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PARRIS N. GLENDENING, Governor H.B. 138
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(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
(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
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- 4293 -
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