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<regulation prefix="Regulation" num=".06" citation="COMAR 10.37.10.06" title_num="10" subtitle_num="37" chapter_num="10" heading="Application for Alternative Method of Rate Determination.">
  <paragraph num="A.">
    <text>At any time on or after July 1, 1974, a hospital may file a written application with the Commission requesting an alternative method for submitting or reviewing any or all of its rates and charges, specifying the reasons for and details of the alternative methods.</text>
  </paragraph>
  <paragraph num="B.">
    <text>If warranted by the circumstances set forth in the application, the Executive Director may grant a temporary approval of an alternative method of rate determination.</text>
  </paragraph>
  <paragraph num="C.">
    <text>The procedure for submitting and reviewing an application under an alternative method of rate determination shall follow as closely as possible the procedure for a regular rate application, except that the time periods and limitations set forth in these regulations do not apply to an application for an alternative method of rate determination.</text>
  </paragraph>
  <paragraph num="D.">
    <text>At anytime after the approval of an alternative method of rate review by the Executive Director, the Commission may initiate further proceedings to determine the hospital's continuing qualification for the alternative method of rate determination.</text>
  </paragraph>
  <paragraph num="E.">
    <text>ARM System.</text>
    <paragraph num="(1)">
      <text>The Commission may implement a system providing for alternative rate setting methods (ARM) which would permit hospitals to accept financial risk for the provision of hospital services under certain conditions and circumstances.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The implementation of an ARM system shall be consistent with the principles of equity and access embodied in the Commission's all-payer rate setting system.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The ARM Manual shall set forth the process and requirements associated with the ARM system.</text>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>Required Reports under ARM System.</text>
    <paragraph num="(1)">
      <text>A hospital granted approval for an alternative method of charging under this regulation is required to file quarterly reports and annual reports, to include but not be limited to those listed below in this section, in order to determine that the hospital continues to qualify for the alternative method of rate determination.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Quarterly Reports. The following reports shall be completed in the form prescribed by the Commission and submitted to the Commission within 30 days after the end of each hospital's calendar quarter:</text>
      <paragraph num="(a)">
        <text>Statistical Data Summary—Each Capitation or Risk-Sharing Contract;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Statistical Data Summary—Each Fixed-Price Contract;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Statistical Data Summary—Other;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Revenue Summary—Each Capitation or Risk-Sharing Contract;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Revenue Summary—Each Fixed-Price Contract; and</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Revenue Summary—Other.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>Annual Reports. The following annual reports shall be completed in the form prescribed by the Commission and submitted to the Commission within 90 days after the end of the appropriate fiscal year:</text>
      <paragraph num="(a)">
        <text>Statement of Revenue and Expense—Each Capitation or Risk-Sharing Contract;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Statement of Revenue and Expense—Each Fixed-Price Contract;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Statement of Revenue and Expense—Other;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Audited Statement of Revenue and Expense—Contracting Entity; and</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Audited Balance Sheet—Contracting Entity.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>Filing of Reports/Extension.</text>
      <paragraph num="(a)">
        <text>A hospital required to file the reports in this section may request a reasonable extension of time for filing, if the extension request is:</text>
        <paragraph num="(i)">
          <text>Made in writing to the attention of the Executive Director;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Supported by sufficient justification; and</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Made at a reasonable time before the due date of a required report.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>The Executive Director shall respond promptly in writing to the requesting hospital upon receipt of the request by either approving or disapproving the request.</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Extensions will be granted only for valid reasons.</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Any required report submitted by a hospital that is substantially incomplete or inaccurate shall be considered untimely filed.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(5)">
      <text>Time for Filing. An application for an alternative rate application shall be filed at least 30 days before the proposed effective date of the alternative rate.</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Penalties.</text>
      <paragraph num="(a)">
        <text>The Commission may impose penalties of up to $1,000 per day for failing to file reports as required under this section.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The Commission may refuse to grant a rate increase to a hospital that does not file a report as required under this section.</text>
      </paragraph>
      <paragraph num="(c)">
        <text>A fine assessed for failure to file an alternative rate application on a timely basis shall begin as of the date the application should have been filed.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="G.">
    <text>Funding for Health Information Technology.</text>
    <paragraph num="(1)">
      <text>The Commission may adjust a hospital's rates for health information technology (HIT) projects in conjunction with action taken by the Maryland Health Care Commission (MHCC) under COMAR 10.25.13.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Upon receipt of a recommendation for funding from the MHCC, the Commission's staff shall:</text>
      <paragraph num="(a)">
        <text>Review the information presented;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Consult with appropriate parties; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Recommend to the Commission approval, denial, or modification of the MHCC recommendation.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>In deciding the course of action to follow on an MHCC HIT project recommendation, the Commission and its staff shall consider, among other things, the following criteria:</text>
      <paragraph num="(a)">
        <text>The basis for the MHCC recommendation;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The applicant's statement of the purpose, mission, vision, goals, and measurable objectives of the project;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The planned approach, including:</text>
        <paragraph num="(i)">
          <text>An explanation of how the project's goals and objectives will be met;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>The technical strategy of the project;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>What activities will be used;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>What personnel will be needed; and</text>
        </paragraph>
        <paragraph num="(v)">
          <text>How that personnel will be utilized;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(d)">
        <text>How the project will be evaluated, as well as specific measurement strategies;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>A timeline that includes the start and end dates of the project and a schedule of activities;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>The credentials of the entity and participating individuals, including information that demonstrates their background and ability to carry out the project successfully;</text>
      </paragraph>
      <paragraph num="(g)">
        <text>The potential of the project to enhance the value of health care in Maryland, such as improving health care outcomes and reducing health care costs;</text>
      </paragraph>
      <paragraph num="(h)">
        <text>Information that demonstrates why the project is needed; and</text>
      </paragraph>
      <paragraph num="(i)">
        <text>A budget that details cost projections for the project that is specific, reasonable, realistic, accurate, and flexible.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>Decision.</text>
      <paragraph num="(a)">
        <text>Based on its consideration of the above-stated criteria and staff's recommendation, the Commission shall decide on the nature, extent, terms, and conditions of any rate adjustment approved.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The decision of the Commission on an MHCC recommendation for HIT funding is final.</text>
      </paragraph>
      <paragraph num="(c)">
        <text>A request for funding under this section is not a contested case under the Administrative Procedure Act.</text>
      </paragraph>
    </paragraph>
  </paragraph>
</regulation>