Ch. 348                                    1996 LAWS OF MARYLAND

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

(4) Except as provided under subsection (d) AND (J) 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;

4. There are significant increases in the cost of providing health
care services; or

5. Costs in a particular health care specialty vary significantly
from the health care cost annual adjustment goal established under subsection (f) of this
section.

(ii) If the Commission determines that voluntary and cooperative
efforts between the Commission and appropriate health care practitioners have been
unsuccessful in bringing the appropriate health care practitioners into compliance with
the health care cost goals of the Commission, the Commission may adjust the conversion
modifier.

(2) If the Commission adjusts the conversion modifier under this subsection
for a particular specialty group, a health care practitioner in that specialty group may not
be reimbursed more than an amount equal to the amount determined according to the
factors set forth in subsection (b)(3)(i) and (ii) of this section and the conversion modifier
established by the Commission.

(e) (1) On an annual basis, the Commission shall publish;

(i) The total reimbursement for all health care services over a
12-month period;

- 2296 -