Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.10 - Maryland Trauma Physician Services Fund › Section 10.25.10.02 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
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 services program of a
				  medical school.
(4)
				  "Fraud" means knowingly and willfully making or causing to be made any false
				  statement or representation of a material fact:
(a) In a claim for payment; or
(b) In determining eligibility for
				  payments.
(5) "Fund"
				  means the Maryland Trauma Physician Services Fund.
(6) "HSCRC" means the Health Services Cost
				  Review Commission.
(7) "Maryland
				  Trauma Registry" means a clinical trauma registry maintained by MIEMSS that:
(a) Monitors and provides information
				  necessary to evaluate major trauma or specialty patient care, outcome, and
				  cost; and
(b) Assesses how
				  designated trauma centers and other hospitals comply with the trauma standards,
				  regulations, and protocols.
(8) Medicaid.
(a) "Medicaid" means the Maryland Medical
				  Assistance Program under Title XIX of the Social Security Act,
				  42 U.S.C. §
													1396, et seq. and the Children and Families
				  Health Care Program under Title XXI of § 4901 of the Balanced Budget Act
				  of 1997, that provide comprehensive medical and other health-related care for
				  indigent and medically indigent persons.
(b) "Medicaid" includes the services provided
				  by a managed care organization under the State waiver program authorized under
				  § 1115 of the Social Security Act,
				  42 U.S.C. §
													1396n.
(9) "Medicaid differential" means the
				  difference in reimbursement between Medicare and Medicaid for trauma services
				  provided by a trauma physician to a Medicaid trauma patient in a trauma
				  center.
(10) "Medicare economic
				  index (MEI)" means the federal Centers for Medicare and Medicaid Services'
				  measure of inflation in the inputs for providing physician services.
(11) "MIEMSS" means the Maryland Institute
				  for Emergency Medical Services Systems.
(12) On-Call Physician.
(a) "On-call physician" means a trauma
				  physician who commits for a specific time period to be available and respond
				  within a certain amount of time, as defined by MIEMSS, to provide care for a
				  trauma patient in the trauma center.
(b) "On-call physician" does not include a
				  physician on standby in a trauma center.
(13) On-Call Costs.
(a) "On-call costs" means the costs to a
				  trauma center to have trauma physicians available and ready to respond to
				  trauma patients within a certain amount of time, as defined by
				  MIEMSS.
(b) "On-call costs" does
				  not include standby costs.
(14) "On-call services application" means the
				  Maryland Trauma Physician Services Fund semiannual on-call trauma services
				  application, developed by the Commission.
(15) "Reasonable compensation
				  equivalent(RCE)":
(a) Is a methodology
				  established by Medicare to set limits on what a hospital may claim per
				  physician specialty standby hour; and
(b) Has the meaning described in 68 FR 45458
				  (Aug. 1, 2003).
(16)
				  Service Period.
(a) "Service period" means the
				  time that trauma services are provided from entrance to the trauma center until
				  dismissal or discharge from the trauma center.
(b) "Service period" includes a subsequent
				  readmission or outpatient visit to the trauma center for services that are
				  directly related to the initial trauma injury.
(17) "Specialty referral center" means:
(a) The Curtis National Hand Center at Union
				  Memorial Hospital;
(b) The Eye
				  Trauma Center at the Wilmer Eye Institute at The Johns Hopkins Hospital;
				  and
(c) The Johns Hopkins Health
				  System Burn Program.
(18) "Standby costs" means costs to a trauma
				  center for paying physicians to be available on site at the trauma center to
				  treat trauma patients.
(19) Trauma
				  Center.
(a) "Trauma center" means a hospital
				  designated by the Maryland Institute for Emergency Medical Services
				  Systems(MIEMSS) as:
(i) The State primary
				  adult resource center;
(ii) A Level
				  I trauma center;
(iii) A Level II
				  trauma center;
(iv) A Level III
				  trauma center;
(v) A pediatric
				  trauma center; or
(vi) A specialty
				  referral center as defined in §B(17) of this regulation.
(b) "Trauma center" includes an
				  out-of-State pediatric trauma center that has entered into an agreement with
				  MIEMSS.
(20) "Trauma
				  patient" means a patient whose trauma services are documented in the Maryland
				  Trauma Registry.
(21) "Trauma
				  physician" means a physician who provides trauma services during the service
				  period to a trauma patient on the Maryland Trauma Registry as defined by the
				  Maryland Institute for Emergency Medical Services Systems(MIEMSS).
(22) "Trauma services" means trauma care
				  provided to a trauma patient in a trauma center, trauma-center-affiliated
				  rehabilitation hospital, or rehabilitation unit of a trauma center.
(23) "Uncompensated care" means trauma
				  services provided by a trauma physician to a trauma patient on the Maryland
				  Trauma Registry who:
(a) Has no health
				  insurance, including private health insurance, Medicare Part B coverage, VA
				  health benefits, or CHAMPUS;
(b) Is
				  not covered by Workers' Compensation coverage;
(c) Is not eligible for Medical Assistance
				  coverage; and
(d) Has not paid the
				  full Medicare reimbursement for the trauma care received, even after documented
				  attempts by the trauma physician to obtain payment.
(24) "Uncompensated care shortfall" means the
				  difference in reimbursement between what Medicare pays and what the trauma
				  physician providing care collects from the uncompensated care trauma
				  patient.
(25) "Uncompensated
				  services claim" means a CMS 1500 form or an ANSI 837 electronic transaction
				  completed according to Commission specifications and submitted for
				  reimbursement of uncompensated care services.