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 10.25.10.11 - Equitable Payment Under the Fund
Universal Citation: MD Code Reg 10.25.10.11
Current through Register Vol. 51, No. 19, September 20, 2024
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 appropriate levels of payment that can be sustained
for the upcoming fiscal year beginning July 1, given the expected revenue in
the Fund.
(2) If expected revenue
in the Fund is insufficient to meet expected payments, the Medicaid
differential payments, uncompensated care shortfall payments, trauma center
on-call payments, and standby payments to an out-of-State pediatric trauma
center shall be adjusted by the same rate to maintain solvency in the
Fund.
(3) The Commission shall
maintain a sufficient balance in the Fund to assure equitable payments across a
fiscal year.
(4) If Fund payments
require adjustment, the Commission shall report to the trauma centers and the
trauma physicians listed on trauma center rosters the expected payment levels
for the upcoming State fiscal year by June 30.
D. If the Commission estimates that operating shortfalls will occur during a fiscal year and that those shortfalls will be sufficiently large that the annual update process cannot be used, the Commission shall use the following conventions:
(1) On-call payments for the next semiannual
reporting period shall be adjusted to preserve solvency in the Fund;
(2) Priority for meeting the funding needs of
Level III trauma centers to maintain physicians shall be maintained;
(3) The Commission may not change Medicaid
reimbursement during a fiscal year, unless a 4-month notice is provided to the
Medicaid program and the uncompensated care and on-call payments have already
been halted; and
(4) The Commission
shall adjust Medicaid reimbursements during subsequent annual update processes
to adjust for any inequities that arise due to implementation of §D(3) of
this regulation during the preceding fiscal year.
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