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<regulation prefix="Regulation" num=".02" citation="COMAR 10.25.10.02" title_num="10" subtitle_num="25" chapter_num="10" heading="Definitions.">
  <paragraph num="A.">
    <text>In this chapter, the following terms have the meanings indicated.</text>
  </paragraph>
  <paragraph num="B.">
    <text>Terms Defined.</text>
    <paragraph num="(1)">
      <text>“Applicant” means a person or entity eligible to file a claim to receive reimbursement from the Fund.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>“Commission” means the Maryland Health Care Commission.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>“Faculty practice plan” means a professional services organization that:</text>
      <paragraph num="(a)">
        <text>Includes physicians; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Is formed to carry out, improve, and supplement the medical education, research, and clinical services program of a medical school.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>“Fraud” means knowingly and willfully making or causing to be made any false statement or representation of a material fact:</text>
      <paragraph num="(a)">
        <text>In a claim for payment; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>In determining eligibility for payments.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(5)">
      <text>“Fund” means the Maryland Trauma Physician Services Fund.</text>
    </paragraph>
    <paragraph num="(6)">
      <text>“HSCRC” means the Health Services Cost Review Commission.</text>
    </paragraph>
    <paragraph num="(7)">
      <text>“Maryland Trauma Registry” means a clinical trauma registry maintained by MIEMSS that:</text>
      <paragraph num="(a)">
        <text>Monitors and provides information necessary to evaluate major trauma or specialty patient care, outcome, and cost; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Assesses how designated trauma centers and other hospitals comply with the trauma standards, regulations, and protocols.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(8)">
      <text>Medicaid.</text>
      <paragraph num="(a)">
        <text>“Medicaid” means the Maryland Medical Assistance Program under Title XIX of the Social Security Act, 42 U.S.C. §1396, et seq. and the Children and Families Health Care Program under Title XXI of §4901 of the Balanced Budget Act of 1997, that provide comprehensive medical and other health-related care for indigent and medically indigent persons.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>“Medicaid” includes the services provided by a managed care organization under the State waiver program authorized under §1115 of the Social Security Act, 42 U.S.C. §1396n.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(9)">
      <text>“Medicaid differential” means the difference in reimbursement between Medicare and Medicaid for trauma services provided by a trauma physician or trauma health care practitioner to a Medicaid trauma patient in a trauma center.</text>
    </paragraph>
    <paragraph num="(10)">
      <text>“Medicare economic index (MEI)” means the federal Centers for Medicare and Medicaid Services' measure of inflation in the inputs for providing physician services.</text>
    </paragraph>
    <paragraph num="(11)">
      <text>“MIEMSS” means the Maryland Institute for Emergency Medical Services Systems.</text>
    </paragraph>
    <paragraph num="(12)">
      <text>On-Call Physician.</text>
      <paragraph num="(a)">
        <text>“On-call physician” means a trauma physician who commits for a specific time period to be available and respond within a certain amount of time, as defined by MIEMSS, to provide care for a trauma patient in the trauma center.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>“On-call physician” does not include a physician on standby in a trauma center.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(13)">
      <text>On-Call Costs.</text>
      <paragraph num="(a)">
        <text>“On-call costs” means the costs to a trauma center to have trauma physicians available and ready to respond to trauma patients within a certain amount of time, as defined by MIEMSS.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>“On-call costs” does not include standby costs.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(14)">
      <text>“On-call services application” means the difference in reimbursement between Medicare and Medicaid for trauma services provided by a trauma physician or trauma health care practitioner to a Medicaid trauma patient in a trauma center.</text>
    </paragraph>
    <paragraph num="(15)">
      <text>“Reasonable compensation equivalent (RCE)”:</text>
      <paragraph num="(a)">
        <text>Is a methodology established by Medicare to set limits on what a hospital may claim per physician specialty standby hour; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Has the meaning described in 68 FR 45458 (Aug. 1, 2003).</text>
      </paragraph>
    </paragraph>
    <paragraph num="(16)">
      <text>Service Period.</text>
      <paragraph num="(a)">
        <text>“Service period” means the time that trauma services are provided from entrance to the trauma center until dismissal or discharge from the trauma center.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>“Service period” includes a subsequent readmission or outpatient visit to the trauma center, or trauma center-affiliated acute care general hospital, for services that are directly related to the initial trauma injury.</text>
      </paragraph>
      <paragraph num="(c)">
        <text>“Service period” includes a subsequent admission or outpatient visit to a trauma center-affiliated rehabilitation hospital, or rehabilitation unit of a trauma center.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(17)">
      <text>“Specialty referral center” means:</text>
      <paragraph num="(a)">
        <text>The Curtis National Hand Center at Union Memorial Hospital;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The Eye Trauma Center at the Wilmer Eye Institute at The Johns Hopkins Hospital; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The Johns Hopkins Health System Burn Program.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(18)">
      <text>“Standby costs” means costs to a trauma center for paying physicians to be available on site at the trauma center to treat trauma patients.</text>
    </paragraph>
    <paragraph num="(19)">
      <text>Trauma Center.</text>
      <paragraph num="(a)">
        <text>“Trauma center” means a hospital designated by the Maryland Institute for Emergency Medical Services Systems (MIEMSS) as:</text>
        <paragraph num="(i)">
          <text>The State primary adult resource center;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>A Level I trauma center;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>A Level II trauma center;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>A Level III trauma center;</text>
        </paragraph>
        <paragraph num="(v)">
          <text>A pediatric trauma center; or</text>
        </paragraph>
        <paragraph num="(vi)">
          <text>A specialty referral center as defined in §B(17) of this regulation.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>“Trauma center” includes a pediatric trauma center that has entered into an agreement with MIEMSS.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(20)">
      <text>“Trauma health care practitioner” means a health care practitioner licensed under the Health Occupations Article who provides care in a trauma center-affiliated general acute care hospital or in a trauma center-affiliated rehabilitation hospital during the service period to trauma patients on the Maryland Trauma Registry as defined by the Maryland Institute for Emergency Medical Services Systems (MIEMSS).</text>
    </paragraph>
    <paragraph num="(21)">
      <text>“Trauma patient” means a patient whose trauma services are documented in the Maryland Trauma Registry.</text>
    </paragraph>
    <paragraph num="(22)">
      <text>“Trauma physician” means a physician who provides care in a trauma center, trauma center-affiliated general acute care hospital, or in a trauma center-affiliated rehabilitation hospital during the service period to a trauma patient on the Maryland Trauma Registry as defined by the Maryland Institute for Emergency Medical Services Systems (MIEMSS).</text>
    </paragraph>
    <paragraph num="(23)">
      <text>“Trauma services” means trauma care provided to a trauma patient in a trauma center, trauma center-affiliated general acute care hospital, trauma center-affiliated rehabilitation hospital, or rehabilitation unit of a trauma center.</text>
    </paragraph>
    <paragraph num="(24)">
      <text>“Uncompensated care” means trauma services provided by a trauma physician or trauma health care practitioner to a trauma patient on the Maryland Trauma Registry who:</text>
      <paragraph num="(a)">
        <text>Has no health insurance, including private health insurance, Medicare Part B coverage, VA health benefits, or CHAMPUS;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Is not covered by Workers' Compensation coverage;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Is not eligible for Medical Assistance coverage; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Has not paid the full Medicare reimbursement for the trauma care received, even after documented attempts by the trauma physician or trauma health care practitioner to obtain payment.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(25)">
      <text>“Uncompensated care shortfall” means the difference in reimbursement between what Medicare pays and what the trauma physician providing care collects from the uncompensated care trauma patient.</text>
    </paragraph>
    <paragraph num="(26)">
      <text>“Uncompensated services claim” means a CMS 1500 form or an ANSI 837 electronic transaction completed according to Commission specifications and submitted for reimbursement of uncompensated care services.</text>
    </paragraph>
  </paragraph>
</regulation>