November 11, 2018
New Faces, New Opportunities
Last Tuesday’s midterm elections have shaken up the political landscape – both nationally and here in Maryland.

At the federal level, Democrats regained control of the United States House of Representatives for the first time in almost a decade, with health care at the top of the Democratic congressional campaign platform this year.

In Maryland, while Larry Hogan became the first Republican governor to be re-elected since 1954, the General Assembly will look substantially different come January. At least 40 percent of the Maryland Senate and nearly a third of the House will be new.

Committee makeup will change significantly with new members and leadership. Notably, the Senate Finance, Budget & Taxation Committee and the Education, Health, and Environmental Affairs committees will have new chairs and vice chairs. In the House of Delegates, the Judiciary Committee will have new leadership for the first time in more than a quarter century.

All of this change poses both challenges and opportunities. It’s crucial that lawmakers understand the vital role of hospitals and value Maryland’s unique model brings to the state. With some of the field’s long-time friends having left the arena, it’s important to forge new relationships and support emerging champions.

Your MHA team has been working since the primary elections to educate both expected new and those returning legislators receiving new committee assignments on the ways they can help address the important concerns of hospitals and health systems.

I’m very pleased to say that MHA’s government affairs team is well prepared for the hard work ahead. They’ve been coordinating strategy with your own government affairs leaders for months. Together, we will ensure that public policy in Maryland enables hospitals and health systems to serve their communities well and make Marylanders healthier.
Bob Atlas
President & CEO
MHA Supports Change to Public Payer Differential
The Health Services Cost Review Commission (HSCRC) is considering a small adjustment to the public payer differential, which would require insurers to share slightly more of the costs of uncompensated care. They currently pay 6 percent, and the proposed change would increase that to 7.7 percent. In a letter to the HSCRC issued Friday, your Maryland Hospital Association stated its strong support for the change, which we state would help to reduce some of the burden of uncompensated care to Medicare and Medicaid. In the letter, MHA also seeks to initiate the new rate on January 1, when the Total Cost of Care model takes effect.

MHA Contact: Michael Robbins , Senior Vice President of Rate Setting
Hospitals Asked to Commit to Good Stewardship of 340B
The American Hospital Association (AHA) and individual 340B hospitals announced new principles in September to ensure good stewardship of the 340B program. This new AHA-led initiative will strengthen the 340B program by increasing transparency while helping 340B hospitals better communicate the immense value of the program for vulnerable patients and communities. A number of hospitals already have committed to the voluntary Good Stewardship Principles. If your organization has not done so yet, please complete the form to sign up your 340B hospitals. Your Maryland Hospital Association will host a call in December to discuss the principles, tools to articulate the benefits of the 340B program, and concerns related to eligibility standards.

MHA Contact: Brett McCone , Vice President of Rate Setting
New Initiative to Improve Maternal Health
Maryland’s hospitals have undertaken the important work of improving maternal morbidity and mortality. The state was one of the first to join the Alliance for Innovation on Maternal Health, an effort led by the American Congress of Obstetricians and Gynecologists to improve safety, and virtually all of Maryland’s birthing hospitals participated in a Maryland Patient Safety Center (MPSC) collaborative to reduce first-time mother cesarean section rates. An upcoming collaborative by MPSC to address opioid use during pregnancy will provide further opportunity to reduce maternal death. Additionally, a new initiative called “Better Health for Mothers and Babies” by the American Hospital Association (AHA) can complement hospitals’ efforts. The initiative will include a website featuring best practices, a series of webinars (register for the first one on November 13 at 2 p.m., here), a national summit, and other coordinated events with AHA partners and stakeholders. For questions, please contact Bonnie Connors Jellen, director of AHA’s Section for Maternal & Child Health, at bjellen@aha.org or 202-626-3751; Jay Bhatt, D.O., AHA senior vice president and chief medical officer, at jbhatt@aha.org or 312-422-2262; or Robyn Begley, R.N., AONE chief executive officer and AHA chief nursing officer, atrbegley@aha.org or 312-422-2824.
Midterm Election Brings New Faces to Annapolis
This year’s election will bring significant changes to the political landscape of Annapolis. Maryland Gov. Larry Hogan easily won a second term and Democrats maintained their veto-proof supermajority in the Maryland House of Delegates and Senate. In addition to several new rank-and-file legislators, much of the legislative leadership will be new as well. For more information on the Senate leadership changes, click here, and for more information on House leadership changes, click here. Notably, three Republicans on the House Judiciary Committee lost their election last week, expanding the already significant turnover in key committees of jurisdiction for hospital priorities. 
CMS Clarifies QP Threshold Test for Care Redesign Program
The Centers for Medicare & Medicaid Services (CMS) has clarified how it will conduct the threshold test for care partners participating in hospitals’ Care Redesign Program and determine clinician eligibility to receive the 5 percent bonus incentive. In the November 2 letter, CMS addresses five issues raised by the Health Services Cost Review Commission, including Qualifying APM Participant (QP) determination. CMS states it agrees with the HSCRC’s understanding that claims between July 1, 2018 and August 31, 2018 will be included in the threshold test.

To view the letter from HSCRC and the response from CMS, click here .

MHA Contact: Erin Dorrien , Director of Policy & Data Analytics
New Care Redesign Program Track Launches in January
The Care Redesign Amendment to the Maryland All-Payer Model Agreement authorizes waivers from fraud and abuse regulations and enhanced Medicare data to hospitals participating in one of three voluntary, hospital-led programs: the Hospital Care Improvement Program (HCIP) for hospital-based physicians, the Complex and Chronic Care Improvement Program (CCIP) for community-based providers, and the newest track, the Episode Care Improvement Program (ECIP), which is aimed at improving clinical episodes after a hospital discharge.

For the fourth performance period beginning January 1, 41 hospitals will be participating in HCIP, two hospitals in CCIP and nine hospitals in ECIP. Your Maryland Hospital Association continues to convene user groups for the respective programs to support implementation, inform future program modifications and provide a forum for sharing. User groups will be held at MHA offices in Elkridge on the following dates:
·         ECIP: November 13 at 9 a.m.
·         HCIP: December 12 at 2 p.m.
Md. Forms Community Health Worker Advisory Committee
Senate Bill 163 (Chapter 441)​ enacted in October 2018 required the state to establish a Community Health Worker Advisory Committee to advise the Maryland Department of Health on the certification and training of community health workers. The law also requires the department to adopt regulations for accrediting certain training programs and may consider requiring that certified community health worker training programs be approved by the state. The Maryland Hospital Association secured two representative seats on the advisory committee. MHA’s representatives are Ryan Moran with MedStar Health and Kate Talbert with Johns Hopkins University. We thank them for their expertise and service.

More information can be found at the Maryland Community Health Worker Advisory Committee home page.
State Court Makes Significant Change to Tort Law
A civil litigant’s right to due process was not violated when she was ordered to pay a punitive damages award 20 times greater than the amount assessed to compensate the victim of her defamatory actions, Maryland’s second-highest court ruled last week, The Daily Record reported. The Court of Special Appeals’ reported 3-0 decision stands in seeming contrast to the U.S. Supreme Court’s 1996 decision in BMW of North America Inc. v. Gore that a punitive-damages ratio of 10:1 should generally be regarded as unconstitutionally excessive.

MHA Contact: Neal Karkhanis , Director of Government Affairs
MHA Comments on Health Exchange 2020 Plan Certification Standards
MHA recently submitted comments to the Maryland Health Benefit Exchange (MHBE) on their 2020 plan certification standards. The MHBE has proposed requiring insurance carriers to provide coverage for a series of services at lower cost-sharing without enrollees first needing to meet deductibles. In the letter, we urged the state to consider populations who need active management of chronic conditions when determining cost-sharing structures for these “before deductible” services. The letter is a continuation of MHA’s growing efforts to focus on commercial insurance enrollees. Improvement in their health care now means improved outcomes as they become Medicare beneficiaries.

MHA Contact: Maansi Raswant , Vice President of Policy & Data Analytics
Behavioral Health Capacity Study Data Collection Wraps Up
Since August 8, 31 hospitals in Maryland have submitted data aimed at identifying the reasons for discharge delays of behavioral health patients in inpatient units. This data collection will conclude November 16. As of Friday, nearly 250 patients have experienced a delay in discharge of at least one day. This data also will highlight the reasons for delay, and the report will inform our advocacy efforts in the Maryland General Assembly’s 2019 session and beyond. As participating hospitals complete the collection and the data become available, your Maryland Hospital Association will share the results more broadly.

MHA Contact: Erin Dorrien , Director of Policy & Data Analytics 
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