PARRIS N. GLENDENING, Governor

Ch. 341

4.       The differences in experience or expertise among health care
practitioners, including recognition of relative preeminence in the practitioner's field or
specialty and the cost of education and continuing professional education;

5.       The geographic variations in practice costs;

6.       The reasonable staff and office expenses deemed necessary
by the Commission to deliver health care services;

7.       The costs associated with a faculty practice plan affiliated
with a teaching hospital; and

8.       Any other factors deemed appropriate by the Commission.

(3) In making a determination under subsection (b)(3)(ii) of this section
concerning the value of a health care service relative to other health care services, the
Commission shall consider:

(i) The relative complexity of the health care service compared to that
of other health care services;

(ii) The cognitive skills associated with the health care service;

(iii) The time and effort that are necessary to provide the health care

service; and

(iv) Any other factors deemed appropriate by the Commission.

(4) Except as provided under subsection (d) of this section, a conversion
modifier shall be:

(i) A payor's standard for reimbursement;

(ii) A health care practitioner's standard for reimbursement; or

(iii) Arrangements agreed upon between a payor and a health care
practitioner.

(d) (1) (i) The Commission may make an effort, through voluntary and
cooperative arrangements between the Commission and the appropriate health care
practitioner specialty group, to bring that health care practitioner specialty group into
compliance with the health care cost goals of the Commission if the Commission
determines that:

1.       Certain health care services are significantly contributing to
unreasonable increases in the overall volume and cost of health care services;

2.       Health care practitioners in a specialty area have attained
unreasonable levels of reimbursable services under a specific code in comparison to
health care practitioners in another specialty area for the same code;

3.       Health care practitioners in a specialty area have attained
unreasonable levels of reimbursement, in terms of total compensation, in comparison to
health care practitioners in another specialty area;

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