Sec. 10.25.10.06. Payments for Medicaid Trauma Patients

A. A trauma physician:

(1) Is eligible for payment from the Fund for trauma services provided to a Medicaid trauma patient on the Maryland Trauma Registry on or after July 1, 2006; and

(2) May seek reimbursement in accordance with this regulation.

B. A trauma physician providing trauma services to a Medicaid trauma patient during the service period shall be reimbursed at the greater of:

(1) The Medicaid routine payment rate; or

(2) Up to 100 percent of the current Medicare facility-based payment in the Baltimore carrier locality area.

C. To be eligible for the Medicaid differential payment described in §B of this regulation, diagnosis codes shall meet one of the following two conditions:

(1) A diagnosis code shall fall between 800.00-959.9; or

(2) If a diagnosis code does not fall between 800.0 -959.9, a supplementary classification of external causes of injury and poisoning (E800-E999) shall appear as a secondary diagnosis code.

D. An organization billing on behalf of physicians eligible for Medicaid differential payments shall designate a trauma service by using the appropriate code in the CPT Modifier field on the electronic claim or on the paper CMS 1500 in accordance with Medicaid claims submission requirements.

E. To be eligible for the Medicaid differential payment described in §B of this regulation, the place of service code shall have one of the following values:

(1) Appropriate code to indicate "acute care inpatient hospital";

(2) Appropriate code to indicate "outpatient hospital";

(3) Appropriate code to indicate "emergency room"; or

(4) Appropriate code to indicate "inpatient rehabilitation hospital".

F. The Maryland Department of Health may apply Medicaid payment rules when adjudicating claims for trauma services to trauma patients.

G. The Fund shall transfer to the Maryland Department of Health than amount sufficient to fully cover the State's share of expenditures for Medicaid differential payments for that fiscal year.