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<section article="ghg" article_name="Health - General" number="19-130" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation">
  <level label="a">
    <level label="1">
      <text>In this section the following words have the meanings indicated.</text>
    </level>
    <level label="2">
      <text>“Fund” means the Maryland Trauma Physician Services Fund.</text>
    </level>
    <level label="3">
      <text>“Maryland Trauma Specialty Referral Centers” means:</text>
      <level label="i">
        <text>The Johns Hopkins Health System Burn Program;</text>
      </level>
      <level label="ii">
        <text>The Eye Trauma Center at the Wilmer Eye Institute at The Johns Hopkins Hospital; and</text>
      </level>
      <level label="iii">
        <text>The Curtis National Hand Center at Union Memorial Hospital.</text>
      </level>
    </level>
    <level label="4">
      <text>“Reasonable compensation equivalent” means the limitation on the cost established by the Centers for Medicare and Medicaid Services that a provider may claim for compensation of services.</text>
    </level>
    <level label="5">
      <text>“Rehabilitation hospital” means a facility classified as a special rehabilitation hospital as described in § 19–307 of this title that is affiliated with a trauma center by common ownership.</text>
    </level>
    <level label="6">
      <level label="i">
        <text>“Trauma center” means a facility designated by the Maryland Institute for Emergency Medical Services Systems as:</text>
        <level label="1">
          <text>The State primary adult resource center;</text>
        </level>
        <level label="2">
          <text>A Level I trauma center;</text>
        </level>
        <level label="3">
          <text>A Level II trauma center;</text>
        </level>
        <level label="4">
          <text>A Level III trauma center;</text>
        </level>
        <level label="5">
          <text>A pediatric trauma center; or</text>
        </level>
        <level label="6">
          <text>The Maryland Trauma Specialty Referral Centers.</text>
        </level>
      </level>
      <level label="ii">
        <text>“Trauma center” includes an out–of–state pediatric trauma center that has entered into an agreement with the Maryland Institute for Emergency Medical Services Systems.</text>
      </level>
    </level>
    <level label="7">
      <text>“Trauma health care practitioner” means a health care practitioner licensed under the Health Occupations Article who provides care in a trauma center or in a rehabilitation hospital to trauma patients on the State trauma registry as defined by the Maryland Institute for Emergency Medical Services Systems.</text>
    </level>
    <level label="8">
      <text>“Trauma physician” means a physician who provides care in a trauma center or in a rehabilitation hospital to trauma patients on the State trauma registry as defined by the Maryland Institute for Emergency Medical Services Systems.</text>
    </level>
    <level label="9">
      <text>“Uncompensated care” means care provided by a trauma physician or a trauma health care practitioner to a trauma patient on the State trauma registry who:</text>
      <level label="i">
        <text>Has no health insurance, including Medicare Part B coverage;</text>
      </level>
      <level label="ii">
        <text>Is not eligible for medical assistance coverage; and</text>
      </level>
      <level label="iii">
        <text>Has not paid the trauma physician or trauma health care practitioner for care provided by the trauma physician or trauma health care practitioner, after documented attempts by the trauma physician or trauma health care practitioner to collect payment.</text>
      </level>
    </level>
  </level>
  <level label="b">
    <level label="1">
      <text>There is a Maryland Trauma Physician Services Fund.</text>
    </level>
    <level label="2">
      <text>The purpose of the Fund is to subsidize the documented costs:</text>
      <level label="i">
        <text>Of uncompensated care incurred by a trauma physician or trauma health care practitioner in providing trauma care to a trauma patient on the State trauma registry;</text>
      </level>
      <level label="ii">
        <text>Of undercompensated care incurred by a trauma physician or trauma health care practitioner in providing trauma care to an enrollee of the Maryland Medical Assistance Program who is a trauma patient on the State trauma registry;</text>
      </level>
      <level label="iii">
        <text>Incurred by a trauma center to maintain trauma physicians on–call as required by the Maryland Institute for Emergency Medical Services Systems;</text>
      </level>
      <level label="iv">
        <text>Incurred by the State primary adult resource center to maintain trauma surgeons, orthopedic surgeons, neurosurgeons, and anesthesiologists on–call and on standby as required by the Maryland Institute for Emergency Medical Services Systems; and</text>
      </level>
      <level label="v">
        <text>Incurred by the Commission and the Health Services Cost Review Commission to administer the Fund and audit reimbursement requests to assure appropriate payments are made from the Fund.</text>
      </level>
    </level>
    <level label="3">
      <text>The Commission and the Health Services Cost Review Commission shall administer the Fund.</text>
    </level>
    <level label="4">
      <text>The Fund is a special, nonlapsing fund that is not subject to § 7–302 of the State Finance and Procurement Article.</text>
    </level>
    <level label="5">
      <text>Interest on and other income from the Fund shall be separately accounted for and credited to the Fund, and are not subject to § 6–226(a) of the State Finance and Procurement Article.</text>
    </level>
  </level>
  <level label="c">
    <text>The Fund consists of:</text>
    <level label="1">
      <text>Motor vehicle registration surcharges paid into the Fund in accordance with § 13–954(b)(2) of the Transportation Article;</text>
    </level>
    <level label="2">
      <text>At least 20% of the fines collected under § 21–902(a)(1), (b)(2), (c)(2), and (d)(1) of the Transportation Article; and</text>
    </level>
    <level label="3">
      <text>Any other money transferred from the General Fund of the State.</text>
    </level>
  </level>
  <level label="d">
    <level label="1">
      <text>Disbursements from the Fund shall be made in accordance with a methodology established jointly by the Commission and the Health Services Cost Review Commission to calculate costs incurred by trauma physicians and trauma centers that are eligible to receive reimbursement under subsection (b) of this section.</text>
    </level>
    <level label="2">
      <text>The Fund shall transfer to the Maryland Department of Health an amount sufficient to fully cover the State’s share of expenditures for the costs of undercompensated care incurred by a trauma physician in providing trauma care to an enrollee of the Maryland Medical Assistance Program who is a trauma patient on the State trauma registry.</text>
    </level>
    <level label="3">
      <text>The methodology developed under paragraph (1) of this subsection shall:</text>
      <level label="i">
        <text>Take into account:</text>
        <level label="1">
          <text>The amount of uncompensated care provided by trauma physicians;</text>
        </level>
        <level label="2">
          <text>The amount of undercompensated care attributable to the treatment of Medicaid enrollees in trauma centers;</text>
        </level>
        <level label="3">
          <text>The cost of maintaining trauma physicians on–call;</text>
        </level>
        <level label="4">
          <text>The number of patients served by trauma physicians in trauma centers;</text>
        </level>
        <level label="5">
          <text>The number of Maryland residents served by trauma physicians in trauma centers; and</text>
        </level>
        <level label="6">
          <text>The extent to which trauma–related costs are otherwise subsidized by hospitals, the federal government, and other sources; and</text>
        </level>
      </level>
      <level label="ii">
        <text>Include an incentive to encourage hospitals to continue to subsidize trauma–related costs not otherwise included in hospital rates.</text>
      </level>
    </level>
    <level label="4">
      <text>The methodology developed under paragraph (1) of this subsection shall use the following parameters to determine the amount of reimbursement made to trauma physicians and trauma centers from the Fund:</text>
      <level label="i">
        <level label="1">
          <text>The cost incurred by a Level II trauma center to maintain trauma surgeons, orthopedic surgeons, and neurosurgeons on–call shall be reimbursed:</text>
        </level>
        <level label="A">
          <text>At a rate of up to 60% of the reasonable compensation equivalent hourly rate for the specialty, inflated to the current year by the physician compensation component of the Medicare economic index as designated by the Centers for Medicare and Medicaid Services; and</text>
        </level>
        <level label="B">
          <text>For the minimum number of trauma physicians required to be on–call, as specified by the Maryland Institute for Emergency Medical Services Systems in its criteria for Level II trauma centers;</text>
        </level>
        <level label="2">
          <text>The cost incurred by a Level III trauma center to maintain trauma surgeons, orthopedic surgeons, neurosurgeons, and anesthesiologists on–call shall be reimbursed:</text>
        </level>
        <level label="A">
          <text>At a rate of up to 60% of the reasonable compensation equivalent hourly rate for the specialty, inflated to the current year by the physician compensation component of the Medicare economic index as designated by the Centers for Medicare and Medicaid Services; and</text>
        </level>
        <level label="B">
          <text>For the minimum number of trauma physicians required to be on–call, as specified by the Maryland Institute for Emergency Medical Services Systems in its criteria for Level III trauma centers;</text>
        </level>
        <level label="3">
          <text>The cost incurred by a Level I trauma center or pediatric trauma center to maintain trauma surgeons, orthopedic surgeons, and neurosurgeons on–call when a post–graduate resident is attending in the trauma center shall be reimbursed:</text>
        </level>
        <level label="A">
          <text>At a rate of up to 60% of the reasonable compensation equivalent hourly rate for the specialty, inflated to the current year by the physician compensation component of the Medicare economic index as designated by the Centers for Medicare and Medicaid Services; and</text>
        </level>
        <level label="B">
          <text>When a post–graduate resident is authorized to be in the trauma center, as specified by the Maryland Institute for Emergency Medical Services Systems in its criteria for Level I trauma centers or pediatric trauma centers;</text>
        </level>
        <level label="4">
          <text>The cost incurred by a Maryland Trauma Specialty Referral Center to maintain trauma surgeons on–call in the specialty of the Center when a post–graduate resident is attending in the Center shall be reimbursed:</text>
        </level>
        <level label="A">
          <text>At a rate of up to 60% of the reasonable compensation equivalent hourly rate for the specialty, inflated to the current year by the physician compensation component of the Medicare economic index as designated by the Centers for Medicare and Medicaid Services; and</text>
        </level>
        <level label="B">
          <text>When a post–graduate resident is authorized to be in the Center, as specified by the Maryland Institute for Emergency Medical Services Systems in its criteria for a Maryland Trauma Specialty Referral Center; and</text>
        </level>
        <level label="5">
          <level label="A">
            <text>A Level II trauma center is eligible for a maximum of 26,280 hours of trauma on–call per year;</text>
          </level>
        </level>
        <level label="B">
          <text>A Level III trauma center is eligible for a maximum of 35,040 hours of trauma on–call per year;</text>
        </level>
        <level label="C">
          <text>A Level I trauma center shall be eligible for a maximum of 4,380 hours of trauma on–call per year;</text>
        </level>
        <level label="D">
          <text>A pediatric trauma center shall be eligible for a maximum of 4,380 hours of trauma on–call per year; and</text>
        </level>
        <level label="E">
          <text>A Maryland Trauma Specialty Referral Center shall be eligible for a maximum of 2,190 hours of trauma on–call per year;</text>
        </level>
      </level>
      <level label="ii">
        <text>The cost of undercompensated care incurred by a trauma physician in providing trauma care to enrollees of the Maryland Medical Assistance Program who are trauma patients on the State trauma registry shall be reimbursed at a rate of up to 100% of the Medicare payment for the service, minus any amount paid by the Maryland Medical Assistance Program;</text>
      </level>
      <level label="iii">
        <text>The cost of uncompensated care incurred by a trauma physician in providing trauma care to trauma patients on the State trauma registry shall be reimbursed at a rate of 100% of the Medicare payment for the service, minus any recoveries made by the trauma physician for the care;</text>
      </level>
      <level label="iv">
        <text>The Commission, in consultation with the Health Services Cost Review Commission, may establish a payment rate for uncompensated care incurred by a trauma physician in providing trauma care to trauma patients on the State trauma registry that is above 100% of the Medicare payment for the service if:</text>
        <level label="1">
          <text>The Commission determines that increasing the payment rate above 100% of the Medicare payment for the service will address an unmet need in the State trauma system; and</text>
        </level>
        <level label="2">
          <text>The Commission reports on its intention to increase the payment rate to the Senate Finance Committee and the House Health and Government Operations Committee, in accordance with § 2–1257 of the State Government Article, at least 60 days before any adjustment to the rate;</text>
        </level>
      </level>
      <level label="v">
        <text>The Commission shall develop guidelines for the reimbursement of the documented costs of the State primary adult resource center under subsection (b)(2)(iv) of this section;</text>
      </level>
      <level label="vi">
        <text>The Commission, in consultation with the Health Services Cost Review Commission, may change the percentage of the reasonable compensation equivalent paid to trauma hospitals if:</text>
        <level label="1">
          <text>The Commission determines that the projected revenue to be collected in the Fund is adequate to support the proposed increase in the percentage of reasonable compensation equivalent inflated to the current year by the physician compensation component of the Medicare economic index; and</text>
        </level>
        <level label="2">
          <text>The Commission reports on its intention to change the percentage of reasonable compensation equivalent to be paid for on–call costs to the Senate Finance Committee and the House Health and Government Operations Committee, in accordance with § 2–1257 of the State Government Article, at least 60 days before any adjustment to the allowable hours;</text>
        </level>
      </level>
      <level label="vii">
        <text>The Commission, in consultation with the Health Services Cost Review Commission, may change the number of allowable hours of trauma on–call each year if the Commission reports on its intention to change the number of allowable hours to the Senate Finance Committee and the House Health and Government Operations Committee, in accordance with § 2–1257 of the State Government Article, at least 60 days before any adjustment to the allowable hours;</text>
      </level>
      <level label="viii">
        <text>The Commission may modify the percentage paid of the reasonable compensation equivalent for on–call hours not more than once each year; and</text>
      </level>
      <level label="ix">
        <text>The total reimbursement to emergency physicians from the Fund may not exceed $300,000 annually.</text>
      </level>
    </level>
    <level label="5">
      <text>In order to receive reimbursement, a trauma physician or trauma health care practitioner in the case of costs of uncompensated care under subsection (b)(2)(i) of this section, or a trauma center in the case of on–call costs under subsection (b)(2)(iii) of this section, shall apply to the Fund on a form and in a manner approved by the Commission and the Health Services Cost Review Commission.</text>
    </level>
    <level label="6">
      <level label="i">
        <text>The Commission and the Health Services Cost Review Commission shall adopt regulations that specify the information that trauma physicians, trauma health care practitioners, and trauma centers must submit to receive money from the Fund.</text>
      </level>
      <level label="ii">
        <text>The information required shall include:</text>
        <level label="1">
          <text>The name and federal tax identification number of the trauma physician rendering the service;</text>
        </level>
        <level label="2">
          <text>The date of the service;</text>
        </level>
        <level label="3">
          <text>Appropriate codes describing the service;</text>
        </level>
        <level label="4">
          <text>Any amount recovered for the service rendered;</text>
        </level>
        <level label="5">
          <text>The name of the trauma patient;</text>
        </level>
        <level label="6">
          <text>The patient’s trauma registry number; and</text>
        </level>
        <level label="7">
          <text>Any other information the Commission and the Health Services Cost Review Commission consider necessary to disburse money from the Fund.</text>
        </level>
      </level>
      <level label="iii">
        <text>It is the intent of the General Assembly that trauma physicians and trauma centers shall cooperate with the Commission and the Health Services Cost Review Commission by providing information required under this paragraph in a timely and complete manner.</text>
      </level>
    </level>
  </level>
  <level label="e">
    <level label="1">
      <text>Except as provided in paragraph (2) of this subsection and notwithstanding any other provision of law, expenditures from the Fund for costs incurred in any fiscal year may not exceed revenues of the Fund.</text>
    </level>
    <level label="2">
      <level label="i">
        <text>The Commission, in consultation with the Health Services Cost Review Commission and the Maryland Institute for Emergency Medical Services Systems, shall develop a process for the award of grants to Level I, Level II, and Level III trauma centers in the delivery of trauma care.</text>
      </level>
      <level label="ii">
        <level label="1">
          <text>The Commission shall issue grants under this paragraph from any balance carried over to the Fund from prior fiscal years.</text>
        </level>
        <level label="2">
          <text>The total amount of grants awarded under this paragraph in a fiscal year may not reduce the balance remaining in the Fund at the end of the fiscal year to less than 15% of the revenue collected in that fiscal year.</text>
        </level>
      </level>
      <level label="iii">
        <text>The process developed by the Commission for the award of grants under this paragraph shall include:</text>
        <level label="1">
          <text>Grant applications and review and selection criteria for the award of grants;</text>
        </level>
        <level label="2">
          <text>Review by the Commission, if necessary, for any project that exceeds certificate of need thresholds; and</text>
        </level>
        <level label="3">
          <text>Any other procedure determined necessary by the Commission.</text>
        </level>
      </level>
      <level label="iv">
        <text>Before awarding grants under this subsection in a fiscal year, the Commission shall report to the Senate Finance Committee and the House Health and Government Operations Committee, in accordance with § 2–1257 of the State Government Article, on the process that the Commission has developed for awarding grants in that fiscal year.</text>
      </level>
    </level>
  </level>
  <level label="f">
    <text>On or before November 1 of each year, the Commission and the Health Services Cost Review Commission shall report to the General Assembly, in accordance with § 2–1257 of the State Government Article, on:</text>
    <level label="1">
      <text>The amount of money in the Fund on the last day of the previous fiscal year;</text>
    </level>
    <level label="2">
      <text>The amount of money applied for by trauma physicians, trauma health care practitioners, and trauma centers during the previous fiscal year;</text>
    </level>
    <level label="3">
      <text>The amount of money distributed in the form of trauma physician, trauma health care practitioner, and trauma center reimbursements during the previous fiscal year;</text>
    </level>
    <level label="4">
      <text>Any recommendations for altering the manner in which trauma physicians, trauma health care practitioners, and trauma centers are reimbursed from the Fund;</text>
    </level>
    <level label="5">
      <text>The costs incurred in administering the Fund during the previous fiscal year;</text>
    </level>
    <level label="6">
      <text>The amount that each hospital that participates in the Maryland trauma system and that has a trauma center contributes toward the subsidization of trauma–related costs for its trauma center;</text>
    </level>
    <level label="7">
      <text>The costs that hospitals reported to the Health Services Cost Review Commission and are accounted for in the global budgets of the hospitals for each of the following:</text>
      <level label="i">
        <text>Trauma standby;</text>
      </level>
      <level label="ii">
        <text>Allowable trauma center costs for reimbursing the trauma director and trauma staff;</text>
      </level>
      <level label="iii">
        <text>Maintaining Maryland Institute for Emergency Medical Services Systems trauma protocols;</text>
      </level>
      <level label="iv">
        <text>Maintaining specialized trauma staff;</text>
      </level>
      <level label="v">
        <text>Procuring specialized trauma equipment; and</text>
      </level>
      <level label="vi">
        <text>Providing trauma education and training; and</text>
      </level>
    </level>
    <level label="8">
      <text>Any improvements made by trauma centers as a result of an increase in funding.</text>
    </level>
  </level>
  <level label="g">
    <text>The Commission shall award an annual grant from the Fund in the amount up to $1,800,000 to Level I pediatric trauma centers as follows:</text>
    <level label="1">
      <text>Up to $900,000 to Johns Hopkins Children’s Center; and</text>
    </level>
    <level label="2">
      <text>Up to $900,000 to Children’s National Medical Center.</text>
    </level>
  </level>
</section>
