Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 5 › Subtitle 37 - HEALTH SERVICES COST REVIEW COMMISSION › Chapter 10.37.10 - Rate Application and Approval Procedures › Section 10.37.10.17 - Forms

Current through Register Vol. 51, No. 14, July 12, 2024
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 REVIEW COMMISSION PUBLIC NOTICE RATE
					 PROCEEDING OF (specify type of application) __________ (name of hospital)
					 (reference to proceeding)
PUBLIC NOTICE is hereby given that (specify type of
					 application) has been filed (by-concerning) (name of hospital) before the
					 Health Services Cost Review Commission in regard to the following rates or rate
					 components:
(Specify services and old and new rates or rate
					 components.)
Further notice shall be given when or if a public or
					 general hearing is held.
The file of this application is available for public
					 inspection at the offices of the Commission, 4160 Patterson Avenue, Baltimore,
					 Maryland 21215, during regular business hours.
HEALTH SERVICES COST REVIEW COMMISSION
C. Notice of Public Hearing.
PUBLIC NOTICE OF PUBLIC HEARING HEALTH SERVICES COST REVIEW
					 COMMISSION RATE PROCEEDING OF (specify type of application) __________ (name of
					 hospital) (reference to proceeding)
Pursuant to regulations of the Commission, the public
					 notice is hereby published of a public hearing before (the Commission) at
					 (location), at (time) A.M. or P.M., on (date), to consider the following issue
					 and/or rates of (name of hospital):
(Set forth issues and/or rates.)
The designated interested parties participating in this
					 proceeding are:
Provider Reimbursement Department of Blue Cross of
					 Maryland, Inc.
Medical Care Programs Administration of the Maryland
					 Department of Health and Mental Hygiene (Medicaid).
Division of Provider Reimbursement and Accounting Policy,
					 Bureau of Health Insurance, Social Security Administration, Department of
					 Health, Education and Welfare of the United States (Medicare).
(List other designated interested parties, if any, for the
					 hospital in question.)
Any person interested in this proceeding may attend the
					 hearing.
All persons wishing to present relevant testimony or a
					 statement at this public hearing shall forward copies to the hospital, each
					 designated interested party and nine copies to the Commission office. The
					 hospital and members of the public shall forward their testimony at least 8
					 days before the hearing. The designated interested parties shall forward their
					 testimony at any time before the close of the first session. The Office of the
					 Commission is as follows:
Health Services Cost Review Commission 4160 Patterson
					 Avenue Baltimore, Maryland 21215
Address of designated interested parties may be obtained at
					 the Commission's office at 764-2605.
All testimony and statements shall identify the proceeding
					 to which they pertain, setting forth the name of the hospital and the docket,
					 file and proceeding number, and must be signed by the person submitting the
					 testimony or statement or by a representative of a group submitting testimony
					 or a statement.
D. Notice
				  of General Hearing:
HEALTH SERVICES COST REVIEW COMMISSION PUBLIC NOTICE OF
					 GENERAL HEARING CONCERNING RATE PROCEEDING OF (specify type of application)
					 ______________ (name of hospital) (reference to proceeding)
Pursuant to rules of procedure of the Commission, public
					 notice is hereby given of a general hearing in the above proceeding at
					 (location), at (time) A.M., or P.M., on (date) concerning the following rates
					 or rate components of (hospital):
(Specify services and old and new rates or rate
					 components.)
Any person, group or organization interested in this matter
					 may attend this hearing and present written or oral statements concerning the
					 above rates or rate components.
Presentations may be limited as to time and the number of
					 spokespersons representing any group or organization may be limited.
The file in the above proceeding is available at the
					 offices of the Commission, 4160 Patterson Avenue, Baltimore, Maryland
					 21215.
HEALTH SERVICES COST REVIEW COMMISSION
E. Notice of Orders Nisi.
PUBLIC NOTICE AS TO ORDERS NISI HEALTH SERVICES COST REVIEW
					 COMMISSION
Pursuant to regulations of the Commission, public notice is
					 hereby given of the following Order Nisi of the Commission: (Order Nisi is to
					 be set forth in full, including tentatively approved rates and issues.)
Motions raising objections to the above tentatively
					 approved rates and/or issues shall be submitted (in person or by mail) to the
					 hospital and nine copies to the Commission office in legibly written or typed
					 copies, within the above deadline, _________________, 20__, identifying the
					 proceeding and Order Nisi to which objections are made.
A copy of the Commission's decision and opinions, if any,
					 may be obtained by written request to the Commission office as follows:
Health Services Cost Review Commission 4160 Patterson
					 Avenue Baltimore, Maryland 21215
Addresses of designated interested parties may be obtained
					 at the Commission's offices at 764-2605.
The record of the complete proceeding in which the above
					 Order Nisi was passed is open for public inspection at the above Commission
					 offices during regular business hours.
HEALTH SERVICES COST REVIEW COMMISSION
F. Order Nisi.
ORDER NISI
Upon (open public hearing) (recommendation of Commission
					 staff, etc.), it is this _____ day of _____________________, 20__, by the
					 Maryland Health Services Cost Review Commission,
ORDERED
, that (the following rate of
					 ________________ hospital be and they hereby are approved), (whatever actions
					 are to occur or whatever issues are to be resolved, etc.), as of the ____ day
					 of ____________ 20__, unless reasonable cause to the contrary is shown on or
					 before the ____ day of __________, 20__.
MARYLAND HEALTH SERVICES COST REVIEW COMMISSION
A majority of the Commission members have concurred in the
					 above Order.
G. Orders.
ORDER
Upon (consideration of Motion to
					 _____________________)(recommendation of Commission's staff, (consideration of
					 etc.), it is, this ____ day of ___________, 20__, by the Maryland Health
					 Services Cost Review Commission,
ORDERED
, that (requested action) be and it
					 hereby is (approved, disapproved, etc.).
MARYLAND HEALTH SERVICES COST REVIEW COMMISSION
A majority of the Commission members have concurred in the
					 above Order.
H. Motions.
MOTION
(Name of movant) hereby moves that the Health Services Cost
					 Review Commission (described action to be taken or question to be answered) and
					 as reasons therefore states:
(Set for the reasons, authorities, citations, etc.)
(date)(signature of movant)
(Type name, title, if any, and address and telephone number
					 of movant)
I. Service.
CERTIFICATE OF SERVICE
I HEREBY CERTIFY THAT on this ____ day of ___________,20__,
					 I (mailed or caused to be mailed) (served or caused to be served) a copy of the
					 above describe pleading) upon (state name and address of a party (parties) or
					 attorney (attorneys) upon whom a copy of the pleading was served)
Date: __________________, 20__
_____________________________________________________________________________
					 (Signature of party filing pleading)
J. Subpoena Duces Tecum for Rate Review.
WRIT OF SUBPOENA DUCES TECUM
TO: (name and address of person subpoenaed)
You are hereby summoned to appear in person at the
					 Commission's offices, 4160 Patterson Avenue, Baltimore, Maryland 21215 on
					 (date) at (time) to give testimony under oath concerning the above
					 proceeding.
You are also commanded then and there to produce the
					 following documents and records:
(description of documents and records)
____ (date)
					 _________________________________________________________________ Health
					 Services Cost Review Commission
K. Summons for Rate Review.
WRIT OF SUMMONS
TO: (Name and address of person summoned)
You are hereby summoned to appear in person at the
					 Commission's offices, 4160 Patterson Avenue, Baltimore, Maryland 21215 on
					 (date) at (time) to give testimony under oath concerning the above
					 proceeding.
____ (date)
					 _________________________________________________________________ Health
					 Services Cost Review Commission
L. Summons for Hearing.
WRIT OF SUMMONS
TO: (Name and address of person summoned)
You are hereby summoned to appear in person at a public
					 hearing before (the Commission), at (location) on (date) at (time) to testify
					 under oath thereat.
____ (date)
					 _________________________________________________________________ Health
					 Services Cost Review Commission
M. Subpoena Duces Tecum for Hearing.
WRIT OF SUBPOENA DUCES TECUM
TO: (name and address of person subpoenaed)
You are hereby summoned to appear in person at a public
					 hearing before (the Commission), in the above proceeding at (location) on
					 (date) at (time) to testify under oath thereat.
You are also commanded then and there to produce the
					 following documents and records:
(description of documents and records)
____ (date)
					 _________________________________________________________________ Health
					 Services Cost Review Commission