<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".06" citation="COMAR 10.25.10.06" title_num="10" subtitle_num="25" chapter_num="10" heading="Payments for Medicaid Trauma Patients.">
  <paragraph num="A.">
    <text>A trauma physician or trauma health care practitioner:</text>
    <paragraph num="(1)">
      <text>Is eligible for payment from the Fund for trauma services provided to a Medicaid trauma patient on the Maryland Trauma Registry on or after July 1, 2024; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>May seek reimbursement in accordance with this regulation.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>A trauma physician or trauma health care practitioner providing trauma services to a Medicaid trauma patient during the service period shall be reimbursed at the greater of:</text>
    <paragraph num="(1)">
      <text>The Medicaid routine payment rate; or</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Up to 100 percent of the current Medicare facility-based payment in the Baltimore carrier locality area.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>To be eligible for the Medicaid differential payment described in §B of this regulation, diagnosis codes shall meet one of the following two conditions:</text>
    <paragraph num="(1)">
      <text>A diagnosis code shall fall between 800.00 — 959.9; or</text>
    </paragraph>
    <paragraph num="(2)">
      <text>If a diagnosis code does not fall between 800.0 — 959.9, a supplementary classification of external causes of injury and poisoning (E800 — E999) shall appear as a secondary diagnosis code.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>An organization billing on behalf of trauma physicians or trauma health care practitioners eligible for Medicaid differential payments shall designate a trauma service by using the appropriate code in the CPT Modifier field on the electronic claim or on the paper CMS 1500 in accordance with Medicaid claims submission requirements.</text>
  </paragraph>
  <paragraph num="E.">
    <text>To be eligible for the Medicaid differential payment described in §B of this regulation, the place of service code shall have one of the following values:</text>
    <paragraph num="(1)">
      <text>Appropriate code to indicate “acute care inpatient hospital”;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Appropriate code to indicate “outpatient hospital”;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Appropriate code to indicate “emergency room”; or</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Appropriate code to indicate “inpatient rehabilitation hospital”.</text>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>The Maryland Department of Health may apply Medicaid payment rules when adjudicating claims for trauma services to trauma patients.</text>
  </paragraph>
  <paragraph num="G.">
    <text>The Fund shall transfer to the Maryland Department of Health an amount sufficient to fully cover the State's share of expenditures for Medicaid differential payments for that fiscal year.</text>
  </paragraph>
</regulation>