate review system.
10.37.10.09.htm 10.37.10.09. 09 Method of Filing.. The application may be filed by private messenger at the Offices of the Commission, or may be filed by registered mail, return receipt requested, at the following address:Health Services Cost Review Commission. 4160 Patterson Avenue. Baltimore, Maryland 21215.
10.37.10.10.htm 10.37.10.10. 10 Docketing and Receipt.. A. Docketing.. 1) When a valid rate application is received, as per the above regulations, it shall be entered on the Commission docket and a file opened.2) Each rate application shall be given an annual docket number and a consecutive page number in the docket.3) Each rate application shall be given a consecutive file number.. 4) A regular rate application file number shall be noted "R". 5) The file number of an order authorizing Commiss
10.37.10.11.htm 10.37.10.11. 11 Recommendations of the Commission's Staff to the Commission.. A. A rate application review shall be completed and the recommendation given to the Commission as soon as possible.B. The recommendation shall include a specification of those areas of costs which the staff believes should be reviewed. When practicable, the recommendation shall also include the amounts challenged by the staff.C. Any of four actions may be recommended to the Commission. If two or more
10.37.10.12.htm 10.37.10.12. 12 Preliminary Commission Order.. A. The Commission shall consider the staff recommendation and, within 20 days of the date of the recommendation, issue its preliminary order adopting or modifying the recommendation, or referring the recommendations back to the staff for further review and subsequent recommendations.B. Order Nisi.. 1) If the Commission issues a preliminary order granting tentative approval of any rates, it shall publish notice of the order nisi and the rates.
10.37.10.13.htm 10.37.10.13. 13 Public Hearing Before the Commission.. A. Testimony shall be in writing and may not be delivered orally, except as set forth in Regulation .14K, of this chapter.B. Presenting Direct Testimony.. 1) Any person who wishes to present direct testimony at the public hearing shall forward copies to the hospital and to every designated interested party, and shall file nine copies at the Commission's office.2) If the public hearing is the result of a hospital rate application pursu
10.37.10.14.htm 10.37.10.14. 14 Conduct of Public Hearing.. A. The Chairman of the Commission shall preside at the public hearing, which may be called to order when the presiding officer is in attendance. If the Chairman is absent or has been disqualified, the Vice-chairman or another commissioner shall preside.B. The Commission may direct that a hearing officer preside at the public hearing. In this case, the hearing officer may exercise all powers given to a presiding commissioner in these regulations duri
10.37.10.15.htm 10.37.10.15. 15 Decision and Opinions of the Commission.. The decision and the opinions of the Commission shall be based solely on the testimony, examination, and evidence presented at the public hearing, on the briefs filed, if any, on the evidence incorporated into the record of the proceeding by reference, on information and data in the record of the proceeding, and on matters as to which the Commission has taken official notice, which matters shall be made known to the parti
10.37.10.16.htm 10.37.10.16. 16 General Hearing Before the Commission.. A. To obtain general information from the region and community in which a hospital is located, the Commission, at its discretion, may hold a general hearing during the course of any rate proceeding.B. A general hearing shall be supplementary to other methods of rate review and may not replace them.C. A general hearing shall be held in the region in which the hospital whose rates are being reviewed is located.
10.37.10.17.htm 10.37.10.17. 17 Forms.. The following forms are illustrative of pleadings and papers commonly used by parties in rate review proceedings and should be used wherever possible and, if necessary, adapted to the facts in the proceeding and the needs of the party using the forms:A. Rate Application.. IN RE THE APPLICATION OF _ [ (Hospitals). BEFORE THE MARYLAND HEALTH SERVICES COST REVIEW COMMISSION. DOCKET: _ PAGE: _ PROCEEDING NO. _. B. Public Notice of Rate Proceeding.. HEALTH SERVICES COST REVI
10.37.10.18.htm 10.37.10.18. 18 Format.. A. All pleadings, motions, and other papers filed in a Commission proceeding shall be typed or legibly written on sheets of bond paper not more than 11 inches long or 8-1/2 inches wide, and each paper shall have a left margin of at least 1 inch and a top margin of at least 1-1/2 inches.B. All pleadings, motions, and other papers, excluding exhibits appended to the pleadings, shall contain a heading at the top of the first page and, excluding appended exhibit
10.37.10.19.htm 10.37.10.19. 19 Filing of a Rate Application.. A. A rate application filed by private messenger at the offices of the Commission shall be deemed to be filed on the date the application is received during normal working hours in the Commission's office.B. A rate application sent by registered mail shall be deemed to be filed 3 days after the application is placed in the U.S. Postal Service, these days to exclude Saturdays, Sundays, and holidays on which mail is not delivere
10.37.10.20.htm 10.37.10.20. 20 Service.. An original and three copies of all other pleadings, documents, testimony, or motions to be considered by the Commission shall be filed at the office of the Commission during regular business hours. All pleadings, documents, testimony, or motions shall contain a certificate of service indicating that the pleading, document, testimony, or motion has been mailed or served upon all designated parties to that proceeding and upon the Commission at its offices.
10.37.10.21.htm 10.37.10.21. 21 Computations of Time Periods and Extensions.. A. In computing any period of time prescribed by these regulations, by order of the Commission or by any applicable statute, the day of the action or default initiating the designated period of time not be included. The last day of the period so computed is to be included unless it is a day on which the office of the Commission is closed, in which event the period runs until the end of the next day on which the office of
10.37.10.22.htm 10.37.10.22. 22 Motions.. A. Motions shall be in writing, except when made at a hearing or conference and shall state concisely the question which the Commission is called upon to determine, or the action the movant desires the Commission to take. It shall state all reasons, authorities, and citations in the body of the motion or in a supporting memorandum. A certificate of service, setting forth all parties upon whom a copy of the motion was served, shall be attached to the motion.
10.37.10.23.htm 10.37.10.23. 23 Subpoenas.. A. At any time, the Commission may issue subpoenas directing a designated person to do the following:1) Appear to testify at a hearing or private pre-hearing conference conducted by the Commission:. 2) Appear at a specified time and date at the Commission offices or any designated place within the State, and, under oath or otherwise, give testimony and answer questions of the Commission or its authorized representatives; or3) Produce documents, rep
10.37.10.24.htm 10.37.10.24. 24 Effective Dates and Suspensions.. A. The effective date of rates applied for in a rate application shall be 30 days from the date of the filing of the rate application with the Commission and shall be specified in the rate application.B. The Commission's staff may recommend the suspension of the effective date of the rates under review.C. At any time during a rate review, the Commission may order a suspension of the effective date of the rates under review, w
10.37.10.25.htm 10.37.10.25. 25 Evidence, Testimony, and Official Notice.. A. The presiding officer at a public hearing or general hearing shall make all rulings as to evidence, testimony, and official notice and he may call on the legal counsel of the Commission for guidance in his rulings.B. All evidence and testimony shall be relevant and pertain solely to the issues being considered in a particular proceeding.C. Redundant evidence or testimony may not be permitted at public or genera
10.37.10.26.htm 10.37.10.26. 26 Patient Rights and Obligations; Hospital Credit and Collection and Financial Assistance Policies.. A. Hospital Information Sheet.. 1) Each hospital shall develop an information sheet that:. a) Describes the hospital's financial assistance policy;. b) Describes a patient's rights and obligations with regard to hospital billing and collection under the law;c) Provides contact information for the individual or office at the hospital that is available to assist the patient, the pat
10.37.10.26-1.htm 10.37.10.26-1. 26-1 Maryland Health Insurance Plan (MHIP) Assessment.. A. The Commission shall determine and assess those funds necessary to operate and administer the MHIP. The Commission shall adjust hospital rates to implement the revenue neutral assessment.B. The Commission shall assess each hospital up to 1 percent of its net patient revenue to operate and administer the MHIP. There shall be no MHIP assessment for Fiscal Year 2016.C. Beginning on September 5, 2003, each hospital w
10.37.10.26-2.htm 10.37.10.26-2. 26-2 Assessment for Savings in Averted Uncompensated Care.. A. Beginning July 1, 2008, the Commission shall assess annually a uniform, broad-based, and reasonable amount in hospital rates to reflect the aggregate reduction in hospital uncompensated care resulting from the expansion of health care coverage under Ch. 7, Acts of 2007 Special Session.B. Given the prospective nature of the rate system, the Commission shall ensure that the assessment amount does not exceed th
10.37.10.27.htm 10.37.10.27. 27 Designated Interested Parties.. A. Designated interested parties for a specific rate review proceeding may include:. 1) Those community oriented groups which the Commission determines have a significant interest in the hospital and its rate application;2) Those third-party payors or their representatives who have been designated by the Commission as interested parties for this proceeding;3) The hospital whose rates are being reviewed;. 4) Maryland Health and Hi
10.37.10.28.htm 10.37.10.28. 28 Right to Counsel.. A hospital or any other party in a rate review proceeding may be represented by legal counsel at any or all times during the proceeding, but there is no requirement that parties have legal counsel.
10.37.10.29.htm 10.37.10.29. 29 Challenges.. A. Any party to a proceeding may challenge the ability of any member of the Commission to consider the rates or issues in that proceeding. Excepting private conferences, this challenge shall be made during the proceeding before its first hearing. Challenges may not be permitted after the first hearing, except in extraordinary circumstances.B. A challenge shall be verified in writing, specifying the member of the Commission and shall set forth all its reasons. The
10.37.10.30.htm 10.37.10.30. 30 Consolidation.. When two or more rate proceedings involve common questions of fact, the Commission, upon a majority vote of its members, may order that the common questions of fact be decided in a consolidated proceeding.
10.37.10.31.htm 10.37.10.31. 31 Burden of Proof.. A. In proceedings initiated by a regular, temporary, or new hospital rate application, the burden of proof of the reasonableness, equity, and lack of undue discrimination of the proposed rates shall rest with the hospital.B. In proceedings initiated by an application for an alternative method of rate determination, the burden of proof of the applicability of the alternative method of rate review to the hospital shall rest with the hospital.
10.37.10.32.htm 10.37.10.32. 32 Severability.. If any section or provision of these regulations is declared unconstitutional or void by any court of competent jurisdiction, or its applicability to any person or circumstances is held invalid, the constitutionality or validity of the remainder of the regulations and the applicability to other persons and circumstances are not affected, and to this end, the sections and provisions of these regulations are declared to be severable.
10.37.10.33.htm 10.37.10.33. 33 Petition for Promulgation, Amendment, or Repeal of Regulation.. A. Any interested party may file with the Commission a petition for the promulgation, amendment, or repeal of a regulation designed to implement, interpret, or prescribe law, policy, organization, procedure, or practice requirements of the Commission. The petition shall set forth:1) The interest of the petitioner and the nature of the relief desired;.
10.37.10.34.htm 10.37.10.34. 34 Petition for Declaratory Ruling.. A. An interested person may file with the Commission a petition for a declaratory ruling with respect to the manner in which the Commission would apply a statute that the Commission enforces, a regulation of the Commission, or an order of the Commission, to a person or property on the facts set forth in the petition.B. The petition for a declaratory ruling shall be filed in writing and shall contain a statement describing in detail the int
10.37.10.35.htm 10.37.10.35. 35 Consideration and Disposition.. A. Consideration.. 1) The petition shall be granted whenever the Commission deems issuing a declaratory ruling advisable under the circumstances.2) In rendering its declaratory ruling, the Commission:. a) Shall consider all the materials submitted with the petition; or. b) May, in its discretion:. i) Consult individuals or materials outside the corners of the petition; or.
10.37.10.36.htm 10.37.10.36. 36 Effect and Appeal.. A. Effect.. 1) A declaratory ruling shall be binding upon the Commission and the petitioner on the statement of facts covered in the declaratory ruling and set forth in the petition.2) After notice and an opportunity to reply, a declaratory ruling may be reconsidered, amended, altered, or revoked by the Commission.B. Appeal. A declaratory ruling is subject to review as provided in State Government Article, §10-305, Annotated Code of Maryland.
10.37.10.9999.htm 10.37.10.9999. Administrative History Effective date: November 7, 1974 (1:4 Md. R. 177). Regulation .16 amended effective August 20, 1975 (2:18 Md. R. 1234). Regulation .100 adopted effective December 10, 1975 (2:28 Md. R. 1680) May 11, 1977 (4:10 Md. R. 767) ―Chapter revised effective October 27, 1976 (3:22 Md. R. 1250). Regulation .01 amended effective November 8, 2004 (31:22 Md. R. 1595). Regulation .01I, J adopted effective January 8, 1990 (16:26 Md. R. 2794).
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