Unless otherwise indicated in this subtitle, MIEMSS shall use the following criteria when designating or reverifying specialty referral centers from among those applicant hospitals that apply for designation or reverification and when contracting with out-of-State specialty referral center hospitals: Applicable standards in this subtitle; Patient volume; Geographic coverage; Population; Demonstrated expertise of the professional staff in the specific specialty care area; Active research program focused on specific specialty care area; Competing applications; and New applications. The criteria listed in Regulation .01 of this chapter do not apply to burn, perinatal, neonatal, or designated primary stroke specialty referral centers. When applying the criteria, MIEMSS may consider: Applicable guidelines and professional standards; Patient outcome standards; and Published results of peer-reviewed research. An applicant hospital shall comply with the applicable standards for specialty referral centers in this subtitle. When considering an applicant hospital, MIEMSS shall take into account the number and distribution of specialty referral centers that will allow designated or contract specialty referral centers to: Minimize duplication of services; Achieve and sustain the volumes necessary for: Optimal outcome, Cost efficiency, Maintenance of expertise, Quality care, Research, and Physician and nurse education; and Minimize the potential adverse effect on quality of care that may result if patient volumes are reduced, Volume criteria will be evaluated for each specialty referral center based on the: Projected number of patients who would require access to that specialty referral center; and Number of physicians who would provide medical care for that population. When considering an applicant hospital, MIEMSS shall: Minimize duplicative services within close proximity; and Consider the number, geographic distribution, and resource capabilities of other specialty referral centers. When considering an applicant hospital, MIEMSS shall take into account the applicant hospital's geographic specialty patient catchment area given the current and projected population density within an area. When considering an applicant hospital, MIEMSS shall take into account the education and specialty training of the following hospital staff: Physicians; Nurses; and Technicians and support staff. When considering an applicant hospital, MIEMSS may give preference to the applicant with an established and ongoing clinical research program focusing on the specific specialty care area. MIEMSS may give preference to an applicant hospital with a designated trauma center which supports or is supported by the presence of a specialty referral center. If there are two or more applicants for the same type of specialty referral center in the same geographic coverage area where patient volumes or population would likely be insufficient to support both applicants, based on the criteria in Regulations .04—.09 of this chapter, MIEMSS shall: Give preference to the applicant with an established specialty referral program that can demonstrate that its past experience and performance: Are indicative of quality patient care, Are consistent with professional standards, and Result in optimal patient outcome; and Consider demonstrated patient outcomes and the recommendations of the site survey team to determine the most qualified applicant if both applicants have been verified through MIEMSS' inspection as meeting the standards for the requested specialty referral center. An applicant hospital that, under this subtitle, has not previously been designated as a specialty referral center by MIEMSS or contracted with MIEMSS as a specialty referral center shall: Be subject to the specialty referral center designation criteria; and Demonstrate that its proposed specialty referral center can generate sufficient patient volume without adversely affecting patient volumes at other existing, designated, or contract specialty referral centers. Education Article, §13-509, Annotated Code of Maryland Effective date: August 9, 1999 (26:16 Md. R. 1247) Regulation .01 amended effective July 1, 2002 (29:12 Md. R. 933) Regulation .02 amended effective June 5, 2006 (33:11 Md. R. 952) Regulation .03 amended effective July 1, 2002 (29:12 Md. R. 933) Regulations .05 —.11 amended effective July 1, 2002 (29:12 Md. R. 933)