January 20, 2019
A Big Step Forward
Gov. Larry Hogan’s proposed fiscal year 2020 budget, released Friday, includes investments that support your mission of care, the health of all Marylanders, and the goals of the new Total Cost of Care Model.

Chief among them is his inclusion of a $40-million reduction of the Medicaid Deficit Assessment — also known as the sick tax. This was the hospital field’s top priority, as we made clear in a letter to Gov. Hogan that was signed by all acute care hospital CEOs. We are grateful that Governor Hogan is proposing that the tax be nearly $100 million less than it was at its peak in 2015.

The $40-million reduction follows a $30-million reduction in the hospital Medicaid tax approved in the current fiscal year’s budget — also championed by the Maryland Hospital Association.

This signals that Gov. Hogan and the state legislature take seriously the state’s commitment to holding down health care costs to ensure that Maryland successfully meets the aggressive financial targets of the Total Cost of Care model contract and reduces health care costs for patients.

Our work is just beginning. The General Assembly will now take up the governor’s budget, and the hospital field will advocate to ensure that this reduction is protected during upcoming negotiations. There are several competing budgetary priorities the governor and the legislature are balancing, including the ongoing work of the Kirwan Commission.

MHA also was pleased to learn that the governor appears to have included full funding for Maryland’s two Institutions for Mental Diseases (IMDs) in his budget proposal. He also fully funded the Keep the Door Open Act commitment, which invests millions of dollars into community behavioral health services.

These investments are vitally important to Maryland, and hospitals are ready to work alongside Gov. Hogan, his administration, and lawmakers to ensure the proper resources are in place to move the state toward better health.
Bob Atlas
President & CEO
Payment Model Work Group Reconvenes
Chris Peterson, the director of clinical and financial information for the Health Services Cost Review Commission (HSCRC), informed members of the HSCRC’s proposal to “pre-fund” the incremental Medicare savings necessary to meet the Total Cost of Care (TCOC) Model requirements. The Medicare Performance Adjustment (MPA) Efficiency Adjustment (separate from the MPA Policy), would adjust Medicare final payments to/from hospitals. Unlike the public payer differential, which holds revenue neutral, the MPA Efficiency Adjustment is similar to the adjustment for sequestration, which would only affect Medicare payments. Peterson said the Centers for Medicare & Medicaid Services is considering whether the adjustment should be made on a quarterly basis, if needed, due to changes in projected Medicare TCOC savings. As proposed, hospitals would be able to “recoup” payment adjustments through participation in Care Redesign Programs. Peterson said staff is considering whether hospitals would be rewarded for Medicare savings in excess of required savings. The MPA Efficiency Adjustment, as proposed, is set to be effective in January 2020. Further consideration of this policy proposal will be taken up by MHA’s Council on Financial Policy. The next meeting of the Payment Models Work Group is March 6 at 8:30 a.m.
MHA Comments on Hospital Acquired Conditions Program
The Maryland Hospital Association (MHA) is supportive of most of the Health Services Cost Review Commission’s (HSCRC) Draft Recommendation for the Maryland Hospital Acquired Conditions Program for Rate Year 2021. In a comment letter to the HSCRC, sent Friday, MHA says it supports narrowing the Potentially Preventable Conditions to the 14 included in the draft recommendation and recommends some additional changes.

To view the comment letter, click here .

MHA Contact: Traci La Valle , Vice President, Rate Setting
Hospital Collaborative Supports Mothers With Substance Use Disorders
The Maryland Patient Safety Center (MPSC) is participating in a two-year collaborative — Obstetric Care for Women with Opioid Use Disorder — in collaboration with the Alliance for Innovation in Maternal (AIM) Health. The collaborative will use the AIM bundle of best practices and offer in-person meetings, webinars, and calls for information sharing. The deadline is February 7, 2019 for Maryland’s hospitals to sign up to participate.

To view the recruitment packet, click here .

For more information, contact Bonnie DiPietro , Director of Operations, Maryland Patient Safety Center.  
Md. General Assembly Update
On Wednesday, Larry Hogan officially began his second term as governor before officially introducing his proposed fiscal year 2020 budget. While not many bills have been introduced yet due to the volume of new legislators and legislative leaders, the Maryland General Assembly spent the week conducting several briefings on issues of interest to legislators. Key agencies providing briefings included the Opioid Operational Command Center, the Maryland Health Benefit Exchange, Maryland Department of Health, and the Maryland Insurance Administration. Your Maryland Hospital Association team presented at a legislative briefing on the recommendations shared by the Maryland Sexual Assault Evidence Kit Policy and Funding Committee and continued meeting with legislators regarding priority hospital issues.
State Grants Available to Support Victims' Services
The Governor’s Office of Crime Control and Prevention has more than $6.5 million in grant funding available for law enforcement, crime prevention, and victims’ services. Eligible applicants include hospital programs that support violence prevention, sexual assault victims, and victims’ services. About $1 million of that — to be awarded for about 10 proposals of up to $100,000 each — must be used by June 30. For details, or to apply for the grants, click here .
Md. Health Care Facilities Advised of Cyber Attack
All health care organizations and facilities in Maryland are being advised to take additional precautions when receiving email requests for changes in financial transactions, according to a notice from the Maryland Coordination and Analysis Center. The notice states that a health care facility in the state has been the target of multiple business email compromise attacks since November 14. To read the full cyber situation bulletin, click here.
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