Home Table of Contents

§ 19-219. Review of costs and rates

West's Annotated Code of MarylandHealth--GeneralEffective: July 1, 2020 to September 30, 2024

West's Annotated Code of Maryland
Health--General
Title 19. Health Care Facilities (Refs & Annos)
Subtitle 2. Health Services Cost Review Commission (Refs & Annos)
Part II. Health Care Facility Rate Setting
Effective: July 1, 2020 to September 30, 2024
MD Code, Health - General, § 19-219
§ 19-219. Review of costs and rates
<Section effective until occurrence of contingency specified in Acts 2008, c. 244, § 4, and Acts 2008, c. 245, § 4. See, also, section effective upon occurrence of contingency specified in Acts 2008, c. 244, § 4, and Acts 2008, c. 245, § 4.>
In general
(a) The Commission may review the costs, and rates, quality, and efficiency of facility services, and make any investigation that the Commission considers necessary to assure each purchaser of health care facility services that:
(1) The total costs of all hospital services offered by or through a facility are reasonable;
(2) The aggregate rates of the facility are related reasonably to the aggregate costs of the facility; and
(3) The rates are set equitably among all purchasers or classes of purchasers without undue discrimination or preference.
Reasonableness of rates
(b)(1) To carry out its powers under subsection (a) of this section, the Commission may review and approve or disapprove the reasonableness of any rate or amount of revenue that a facility sets or requests.
(2) A facility shall:
(i) Charge for services only at a rate set in accordance with this subtitle; and
(ii) Comply with the applicable terms and conditions of the all-payer model contract.
(3) In determining the reasonableness of rates, the Commission may take into account objective standards of efficiency and effectiveness.
Alternate methods of rate determination
(c) Consistent with the all-payer model contract, and notwithstanding any other provision of this subtitle, the Commission may:
(1) Establish hospital rate levels and rate increases in the aggregate or on a hospital-specific basis;
(2) Promote and approve alternative methods of rate determination and payment of an experimental nature for the duration of the all-payer model contract; and
(3) On request of the Secretary, assist in the implementation of federally approved model programs.

Credits

Added as Health-General § 19-216 by Acts 1982, c. 21, § 2, eff. July 1, 1982. Amended by Acts 1984, c. 470, § 1, eff. July 1, 1984; Acts 1985, c. 10, § 3, eff. July 1, 1985; Acts 1985, c. 112, § 1, eff. June 1, 1985. Renumbered as Health-General § 19-219 and amended by Acts 1999, c. 702, § 2, eff. Oct. 1, 1999. Amended by Acts 2002, c. 153, § 4, eff. Jan. 1, 2003; Acts 2003, c. 1, § 1, eff. April 8, 2003; Acts 2008, c. 244, § 1, eff. July 1, 2008; Acts 2008, c. 245, § 1, eff. July 1, 2008; Acts 2014, c. 263, § 1, eff. July 1, 2014; Acts 2015, c. 263, § 1, eff. Oct. 1, 2015; Acts 2020, c. 505, § 1, eff. July 1, 2020.
Formerly Art. 43, § 568U.

Editors' Notes

HISTORICAL AND STATUTORY NOTES
2002 Legislation
Acts 2002, c. 153, § 12, provides:
“SECTION 12. AND BE IT FURTHER ENACTED, That if the State loses its Medicare Waiver under § 1814(b) of the federal Social Security Act:
“(1) the hospital rate funding mechanism for the Maryland Health Insurance Plan specified under § 19-219 of the Health--General Article shall terminate at the end of the Plan year during which the State loses the waiver; and
“(2) the Board for the Maryland Health Insurance Plan shall make recommendations to the General Assembly as soon as practicable regarding the adoption of a new funding mechanism for the Plan.”
2008 Legislation
Acts 2008, c. 244, §§ 2, 3, and 4, and Acts 2008, c. 245, §§ 2, 3, and 4, provide:
“SECTION 2. AND BE IT FURTHER ENACTED, That it is the intent of the General Assembly that the Department of Health and Mental Hygiene policy of imposing Medicaid day limits on hospital services shall cease effective July 1, 2008.
“SECTION 3. AND BE IT FURTHER ENACTED, That notwithstanding § 19-214(d)(1), (2), and (5) of the Health--General Article, as enacted by Section 1 of this Act, § 15-701 of the Health--General Article, or a delay in the expansion of health care coverage beyond July 1, 2008, under Chapter 7 of the Acts of the 2007 Special Session of the General Assembly:
“(1) funds generated from the assessment under § 19-214(d)(1)(i) of the Health--General Article, as enacted by Section 1 of this Act, may be used to pay for the elimination of Medicaid day limits on hospital services for the period of July 1, 2008, through December 31, 2008; and
“(2) the Health Services Cost Review Commission shall ensure that the assessment under § 19-214(d)(1)(i) of the Health--General Article, as enacted by Section 1 of this Act, does not exceed the savings realized in averted hospital uncompensated care from:
“(i) the health care coverage expansion; and
“(ii) the elimination of Medicaid day limits on hospital services for the period of July 1, 2008, through December 31, 2008.
“SECTION 4. AND BE IT FURTHER ENACTED, That if the State's Medicare waiver under § 1814(b) of the federal Social Security Act terminates or the provisions of 42 C.F.R. 433.68 are changed to prohibit the assessment authorized under this Act, this Act shall be abrogated and of no further force and effect.”
2009 Legislation
Acts 2009, c. 487, § 16, amended Acts 2008, c. 245, § 3, to read:
“SECTION 3. AND BE IT FURTHER ENACTED, That notwithstanding § 19-214(d)(1) , (2), and (5) of the Health--General Article, as enacted by Section 1 of this Act, § 15-701 of the Health--General Article, or a delay in the expansion of health care coverage beyond July 1, 2008, under Chapter 7 of the Acts of the General Assembly of the 2007 Special Session:
“(1) funds generated from the assessment under § 19-214(d)(1)(i) of the Health--General Article, as enacted by Section 1 of this Act, may be used to pay:
“(i) for the elimination of Medicaid day limits on hospital services for the period of July 1, 2008, through December 31, 2008; and
“(ii) for Medicaid payments to hospitals between July 1, 2009, and June 2010; and
“(2) the Health Services Cost Review Commission shall ensure that the assessment under § 19-214(d)(1)(i) of the Health--General Article, as enacted by Section 1 of this Act, does not exceed the savings realized in averted hospital uncompensated care from:
“(i) the health care coverage expansion; and
“(ii) the elimination of Medicaid day limits on hospital services for the period of July 1, 2008, through December 31, 2008.”
MD Code, Health - General, § 19-219, MD HEALTH GEN § 19-219
Current through legislation effective July 1, 2020, from the 2020 Regular Session of the General Assembly.
End of Document© 2020 Thomson Reuters. No claim to original U.S. Government Works.