Ch. 258                                    1994 LAWS OF MARYLAND

(2)     In making a determination under subsection (b)(3)(i) of this section
concerning the resources of a health care practitioner necessary to deliver health care
services, the Commission:

(i) Shall ensure that the compensation for health care services is
reasonably related to the cost of providing the health care service; and

(ii) Shall consider:

1.       The cost of professional liability insurance;

2.       The cost of complying with all federal, State, and local
regulatory requirements;

3.       The reasonable cost of bad debt and charity care;

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 [or patient] and a
health care practitioner, OR FOR SERVICES NOT COVERED BY A HEALTH BENEFIT
PLAN, BETWEEN A PATIENT AND A HEALTH CARE PRACTITIONER.

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