PARRIS N. GLENDENING, Governor

Ch. 348

(6) THE PAYMENT SYSTEM UNDER THIS SECTION SHALL INCLUDE A
PAYMENT SYSTEM APPLICABLE TO HEALTH CARE PRACTITIONERS WHO TREAT
SOFT TISSUE INJURIES WHICH MAY BE CAUSED BY AN ACCIDENT INVOLVING A
MOTOR VEHICLE.

[(6)] (7) The Commission and the licensing boards shall develop, by
regulation, appropriate sanctions, including, where appropriate, notification to the
Insurance Fraud Unit of the State, for health care practitioners who violate the standards
established by the Commission to prohibit unbundling and upcoding.

(c) (1) In establishing a payment system under this section, the Commission
shall take into consideration the factors listed in this subsection.

(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

- 2295 -