December 22, 2019
Looking to the ‘20s
As we enter the holiday time and reflect on the year now ending, it’s striking how many challenges the Maryland hospital field faced and what you’ve accomplished.

The new Total Cost of Care Model launched and you blew through the first year’s savings target. You built upon quality achievements from the previous model of lower readmissions and 30-day mortality.

In 2019 you more forcefully addressed the social needs of patients and disparities in health outcomes.

And we’ve seen changes of control, facility reconfigurations, and leadership changes as our hospitals and health systems innovate and transform care to meet future needs.

In this incredibly busy year for Maryland hospitals, MHA has been right there with you as advocate, convener, problem solver, and thought leader.

Through it all, the field, by working together on shared interests and for the benefit of all the people of Maryland, enters the 2020s better connected and therefore stronger.

It has been my pleasure to work with so many of you. Your dedication and compassion are clear. You work hard to build up your businesses and communities—to make Maryland a better place for all who live here.

Through the holidays, we will recharge and gear up for the 2020 legislative session. It will be an uphill battle and we’re up to the challenge.

Wishing you, your family, and your hospital or health system team a safe and healthy holiday season and a very happy New Year!
Bob Atlas
President & CEO
Webinar to Present Final Evaluation of Maryland All-Payer Model
The CMS Innovation Center and RTI International will present the final results of the independent evaluation of the Maryland All-Payer Model in a webinar January 23 at 9 a.m. During the webinar, participants will learn how Maryland performed on the goals of the model in its agreement with CMMI, the impact of the model on payers, as well as hospitals and the patients they serve, and future goals of the Maryland Total Cost of Care Model. To register for the webinar, click here .
Performance Measurement Work Group Update
The Health Services Cost Review Commission’s (HSCRC) Performance Measurement Work Group convened December 18. HSCRC staff reviewed the draft Maryland Hospital Acquired Conditions (MHAC) policy as presented at the monthly commission meeting December 11. Staff provided additional analysis and hospital insights on the increase in potentially preventable conditions (PPCs) that were moved from the payment policy to monitoring only. HSCRC staff stated that, though it is important to ensure we don’t see drastic unexplained increases in clinically significant nonpayment PPCs, CMS says their focus will be on the payment PPCs in evaluating Maryland’s quality performance. Work group members discussed alternatives to the proposal that hospitals would be excluded from the MHAC program if they don’t qualify for at least 6 payment PPCs, however no consensus was reached on a different approach to address the volatility of performance for hospitals which don’t meet the proposed standard. Comments on the MHAC policy are due January 6.

HSCRC staff reviewed the proposed inclusion of oncology patients in the Readmissions Reduction Incentive Program (RRIP) policy and stated they would provide additional validation at the January Performance Measurement Workgroup (PMWG) meeting. Staff then reviewed modeling detailing payer-specific readmissions benchmark analysis stating that the proposed improvement target for the rate year 2022 policy of 7.5% over five years and an attainment target of 11.23% were reasonably with the range of the modeling. Staff then shared modeling on the proposed disparity component of the RRIP policy stating that by including a disparity component in the policy now as reward only, would allow us to get credit sooner towards potential five-year goals with CMS. Staff added that there should be no assumption that there would be immediate adoption of a penalty component in future years, and that CMMI is very interested in a statewide goal to address disparities and that success on this would require the entire state to step up to address these goals.

Staff asked that members bring potential measures to be explored for hospital quality and care transformation across the system goals in the Statewide Integrated Health Improvement Strategy to the January PMWG meeting.

For questions or additional information, contact Brian Sims .
Spending Affordability Committee Decisions
This week, the Maryland General Assembly’s Spending Affordability Committee made their official recommendations to the Governor and legislature regarding the state’s fiscal year 2021 budget. The Department of Legislative Services (DLS) reported that there is a projected $419-million structural deficit for fiscal year 2021. The committee recommended that the Governor and General Assembly address the structural deficit this session and leave a minimum projected cash fund balance of $100 million for next fiscal year. The committee cited the expected Kirwan legislation and the fact that the economy is likely at or near its peak as reasons to address next year’s deficit and leave a healthy cash fund and rainy day fund balances. While the state’s budget landscape has improved since the Spring, the structural deficit and expected passage of Kirwan legislation will continue placing pressure on the state’s FY 2021 budget.
MHA Contact: Brian Frazee
Baltimore City Council PILOT Hearing
On Thursday evening, the Baltimore City Council held an informational hearing on a resolution that asked for a briefing on the 2016 nonprofit assessment agreement, or PILOT (Payment in Lieu of Taxes), as well as the options for potentially renegotiating the 10-year agreement between Baltimore’s hospitals and educational institutions. The City’s Law Department provided their opinion that the agreement is unenforceable before several interested parties testified. MHA Vice President of Government Affairs Brian Frazee served on a panel and explained hospitals’ financial constraints under our unique global budgeting system.

MHA Contact: Brian Frazee
EMS Innovation Group Holds First Meeting
The Emergency Medical Services Innovation Group, convened at the request of the Stakeholder Innovations Group (SIG), held the its first meeting December 16. The SIG requested the formation of the EMS subgroup to make recommendations on the potential to spread the federal ET3 model in Maryland and align innovations in paramedicine with the Total Cost of Care Model. The group will continue to meet throughout 2020 with the goals of making recommendations to the Health Services Cost Review Commission to implement for the 2021 rate year, if consensus on a model is reached. For more information contact Erin Dorrien .
 Maryland Health Insurance Coverage Protection Commission Meets; TEXAS v. AZAR Ruling by Appeals Court
The Maryland Health Insurance Coverage Protection Commission met December 17 to discuss improvements to the small business health options program, further explore additional state subsidies for individuals purchasing coverage on the state health benefit exchange, and review a legislative proposal that would enumerate coverage protections outlined in the Affordable Care Act (ACA) at the state level. MHA CEO & President Bob Atlas advocated for the adoption of state-level consumer coverage protections in light of the continuous erosion of the ACA at the federal level, including a potential ACA repeal by the courts. Atlas also noted that the commission’s efforts should address the impact a repeal would have on Maryland’s entire health care system, and not just the insurance markets. The commission will meet in January to finalize recommendations for the upcoming legislative session.

On December 18, the Fifth Circuit Court of Appeals held that the ACA’s individual mandate is unconstitutional. The court found that the individual mandate, as currently set to zero dollars, is no longer considered a tax as classified under the 2012 Supreme Court decision in NFIB v. Sebelius , and is therefore unconstitutional. The court remanded this case back to the Texas district court to consider the severability of the individual mandate from the rest of the ACA. It is likely that regardless of the district court’s findings, the defendants will petition the Supreme Court for review. The Fifth Circuit Court of Appeal’s decision does not have any immediate effect on Maryland’s laws. MHA is continuing to monitor the developments in this case and is working to understand any implications for the Maryland Total Cost of Care Model. As discussed above, MHA is actively engaged in working with policymakers to ensure continued protections for Maryland’s residents in the event that the entire ACA is struck down.

For more information, contact Maansi Raswant .
Medicaid Behavioral Health System of Care Work Group has Fifth Meeting
The Medicaid Behavioral Health System of Care Work Group met last week to continue discussions on improvements to the state’s behavioral health system. The group walked through the state’s draft framework to operationalize design principles , which contains ideas and initiatives raised by stakeholders within the work group and discussion groups. Maryland Medicaid will attend MHA’s Medicaid System of Care Task Force meeting in January, when the task force will provide feedback to the state on the draft framework, and share recommendations on improving the state’s behavioral health care system.

For more information, contact Maansi Raswant.
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