Ch. 440

2003 LAWS OF MARYLAND

[(6)] (5) (i) "Trauma center" means a primary adult resource center,
level I trauma center, level II trauma center, level III trauma center, or pediatric
trauma center that has been designated by the institute to provide care to trauma
patients.

(ii) "Trauma center" includes an out-of-state pediatric facility that
has entered into an agreement with the institute to provide care to trauma patients.

[(7)] (6) "Trauma patient" means a patient that is evaluated or treated
in a trauma center and is entered into the State trauma registry as a trauma patient.

[(8)] (7) "Trauma physician" means a licensed physician who has been
credentialed or designated by a trauma center to provide care to a trauma patient at
a trauma center.

(b) (1) In addition to any other provisions of this subtitle, for a covered
service rendered to an enrollee of a health maintenance organization by a health care
provider not under written contract with the health maintenance organization, the
health maintenance organization or its agent:

(i) Shall pay the health care provider within 30 days after the
receipt of a claim in accordance with the applicable provisions of this subtitle; and

(ii) Shall pay the claim submitted by:

1.       A hospital at the rate approved by the Health Services
Cost Review Commission;

2.       A trauma physician for trauma care rendered to a trauma
patient in a trauma center, at the greater of:

A.       140% of the rate paid by the Medicare program, as
published by the Centers for Medicare and Medicaid Services, for the same covered
service, to a similarly licensed provider; or

B.      The rate as of January 1, 2001 that the health
maintenance organization paid in the same geographic area, as published by the
Centers for Medicare and Medicaid Services, for the same covered service, to a
similarly licensed provider; and

3.       Any other health care provider at the greater of:

A.      125% of the rate the health maintenance organization
pays in the same geographic area, as published by the Centers for Medicare and
Medicaid Services, for the same covered service, to a similarly licensed provider under
written contract with the health maintenance organization; or

B.      The rate as of January 1, 2000 that the health
maintenance organization paid in the same geographic area, as published by the
Centers for Medicare and Medicaid Services, for the same covered service, to a
similarly licensed provider not under written contract with the health maintenance
organization.

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