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<section article="gho" article_name="Health Occupations" number="1-301" title_number="1" title_name="Definitions; General Provisions" subtitle_number="3" subtitle_name="Patient Referrals">
  <level label="a">
    <text>In this subtitle the following words have the meanings indicated.</text>
  </level>
  <level label="b">
    <level label="1">
      <text>“Beneficial interest” means ownership, through equity, debt, or other means, of any financial interest.</text>
    </level>
    <level label="2">
      <text>“Beneficial interest” does not include ownership, through equity, debt, or other means, of securities, including shares or bonds, debentures, or other debt instruments:</text>
      <level label="i">
        <text>In a corporation that is traded on a national exchange or over the counter on the national market system;</text>
      </level>
      <level label="ii">
        <text>That at the time of acquisition, were purchased at the same price and on the same terms generally available to the public;</text>
      </level>
      <level label="iii">
        <text>That are available to individuals who are not in a position to refer patients to the health care entity on the same terms that are offered to health care practitioners who may refer patients to the health care entity;</text>
      </level>
      <level label="iv">
        <text>That are unrelated to the past or expected volume of referrals from the health care practitioner to the health care entity; and</text>
      </level>
      <level label="v">
        <text>That are not marketed differently to health care practitioners that may make referrals than they are marketed to other individuals.</text>
      </level>
    </level>
  </level>
  <level label="c">
    <level label="1">
      <text>“Compensation arrangement” means any agreement or system involving any remuneration between a health care practitioner or the immediate family member of the health care practitioner and a health care entity.</text>
    </level>
    <level label="2">
      <text>“Compensation arrangement” does not include:</text>
      <level label="i">
        <text>Compensation or shares under a faculty practice plan or a professional corporation affiliated with a teaching hospital and comprised of health care practitioners who are members of the faculty of a university;</text>
      </level>
      <level label="ii">
        <text>Amounts paid under a bona fide employment agreement between a health care entity and a health care practitioner or an immediate family member of the health care practitioner;</text>
      </level>
      <level label="iii">
        <text>An arrangement between a health care entity and a health care practitioner or the immediate family member of a health care practitioner for the provision of any services, as an independent contractor, if:</text>
        <level label="1">
          <text>The arrangement is for identifiable services;</text>
        </level>
        <level label="2">
          <text>The amount of the remuneration under the arrangement is consistent with the fair market value of the service and is not determined in a manner that takes into account, directly or indirectly, the volume or value of any referrals by the referring health care practitioner; and</text>
        </level>
        <level label="3">
          <text>The compensation is provided in accordance with an agreement that would be commercially reasonable even if no referrals were made to the health care provider;</text>
        </level>
      </level>
      <level label="iv">
        <text>Compensation for health care services pursuant to a referral from a health care practitioner and rendered by a health care entity, that employs or contracts with an immediate family member of the health care practitioner, in which the immediate family member’s compensation is not based on the referral;</text>
      </level>
      <level label="v">
        <text>An arrangement for compensation which is provided by a health care entity to a health care practitioner or the immediate family member of the health care practitioner to induce the health care practitioner or the immediate family member of the health care practitioner to relocate to the geographic area served by the health care entity in order to be a member of the medical staff of a hospital, if:</text>
        <level label="1">
          <text>The health care practitioner or the immediate family member of the health care practitioner is not required to refer patients to the health care entity;</text>
        </level>
        <level label="2">
          <text>The amount of the compensation under the arrangement is not determined in a manner that takes into account, directly or indirectly, the volume or value of any referrals by the referring health care practitioner; and</text>
        </level>
        <level label="3">
          <text>The health care entity needs the services of the practitioner to meet community health care needs and has had difficulty in recruiting a practitioner;</text>
        </level>
      </level>
      <level label="vi">
        <text>Payments made for the rental or lease of office space if the payments are:</text>
        <level label="1">
          <text>At fair market value; and</text>
        </level>
        <level label="2">
          <text>In accordance with an arm’s length transaction;</text>
        </level>
      </level>
      <level label="vii">
        <text>Payments made for the rental or lease of equipment if the payments are:</text>
        <level label="1">
          <text>At fair market value; and</text>
        </level>
        <level label="2">
          <text>In accordance with an arm’s length transaction; or</text>
        </level>
      </level>
      <level label="viii">
        <text>Payments made for the sale of property or a health care practice if the payments are:</text>
        <level label="1">
          <text>At fair market value;</text>
        </level>
        <level label="2">
          <text>In accordance with an arm’s length transaction; and</text>
        </level>
        <level label="3">
          <text>Provided in accordance with an agreement that would be commercially reasonable even if no referrals were made.</text>
        </level>
      </level>
    </level>
  </level>
  <level label="d">
    <text>“Direct supervision” means a health care practitioner is present on the premises where the health care services or tests are provided and is available for consultation within the treatment area.</text>
  </level>
  <level label="e">
    <text>“Faculty practice plan” means a tax–exempt organization established under Maryland law by or at the direction of a university to accommodate the professional practice of members of the faculty who are health care practitioners.</text>
  </level>
  <level label="f">
    <text>“Group practice” means a group of two or more health care practitioners legally organized as a partnership, professional corporation, foundation, nonprofit corporation, faculty practice plan, or similar association:</text>
    <level label="1">
      <text>In which each health care practitioner who is a member of the group provides substantially the full range of services which the practitioner routinely provides through the joint use of shared office space, facilities, equipment, and personnel;</text>
    </level>
    <level label="2">
      <text>For which substantially all of the services of the health care practitioners who are members of the group are provided through the group and are billed in the name of the group and amounts so received are treated as receipts of the group; and</text>
    </level>
    <level label="3">
      <text>In which the overhead expenses of and the income from the practice are distributed in accordance with methods previously determined on an annual basis by members of the group.</text>
    </level>
  </level>
  <level label="g">
    <text>“Health care entity” means a business entity that provides health care services for the:</text>
    <level label="1">
      <text>Testing, diagnosis, or treatment of human disease or dysfunction; or</text>
    </level>
    <level label="2">
      <text>Dispensing of drugs, medical devices, medical appliances, or medical goods for the treatment of human disease or dysfunction.</text>
    </level>
  </level>
  <level label="h">
    <text>“Health care practitioner” means a person who is licensed, certified, or otherwise authorized under this article to provide health care services in the ordinary course of business or practice of a profession.</text>
  </level>
  <level label="i">
    <text>“Health care service” means medical procedures, tests and services provided to a patient by or through a health care entity.</text>
  </level>
  <level label="j">
    <text>“Immediate family member” means a health care practitioner’s:</text>
    <level label="1">
      <text>Spouse;</text>
    </level>
    <level label="2">
      <text>Child;</text>
    </level>
    <level label="3">
      <text>Child’s spouse;</text>
    </level>
    <level label="4">
      <text>Parent;</text>
    </level>
    <level label="5">
      <text>Spouse’s parent;</text>
    </level>
    <level label="6">
      <text>Sibling; or</text>
    </level>
    <level label="7">
      <text>Sibling’s spouse.</text>
    </level>
  </level>
  <level label="k">
    <level label="1">
      <text>“In–office ancillary services” means those basic health care services and tests routinely performed in the office of one or more health care practitioners.</text>
    </level>
    <level label="2">
      <text>Except for a radiologist group practice or an office consisting solely of one or more radiologists, “in–office ancillary services” does not include:</text>
      <level label="i">
        <text>Magnetic resonance imaging services;</text>
      </level>
      <level label="ii">
        <text>Radiation therapy services; or</text>
      </level>
      <level label="iii">
        <text>Computer tomography scan services.</text>
      </level>
    </level>
  </level>
  <level label="l">
    <level label="1">
      <text>“Referral” means any referral of a patient for health care services.</text>
    </level>
    <level label="2">
      <text>“Referral” includes:</text>
      <level label="i">
        <text>The forwarding of a patient by one health care practitioner to another health care practitioner or to a health care entity outside the health care practitioner’s office or group practice; or</text>
      </level>
      <level label="ii">
        <text>The request or establishment by a health care practitioner of a plan of care for the provision of health care services outside the health care practitioner’s office or group practice.</text>
      </level>
    </level>
  </level>
</section>
