- A. Generally. The Commission may, on its own or upon application from a hospital, permit charges for services to be changed without its prior approval in those cases when 66-2/3 percent or more of the annual gross patient revenue attributable to the services is derived from either Medicaid or Medicare patients, or both, who are not required by State law or by the terms of the Medicare Waiver to pay Commission-approved rates for those services. The Commission shall consider this action only in those instances when the annual gross revenue for nonphysician services is not more than $20 million (in 1996 dollars), adjusted by an appropriate index of inflation, or when the annual gross revenue subject to Commission rate-setting jurisdiction is not more than $5 million (in 1996 dollars) adjusted by an appropriate index of inflation.
- B. Filing of Application. A hospital seeking a rate-setting exemption under this regulation shall file a written application with the Commission identifying the service or services for which the exemption is requested. The application shall contain accurate and supporting documentation that the conditions set forth in §A of this regulation have been met for a minimum period of 12 months immediately before the application. The filing of an application for a rate-setting exemption does not constitute a contested case within the meaning of that term as defined in the Administrative Procedure Act.
- C. Review of Application. The Commission staff shall review the application within a reasonable period of time and prepare a written recommendation on the request to the Commission. The decision to grant or deny the application rests within the sound discretion of the Commission.
- D. Required Reports. A hospital granted an exemption under this regulation is required to file quarterly reports, in a manner to be prescribed by the Commission, in order to verify that the conditions set forth in §A of this regulation still obtain. The hospital shall continue to file all other required reports in conformity with the Commission's Accounting and Budget Manual for Fiscal and Operating Management (the Manual), which is incorporated by reference under COMAR 10.37.01.02.
- E. Attestation. Responsible officials of an applicant hospital are required to attest that, to the best of their knowledge and belief, the reports filed, as required under §D of this regulation, have been prepared in conformity with the Commission's uniform accounting and financial reporting system as set forth in the Manual.
- F. Further Investigation. If the Commission considers a further investigation necessary or desirable to authenticate information reported by a hospital seeking a rate-setting exemption, the Commission may make any further examination of the records or accounts of the hospital in accordance with the rules or regulations of the Commission.
- G. Termination of Exemption. The Commission may terminate an exemption granted under this regulation at any time for cause.
Authority: Health-General Article, §§9-207, 19-210, 19-212, 19-215, 19-217, 19-219, and 19-220, Annotated Code of Maryland
Effective date: June 14, 1975 (2:15 Md. R. 1066; 2:20 Md. R. 1298)
Chapter revised effective August 18, 1976 (3:17 Md. R. 915)
Regulation .02 amended effective October 6, 2008 (35:20 Md. R. 1775)
Regulation .05 adopted effective July 28, 1978 (5:15 Md. R. 1189)
Regulation .05 amended effective August 31, 1992 (19:17 Md. R. 1607)
Regulation .05F amended effective April 15, 1991 (18:7 Md. R. 773)
Regulation .05G amended effective January 2, 1993 (19:26 Md. R. 2288)
Regulations .06 and .07 adopted effective August 3, 1981 (8:15 Md. R. 1308)
Regulation .06A, B amended effective November 19, 1984 (11:23 Md. R. 1992)
Regulation .08 adopted effective April 12, 1982 (9:7 Md. R. 711)
Regulation .08 amended effective October 10, 1983 (10:20 Md. R. 1788)
Regulation .09 adopted as an emergency provision effective April 1, 1984 (11:8 Md. R. 712); emergency status expired July 1, 1984; adopted permanently effective November 19, 1984 (11:23 Md. R. 1992)
Regulation .09 amended effective February 9, 1987 (14:3 Md. R. 274)
Regulation .09A amended effective July 9, 1990 (17:13 Md. R. 1611); December 8, 2005 (32:24 Md. R. 1905)
Regulation .09B amended effective January 8, 1990 (16:26 Md. R. 2794); July 10, 2000 (27:13 Md. R. 1211); December 8, 2005 (32:24 Md. R. 1905)
Regulation .10 adopted effective September 3, 1990 (17:17 Md. R. 2080)
Regulation .10 amended effective August 5, 1991 (18:15 Md. R. 1727)
Regulation .10A amended effective October 6, 1997 (24:20 Md. R. 1404)