November 25, 2018
Giving Thanks
Thanksgiving is, of course, a time to reflect on what we all are thankful for – family, friends, our health, meaningful work, and more.
This year, as I gathered with my family, I was mindful – and thankful – that there are so many hard working doctors, nurses, and other caregivers in our hospitals and medical centers day and night – including holidays – to ensure that every Marylander who needs care can get it.
I am also thankful for Maryland’s great hospitals and health systems. Our hospitals are making great strides in quality and safety. You’re working to exceed patients’ expectations and deliver top-notch care at every level – not just in inpatient settings but also in emergency departments, ambulatory sites, patients’ homes and, increasingly, in the digital domain.
Your passion for ensuring that the most vulnerable among us are taken care of is inspiring. Toward that end, it’s great to see that hospitals recognize the value of addressing the social determinants of health, including education, housing, public safety, and more.
On behalf of all the staff of the Maryland Hospital Association, it is an honor to stand alongside you and support your efforts to improve the health of all Marylanders. Thank you.
Bob Atlas
President & CEO
HSCRC Volume Methodology and Rate Modernization Work Groups Underway
Maryland Hospital Association (MHA) staff and hospital representatives recently met with Health Services Cost Review Commission (HSCRC) staff and other stakeholders to address important policy and methodology issues. Most recently, the initial Volume Methodology Work Group met to discuss fundamental policy incentives under Maryland’s All Payer Model and global budgets, as well as potential case mix logic changes to better measure service mix and intensity. MHA staff plan to initiate a member work group to develop consensus recommendations for approval by MHA’s governance councils that will ultimately be shared with the commission. The HSCRC’s Rate Modernization Work Group is also meeting to refine the underlying unit rate structure, including direct and overhead cost allocations.

MHA Contact: Brett McCone , Vice President, Rate Setting
MHA Seeks to Lower Revenue at Risk on QBR
The Maryland Hospital Association (MHA) submitted comments to the Health Services Cost Review Commission Monday on draft recommendations for updating the Quality Based Reimbursement (QBR) program for rate year 2021. MHA urged the commission to lower the revenue at risk on its QBR program and to make other adjustments to bring it more in line with the national program.

Click here to read the letter.
MHA Supports Moving Up Implementation of 340B Rule
The Maryland Hospital Association (MHA) on Wednesday submitted comments to the U.S. Health Resources and Services Administration in support of moving up the implementation and compliance date for a key piece of the federal 340B program. The Drug Pricing Program Ceiling Price and Civil Monetary Penalties establishes the process for calculating the maximum price for drugs acquired under 340B and assessing monetary penalties for drug manufacturers that do not comply. The American Hospital Association will host a webinar November 28 at 3 p.m. on the 340B program. During the event, AHA staff will share information about the 340B good stewardship principles and updates on the latest congressional, regulatory, and legal developments that affect the program. To register, click here.
Md. Commission Considers Ways to Preserve Affordable Insurance
Last week the Maryland Health Insurance Coverage Protection Commission met to discuss ways to preserve affordable insurance coverage for Marylanders. The commission, co-chaired by Sen. Brian J. Feldman (D-Montgomery) and Del. Joseline Peña-Melnyk (D-Prince George’s), is set to issue legislative recommendations by the end of the year. The commission has focused on legislation that would establish penalties for anyone who doesn’t have health coverage – better known as the “Individual Mandate-Down Payment." The mandate would require residents to pay the state a penalty for going without coverage. Under the proposal, funds raised by the individual mandate would be used to help people purchase health insurance, reduce premiums, and pay for administrative costs. Advocates estimate 80,000 people would be impacted in Maryland should legislation pass. The penalties would mirror those from the Affordable Care Act — $700 for individuals and $2,100 for families. When combined with federal tax credits that remain available, the penalties should be sufficient to purchase insurance.
Bob Atlas, President & CEO of the Maryland Hospital Association, offered several important considerations the commission should review prior to moving forward with the proposal. Maryland’s hospitals support broad-based coverage and have consistently been in support of efforts to stabilize the insurance market. People with affordable insurance and access to appropriate services, help manage uncompensated care. The mandate also provides a way to balance the risk-pool within the insurance exchange and may provide added stability to the market beyond the life of the reinsurance program only funded through 2021. Atlas recommended that a deeper analysis be conducted to better understand how premiums rates might be impacted if there are reductions in the reinsurance program and the future affordability of such plans. Atlas offered suggestions for the commission to consider cost sharing structures, more transparency by carriers and better incentives for care management to get to the underlying costs of insurance.

Additional information can be found on the commission’s website .
Care Redesign Program Participation Agreement for Next Performance Period Released
The final Care Redesign Program (CRP) Participation Agreement for performance period four (January 1, 2019 through December 31, 2019) has been released. All hospitals participating in any CRP (Hospital Care Improvement Program, Complex and Chronic Care Improvement Program, and/or Episode Care Improvement Program) in performance period four, including those already participating, need to sign the new participation agreement and return the document to care.redesign@crisphealth.org by December 7. The agreement can be found here. Your Maryland Hospital Association will continue to provide updates on all CRP requirements and deadlines.
MHCC Maintenance of Certification
The Maryland Health Care Commission (MHCC) was asked by the chair of the state Health and Government Operations Committee to study physician maintenance of certification requirements. The Maryland Hospital Association (MHA) and hospitals were well represented on the work group. MHCC supports steps to reduce physician burden and improve physician retention while maintaining quality of care. Although no consensus was reached on a legislative approach to this issue, members were able to clarify initial positions and identified non-legislative approaches to remedy the current impasse. Some alternatives to legislation include modernizing requirements within traditional board certifying organizations, encourage acceptance of alternative board certification organizations and increase awareness of alternative pathways for board recertification. MHA has agreed to partner with MedChi to ensure physicians and hospital administration are aware of the alternative recertification option offered as part of the qualification for physician privileging. The MHA is committed to disseminating information about the program to our membership. We think a partnership with MedChi will bolster these efforts and help remedy a noted barrier for Maryland’s physicians.
The work group recommendations and resources can be found on the MHCC work group home page.
MHA Contact: Jennifer Witten , Vice President, Government Affairs
Webinar Focused on Response to Opioid Crisis
The Opioid Operational Command Center will host a  webinar November 28 at 9:30 a.m., focused on supporting first responders who are on the front lines of the heroin and opioid crisis. The Supporting First Responders: Combating Compassion Fatigue & Fostering Resilience webinar will include presentations by:
  • Dr. Timothy Chizmar (Assistant State EMS Medical Director, Maryland Institute for Emergency Medical Services Systems)
  • Vernon Herron (Director, Baltimore City Policy Department)
  • Heather Press (Overdose Prevention Certified Peer Support Specialist, Carroll County Health Department) 
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