Sec. 10.67.11.02. GME Allocation Payment

A. Purpose. GME allocation payments to teaching hospitals are intended to:

(1) Reaffirm the Program's historic commitment to preserving graduate medical education at each of the State's teaching hospitals, by maintaining Program payments supporting graduate medical education at levels equivalent to inflation-adjusted FY 1995 expenditures;

(2) Promote the training of primary care practitioners;

(3) Promote the development of innovative approaches to improve the Program population's access to health care services; and

(4) Ameliorate the new funding procedure's impact on MCOs that historically have experienced low utilization of teaching hospitals, by adopting an initial moderate reduction, pursuant to §B(4) of this regulation and COMAR 10.67.05.15, of the amount of GME-allocatable dollars included in teaching hospitals' GME allocation payments during the first 3 years of separate GME funding.

B. GME Allocation Payments to Teaching Hospitals. Beginning in FY 1999, the Department shall, on a quarterly basis, pay each teaching hospital a GME allocation payment, calculated as follows:

(1) The Department shall calculate the combined dollar amount of payments made by the Program to teaching hospitals during FY 1995, including only those payments attributable to utilization:

(a) Of services that, if delivered during the fiscal year during which the GME allocation payment is made, would be included in the Maryland Medicaid Managed Care Program mandatory benefits package established by COMAR 10.67.06; and

(b) By recipients who, if the utilization had occurred during the fiscal year in which the GME allocation payment is made:

(i) Would have met the eligibility criteria for the Maryland Medicaid Managed Care Program, pursuant to COMAR 10.67.02.01; and

(ii) Would not have met the eligibility criteria for the rare and expensive case management program, pursuant to COMAR 10.09.69.03;

(2) The amount resulting from the calculation described in §B(1) of this regulation is reduced by the dollar amount of included payments for inpatient hospital services that, if they had been incurred during the fiscal year of the GME allocation payment, would have been subject to avoidance by an MCO pursuant to the stop-loss provisions of COMAR 10.67.04.22;

(3) The amount resulting from the calculation described in §B(2) of this regulation is trended forward to adjust for the time differential between the base year (FY 1995) and the contract year;

(4) The amount resulting from the calculation described in §B(3) of this regulation is reduced to reflect the managed care discount incorporated into capitation rates pursuant to COMAR 10.67.04.18-1B(2);

(5) The amount resulting from the calculation described in §B(4) of this regulation is multiplied by the percentage of Program payments considered, pursuant to COMAR 10.67.04.18-1A(1)-(3), to be attributable to GME; and

(6) The amount resulting from the calculation described in §B(5) of this regulation is multiplied by 0.25, to reflect the GME allocation's quarterly payment schedule.