Md. Code Regs. 10.37.03.05

Current through Register Vol. 51, No. 25, December 13, 2024

Section 10.37.03.05 - Overcharges and Undercharges by Hospitals

A. For purposes of this regulation, the following definitions apply:

(1) "Overcharge" means any charge for a hospital service under the jurisdiction of the Commission that is in excess of its approved rate.

(2) "Undercharge" means any charge for a hospital service under the jurisdiction of the Commission that is less than its approved rate.

B. When any hospital overcharges by more than the allowed corridors, as defined in §G of this regulation, that overcharge shall be recovered in prospective rates at 140 percent plus appropriate interest factors.

C. When any hospital overcharges less than the allowed corridor, as defined in §G of this regulation, that overcharge shall be reduced from prospectively approved rates at the actual amount of overcharge plus appropriate interest.

D. When any hospital undercharges more than 2 percent in obstetrics, nursery, labor and delivery, clinic, emergency room, pediatrics, or intensive care units, that undercharge may not be recovered in prospective periods.

E. When any hospital undercharges less than 2 percent in the patient service centers listed in §D of this regulation, that undercharge shall be added to prospectively approved rates at the actual amount of undercharges.

F. When a hospital undercharges beyond the allowed corridors, as defined in this section, the amount of undercharge in excess of the corridors less 40 percent shall be added to prospectively approved rates. These allowed undercharge corridors are defined as follows:

(1) Patient care areas, when the unit of service is a patient day, not listed in §D of this regulation ----- 3 percent;

(2) Admissions center ---------------------------------- 3 percent;

(3) Ancillary service areas and ambulatory service areas not listed in §D of this regulation -------------- 5 percent.

G. Overcharge Corridors and Pricing for Medical/Surgical Supplies and Drugs.

(1) The allowed overcharge corridors are defined as follows:

(a) Daily patient care areas, ambulatory service areas, and admissions center ----------------------- 2 percent;

(b) Labor and delivery room -------------------------- 3 percent;

(c) Renal dialysis ----------------------------------- 5 percent;

(d) Ancillary service areas other than labor and delivery room and renal dialysis --------------------------- 3 percent.

(2) There are no price corridors for medical/surgical supplies and drugs.

H. Notwithstanding this regulation, if any hospital's net overcharges are more than 1 percent of the hospital's total approved revenue, that overcharge shall be recovered in prospective rates at 140 percent plus appropriate interest factors.

I. In cases when a flagrant disregard of approved rates is found, the Commission may require direct repayment of overcharges and penalties to those patients who were overcharged.

J. The Commission may assess penalties as described in this regulation, for rates approved effective July 1, 1978.

Md. Code Regs. 10.37.03.05

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)