CurrentBlue Cross Blue Shield - MarylandPolicy N/A

Physician's On‑Duty / Off‑Duty Compensation

Governs types of physician coverage (on-duty, off-duty, normal) and permitted compensation methods for physicians serving DHMH 24-hour facilities in Maryland; affects facility management and physicians employed or contracted to provide coverage.

Policy Summary

PayerBlue Cross Blue Shield - Maryland

PolicyPhysician's On‑Duty / Off‑Duty Compensation

Policy CodePolicy N/A

Change TypeRecodification / non‑substantive

Effective DateMay 16, 2016

Next Review DateN/A

Key ActionFacility Superintendent (or designee) and Budget Officer must approve rates of pay and contracts; outside vendor contracts require prior approval and must follow State Finance and Procurement rules.

SourceLink

POLICY UPDATE CHANGES

Recodifies prior policy number and updates formatting and hyperlinks; characterized as routine, non-substantive changes.

May 16, 2016version effective date

24-hourfacilities occupancy covered

3max comp leave per 16‑hr weekday

3max comp leave per 24‑hr weekend/holiday

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Physician coverage compensation criteria

Compensation and staffing criteria for physicians providing coverage:

All physicians providing normal coverage, on-duty coverage, or off-duty coverage for the Department's facilities must be licensed physicians recognized by the State of Maryland.

Permitted staffing and compensation

Facility management may use physicians on the facility's payroll to provide on-duty coverage and compensate them on a monetary or compensatory time basis.
Facility management may use staff physicians to provide off-duty coverage and compensate them on the appropriate monetary or compensatory time basis for actual hours worked if called by the facility for duty on the facility's premises.
A facility without a staff physician may make other arrangements for required off-duty coverage provided applicable approvals are obtained.

Off-duty compensatory leave formula

Up to 3 hours compensatory leave for each 16-hour period of off-duty coverage on a weekday.
Up to 3 hours compensatory leave for each 24-hour period of off-duty coverage on a weekend day or holiday.
For lesser periods of off-duty coverage, compensatory leave is earned on a pro rata basis provided the pro rata amount is at least 0.5 hour of compensatory time or the minimum compensatory time earnable for FLSA-exempt employees for the assigned period of coverage.

ALL of the following

Staff physicians may not receive monetary reimbursement for providing off-duty coverage to the facility on whose payroll they are carried.
Compensable hours for physicians on the facility's payroll are determined in accordance with the definition of 'Work Time' in COMAR 17.04.11.02B and, where not specified in COMAR, the Fair Labor Standards Act.
Physicians on the payroll who provide on-duty or off-duty coverage must be compensated via the Comptroller's Regular Payroll (Exception Time Report) and/or the Special Payments Payroll (Positive Time Report) process.
Payments to individual physicians for providing coverage are not to be paid on a Comptroller transmittal because an employer-employee relationship exists.

Licensing note: Nothing in this policy prohibits hiring physician staff solely to provide on-duty coverage or off-duty coverage.

Referenced Authorities and Compensation Details

Referenced laws and regulationsmixed

Annotated Code of Maryland, State Finance and Procurement Article	http://mgaleg.maryland.gov/webmga/frmStatutesText.aspx?article=gsf&section=1101&ext=html&session=2015RS&tab=subject5
Code of Maryland Regulations (COMAR)
COMAR 17.04.11.02B	http://www.dsd.state.md.us/comar/comarhtml/17/17.04.11.02.htm
COMAR Title 21 - Procurement	http://www.dsd.state.md.us/COMAR/subtitle_chapters/21_Chapters.aspx
Fair Labor Standards Act, Code of Federal Regulations (29 CFR, Part 785)	https://www.gpo.gov/fdsys/pkg/CFR-2011-title29-vol3/pdf/CFR-2011-title29-vol3-part785toc-id1878.pdf

Minimum compensatory time increment

Minimum increment for pro rata compensatory leaveCompensatory leave is earned on a pro rata basis for lesser off-duty coverage periods only if the pro rata amount is at least 0.5 hour or equals the minimum compensatory time earnable for FLSA-exempt employees.

Maximum per 16-hour weekday off-duty periodUp to 3 hours compensatory leave may be earned for each 16-hour period of off-duty coverage on a weekday.

Maximum per 24-hour weekend/holiday periodUp to 3 hours compensatory leave may be earned for each 24-hour period of off-duty coverage on a weekend day or holiday.

Approvals, Procurement, and Administrative Requirements

Prior Authorization

Approval and procurement requirements for physician coverage contracts and pay rates

Contracts for payments to provider services or corporate entities that supply licensed physicians must have prior approval of the facility's Superintendent (or designee) and Budget Officer and must comply with the State Finance and Procurement Article and COMAR Title 21; rates of pay for physicians providing on-duty or off-duty coverage must be approved by the facility's Superintendent (or designee) and Budget Officer within the budget process (and new rates outside the budget process must be approved through the DHMH Budget Management Office).

Prior approval required for contracts to provider services or corporate entities by Superintendent (or designee) and Budget Officer; must follow State Finance and Procurement Article and COMAR Title 21.
Rates of pay for on-duty/off-duty coverage must be approved by Superintendent (or designee) and Budget Officer within the budget process; new rates outside the budget process require DHMH Budget Management Office approval.

Key Definitions

Facilities

Definition of Facilities'Facilities' means hospitals and other health care centers of DHMH which have 24-hour occupancy.

ScopeApplies to DHMH hospitals and other DHMH health care centers that maintain 24-hour occupancy.

Implication for coverage typesFacilities are the settings where normal, on-duty and off-duty physician coverage rules and compensation apply.

Normal coverage / normal work hours

Definition'Normal coverage' or 'normal work or duty hours' means the routine schedule of physician coverage established by the physician's appointing authority.

ExclusionsNormal work hours do not include after-hours, evenings, weekends, and holidays.

Who sets scheduleThe physician's appointing authority establishes the routine schedule that constitutes normal coverage.

Off-duty coverage

Definition'Off-duty coverage' means physician coverage during which the physician is reachable at all times by the facility via local phone call, pager, or other normal communication methods.

Availability and responsePhysician must be located within a reasonable distance and able to respond immediately to calls for a physician at the facility.

Scope of service and restrictionsPhysician must be prepared to render services wherever needed at the facility and their activities are not substantially restricted.

On-duty coverage

Definition'On-duty coverage' means physician coverage during which the physician is physically in the facility and the physician's location is known at all times.

AvailabilityPhysician is available for routine and emergency medical service at all times while on-duty.

Activity restrictionWhile on-duty, the physician's activities are substantially restricted; facilities may consider certain assigned off-duty periods as on-duty when required presence is mandated.

Staff Physicians

Definition'Staff Physicians' means those physicians on the regular and/or Special Payments Payroll of a facility who provide normal work hours and/or on-duty coverage.

Compensation for off-duty workStaff physicians may be compensated on a monetary or compensatory time basis for actual hours worked if called to the facility's premises, but may not receive monetary reimbursement for providing off-duty coverage to the facility on whose payroll they are carried.

Payroll processingPhysicians on the payroll who provide on-duty or off-duty coverage must be compensated via the Comptroller's Regular Payroll (Exception Time Report) and/or the Special Payments Payroll (Positive Time Report) process; individual payments are not to be made on a Comptroller transmittal.