March 22, 2020
Leading During Crisis
You know this. The events of the past week were unimaginable just a short time ago. The rapid spike in cases of COVID-19 around the country and here in Maryland is challenging us all like never before.

Your efforts to carry us through this crisis are appreciated and recognized by leaders and the public statewide. We’ve been glad to see the public outpouring of support for your workers, the desire to pitch in with donations, and messages of thanks.

Earlier this morning Del. Shane Pendergrass, who chairs the Health and Government Operations Committee, wrote to me, saying, “I’m thinking of your members, all our hospitals, and I’m grateful for what your organizations are facing and doing. Please pass that along.”

MHA—and the state as a whole—are united behind you as you protect and save lives.

We’re hearing troubling stories of health care workers in other states running out of equipment to help patients and protect themselves. Governors in California, New York and elsewhere took unprecedented steps to order all people not performing life-sustaining functions to stay home.

We support Gov. Hogan’s measures closing businesses and limiting gatherings to promote social distancing and prevent the spread. We are advising his team so that any future tightening of restrictions does not impede your vital work.

You need help on surge capacity—beds, equipment, supplies and people. MHA is at the table with MDH and Maryland Emergency Management to plan and find resources.

Maryland’s federal delegation has asked us to tell them how to advocate for your needs in their discussions about COVID-19-related bills. We’re in touch with them steadily. 

Thank you for what you and your teams are doing right now to keep Marylanders safe and to prepare for what’s to come.
Bob Atlas
President & CEO
For a comprehensive list of resources, guidance for hospitals, and updates from MHA, go to mhaonline.org/coronavirus .
Childcare Opportunities for Emergency Workers
We expect information early this week outlining how the state is providing emergency personnel with childcare support as COVID-19 cases escalate in Maryland. This will include roll out of services through The Y in Central Maryland facilities and other locations. We are working with the state and other partner and will share the details with you as they are finalized.
MHCC Updates Guidance on Emergency CON
On March 21, the Maryland Health Care Commission released updated guidance for emergency Certificate of Need (CON) applications. Hospitals wishing to add beds can file a simple letter with the information below. After consulting with MHCC’s chairman and the Office of Health Care Quality (OHCQ), MHCC’s executive director can issue approval, generally within 24 hours. The simple application must include:
  • Project description (increased licensed beds, minor maintenance to reopen mothballed space, etc.)
  • Where the project will occur
  • When the project will effective
  • Approximate cost, if know
  • Status of unused physical bed space in the hospital that is unused
AHCA Interim Guidance: SNFs Accepting Admissions from Hospitals During COVID-19 Pandemic
The American Health Care Association (AHCA) released interim guidance to skilled nursing facilities (SNFs) to for making decisions about accepting hospital discharges to SNFs. The full guidance is available here .
AHCA also urges SNFs to begin now creating separate wings, units or floors by moving current residents to handle admissions from the hospital and keep current residents separate, if possible.
MDH Releases Guidelines on Expanded Telehealth Services
The Maryland Department of Health (MDH) Behavioral Health Administration (BHA) released three communications with guidelines for expanded telehealth services as a result of COVID-19 during the state of emergency.
These documents are posted on the BHA Website as well.
For questions about the guidelines, email ivajean.smith@maryland.gov .
CareFirst Offers Provider-Specific Website for COVID-19
CareFirst has issued new guidance for providers and updated some enrollee benefits. The information on the provider-specific page includes details on billing for testing and treatment related to COVID-19, coverage of telehealth services, and benefit changes made as of March 16. Please note that the benefit changes apply only to CareFirst’s fully insured members. 
FEMA Public Assistance and Policy Guide
On March 13, President Trump declared a national emergency, which among other things, allows for reimbursement of disaster related expenditures through the FEMA Public Assistance (PA) Program. There are FEMA policies that must be followed by acute care hospitals to successfully apply to FEMA for reimbursement of disaster related expenses. While FEMA typically issues guidance for each situation, and will likely do so for the COVID-19 outbreak, hospitals should refer to FEMA’s latest guidance here
Hospitals should capture the expenses to stand up capacity, including staff time to organize, inspect, move equipment and supplies to ready the space, along with supply and equipment costs. These should be tracked separately from projected and actual expenses to operate additional capacity. These are expected to be reimbursed through hospital charges. MHA staff are working on more detailed guidance to share with the field. For more information, please contact Brett McCone or Katie Eckert .
Register today for MHA’s Annual Membership Meeting, June 15-16 
Performance Measurement Workgroup Update
The Health Services Cost Review Commission’s (HSCRC) Performance Measurement Work Group convened March 18 via webinar. Alyson Schuster, deputy director of quality methodologies, read a statement from Executive Director Katie Wunderlich and Commission Chair Adam Kane acknowledging the operational and financial impacts the COVID-19 response will have on hospitals. She also stated that they would be working to consider and identify how this response may or should impact quality policies in particular. They will ask hospitals for insights into how their volumes and rate structure is impacted. Any questions or information can be sent to HSCRC.COVID-19@Maryland.gov .

HSCRC staff reviewed the rate year 2021 Potentially Avoidable Utilization (PAU) preliminary results, and PAU savings calculation methodology yielding a proposed required revenue reduction of 0.29% or $51.3 million in savings for rate year 2021. Considering the shift to a per capita measure of PAU and the geographic attribution for the proposed inclusion of pediatric quality indicators in the PAU policy, staff stated that they would be working with Medicaid to discuss how their MCO networks and patterns of utilization may unequally impact hospitals.

HSCRC has since suspended the Performance Measurement Workgroup meetings until further notice. The materials from the March 18 meeting are here , here and here . For questions or additional information, contact Brian Sims . More updates on HSCRC’s response to the COVID-19 outbreak, is available here: hscrc.maryland.gov/pages/default.aspx .
Joint Commission Suspends All Regular Surveying
On Monday, the Joint Commission suspended all regular surveying until further notice. If any organizations go past their accreditation due date, accreditation will be extended without disruption to accreditation status. The Joint Commission said a small number of surveys may need to continue, such as for high risk situations. Postponed surveys will occur at a later date. Earlier this month, CMS directed agencies to suspend certain non-emergency inspections, allowing inspectors to prioritize the most serious health and safety threats like infectious diseases and abuse.
Leapfrog Extends Submission Deadline for Spring 2020 Hospital Survey
Leapfrog will now accept hospital and ASC surveys until Aug. 31 with, and the results are expected to be released publicly in September. Leapfrog will host a series of webinars to explain changes in the hospital survey, scoring and public reporting of hand hygiene, and removal of the CPOE evaluation tool requirement for general hospitals. The registration and schedule for webinars are now available.
Hospital Field Achieves Key Priorities in Abbreviated Session
The Maryland General Assembly adjourned Sine Die March 18—cutting short the legislative session due to the coronavirus/COVID-19 outbreak. MHA worked to advance several emergency bills to address the public health crisis, including removing barriers for care delivered via telehealth. Lawmakers are expected to return in late May for a special session to take up veto overrides and COVID-19 issues. MHA’s Sine Die report is available here . Session overview materials, including a post-session action map with health care related bills that passed and a PowerPoint presentation with key session outcomes, will be sent to the field soon. Despite the abbreviated timeline, MHA secured several field priorities this session. A snapshot of key hospital victories within the field’s top four priorities are below. Click here for a full list of bills MHA tracked, including their final outcomes, during the 2020 legislative session.
  • Rescue Maryland’s medical liability climate
-Secured study on opportunities to stabilize the hospital reinsurance market
-Resisted efforts to eliminate the cap on non-economic damages

  • Build and retain Maryland’s health care workforce
-Passed MHA legislation to double funding and streamline administration of the physician loan assistance repayment program
-Advanced multiple bills to prevent workplace violence and support health care workers

  • Improve access to behavioral health services
-Passed MHA legislation allowing behavioral health patients to bypass hospital emergency departments
-Protected funding for Maryland’s two Institutions for Mental Diseases

  • Reduce Medicaid Deficit Assessment
-Secured a $15 million Medicaid Deficit Assessment for fiscal year 2021
HIV Prophylaxis Pilot Program
The Governor’s Office of Crime Prevention, Youth and Victim Services’ released a new abbreviated protocol for providing HIV prophylaxis to victims of sexual assault. State law requires that qualifying victims have access to the full 28-day course of HIV prophylaxis at no out-of-pocket cost. State law also allows for the use of a pharmaceutical patient assistance programs or a patient’s insurance as long as the patient does not incur any cost. All hospitals are asked to evaluate their ability to provide access to this medication for victims of sexual assault. A sexual assault forensic exam is not required, which means that individuals can present at any access point along the care continuum from primary care offices to urgent care centers and hospitals that do not provide forensic services.
The Governor’s Office of Crime Prevention, Youth, and Victim Services will collaborate with any medical facility, pharmacy, pharmaceutical company, or any other related entity, to ensure all victims receive a screening, medication, and follow-up care. All inquiries should be sent to saru.claims@maryland.gov .
MHA will continue to work with the state as guidance is finalized and will coordinate a webinar in the coming months. For questions, contact Jane Krienke
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Maryland Hospital Association | www.mhaonline.org