Section 19-147 – Ratings Examiners
(a) The Commission shall approve an entity that meets the requirements of this section to be a ratings examiner. (b) To be approved by the Commission as a ratings examiner, an entity examining a physician rating system shall require a physician rating system to: (1) Use only quality of performance and cost efficiency as measurement categories; (2) Calculate and […]
Section 19-128 – Appeal of Administrative Decision
(a) (1) In this section, “aggrieved party” means: (i) An interested party who presented written comments on the application to the Commission and who would be adversely affected by the decision of the Commission on the project; or (ii) The Secretary. (2) The grounds for appeal by the Secretary shall be that the decision is inconsistent with the State health […]
Section 19-129 – Merger or Consolidation of Hospitals
(a) Notwithstanding the fact that a merger or consolidation may limit free economic competition, the Commission may approve the merger or consolidation of 2 or more hospitals if the merger or consolidation: (1) Is not inconsistent with the State health plan or any institution-specific plan; (2) Will result in the delivery of more efficient and effective hospital services; […]
Section 19-130 – Maryland Trauma Physician Services Fund
(a) (1) In this section the following words have the meanings indicated. (2) “Fund” means the Maryland Trauma Physician Services Fund. (3) “Maryland Trauma Specialty Referral Centers” means: (i) The Johns Hopkins Health System Burn Program; (ii) The Eye Trauma Center at the Wilmer Eye Institute at The Johns Hopkins Hospital; and (iii) The Curtis National Hand Center at Union Memorial Hospital. […]
Section 19-132 – Definitions
(a) In this Part III of this subtitle the following words have the meanings indicated. (b) “Ambulatory surgical facility” has the meaning stated in § 19–3B–01 of this title. (c) “Carrier” means: (1) An insurer or nonprofit health service plan that holds a certificate of authority and provides health insurance policies or contracts in the State in accordance with […]
Section 19-133 – Maryland Medical Care Data Base
(a) In this section, “code” means: (1) The applicable Current Procedural Terminology (CPT) code as adopted by the American Medical Association; or (2) If a CPT code is not available, the applicable code under an appropriate uniform coding scheme approved by the Commission. (b) The Commission shall establish a Maryland medical care data base to compile statewide data on […]
Section 19-134 – Medical Care Electronic Claims Clearinghouses
(a) (1) In order to more efficiently establish a medical care data base under § 19–133 of this subtitle, the Commission shall establish standards for the operation of one or more medical care electronic claims clearinghouses in Maryland and may license those clearinghouses meeting those standards. (2) In adopting regulations under this subsection, the Commission shall consider appropriate […]
Section 19-135 – Cost Control; Clinical Resource Management System
(a) The Commission may implement a system to encourage health care practitioners to voluntarily control the costs of health care services. (b) The Commission may require health care practitioners of selected health care specialties to cooperate with licensed operators of clinical resource management systems that allow health care practitioners to critically analyze their charges and utilization of […]
Section 19-136 – Obtaining Information Relating to the Utilization or Cost of Health Care Services
In any matter that relates to the utilization or cost of health care services rendered by health care practitioners or office facilities, the Commission may: (1) Hold a public hearing; (2) Conduct an investigation; or (3) Require the filing of any reasonable information.
Section 19-137 – Investigations to Authenticate Information
If the Commission considers a further investigation necessary or desirable to authenticate information in a report that a health care practitioner or office facility files under this subtitle, the Commission may make necessary further examination of the records or accounts of the health care practitioner or office facility, in accordance with the regulations of the […]