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PARRIS N. GLENDENING, Governor
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Ch. 64
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(II) IN ADDITION TO THE INFORMATION REQUIRED UNDER ITEM (I)
OF THIS PARAGRAPH, THE COMMISSION MAY PUBLISH ANY OTHER INFORMATION
THAT THE COMMISSION DEEMS APPROPRIATE, INCLUDING INFORMATION ON
CAPITATED HEALTH CARE SERVICES.
[(g)] (H) In developing the medical care data base, the Commission shall
consult with representatives of the Health Services Cost Review Commission, health
care practitioners, payors, and hospitals to ensure that the medical care data base is
compatible with, may be merged with, and does not duplicate information collected by
the Health Services Cost Review Commission.
(i) The Commission, in consultation with the Insurance Commissioner,
payors, health care practitioners, and hospitals, may adopt by regulation standards
for the electronic submission of data and submission and transfer of the uniform
claims forms established under § 15-1003 of the Insurance Article.
[19-136.
(a) (1) In this section the following words have the meanings indicated.
(2) "Code" means the applicable Current Procedural Terminology (CPT)
code as adopted by the American Medical Association or other applicable code under
an appropriate uniform coding scheme approved by the Commission.
(3) "Payor" means:
(i) A health insurer or nonprofit health service plan that holds a
certificate of authority and provides health insurance policies or contracts in the
State in accordance with the Insurance Article or the Health - General Article; or
(ii) A health maintenance organization that holds a certificate of
authority.
(4) Unbundling means the use of two or more codes by a health care
provider to describe a surgery or service provided to a patient when a single, more
comprehensive code exists that accurately describes the entire surgery or service.
(b) (1) By January 1, 1999, the Commission shall implement a payment
system for all health care practitioners in the State.
(2) The payment system established under this section shall include a
methodology for a uniform system of health care practitioner reimbursement.
(3) Under the payment system, reimbursement for each health care
practitioner shall be comprised of the following numeric factors:
(i) A numeric factor representing the resources of the health care
practitioner necessary to provide health care services;
(ii) A numeric factor representing the relative value of a health care
service, as classified by a code, compared to that of other health care services; and
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- 589 -
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