November 18, 2018
Support 340B Programs for Vulnerable Populations
Caring for the most vulnerable among us is at the heart of our mission each day in Maryland’s hospitals. The federal 340B drug pricing program supports that mission by allowing about half of our hospitals to purchase outpatient drugs at discounted rates. Hospitals can reinvest savings to reduce avoidable utilization and improve outcomes for our patients.
This week, your Maryland Hospital Association shared the news that the U.S. Health Resources and Services Administration (HRSA) is considering moving up the implementation and compliance date for a key piece of 340B. We’ve been waiting for the Drug Pricing Program Ceiling Price and Civil Monetary Penalties to take effect since early 2017.
The rule establishes the process for calculating the maximum price for drugs acquired under 340B and assessing monetary penalties for drug manufacturers that do not comply. Now, HRSA says it will consider moving the effective date up six months to January 1, 2019.
The American Hospital Association (AHA) and MHA will submit comments in support of this change. We encourage all Maryland 340B hospitals to do the same by the November 23 deadline. Here is a model letter from AHA, and a link to submit your comments.
We’d also like to encourage 340B hospitals to sign onto new principles to ensure good stewardship of the program. Following the principles will help 340B hospitals better demonstrate the immense value of the program for vulnerable patients and communities.
Although Maryland’s hospitals are exempt from OPPS payments, any cuts to 340B may reduce access to health care and limit resources needed to better serve disadvantaged populations.
For help acting upon our 340B recommendations, please contact Brett McCone, vice president.
Bob Atlas
President & CEO
HSCRC Acts on Rate Spend Down Plan
At the November Health Services Cost Review Commission (HSCRC) meeting, commissioners took action on a rate spend down plan for the University of Maryland Medical Center-Midtown Campus and reductions to some hospitals’ global budgets as a result of services moving from regulated to unregulated settings.

Details of these actions and other commission activities can be found in this month’s issue of Newsbreak .
Webinar Planned on CRISP's Emergent Imaging
On December 10, from 7:30-8:30 a.m., the Maryland Hospital Association, in partnership with the Chesapeake Regional Information System for our Patients (CRISP), will host a webinar on CRISP’s Emergent Imaging feature to share stroke images statewide. The Emergent Imaging feature enables community hospitals to publish stroke images to a dedicated worklist that includes specialists at Maryland’s stroke centers. This approach can help providers save critical time and make informed treat-or-transfer decisions. The webinar will feature content from early adopters and provide hospital leaders the opportunity to consider the clinical and financial benefits of a statewide approach. For those leaders that favor this approach they can submit a letter of interest after the webinar to MHA, which will inform how the solution can be scaled. To register for the webinar, click here.
Hospitals Recruited to Aid Mothers With Substance Use Disorders
In the coming months, a statewide collaborative will launch with the goal of helping our most vulnerable mothers – those who have substance use disorders. The Maryland Patient Safety Center (MPSC) will begin recruiting Maryland’s 32 birthing hospitals in December to participate in the collaborative. MPSC is participating in the collaborative — Obstetric Care for Women with Opioid Use Disorder — in collaboration with the Alliance for Innovation in Maternal Health.

The recruitment packet is available here .
Atlas: Helping Marylanders' Reach Their Health Potential
Bob Atlas, President & CEO of the Maryland Hospital Association, offered commentary on WYPR Tuesday. In his remarks, he called for an “all hands on deck” approach to addressing the underlying issues that affect the health of Marylanders, including education, housing, and access to healthy foods.

To listen to the full segment, click here .
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 participate in HCIP, two hospitals in CCIP, and nine hospitals in ECIP. Your Maryland Hospital Association (MHA) continues to convene user groups for the respective programs to support implementation, inform future program modifications, and provide a forum for sharing. An ECIP user group was held November 13, and an HCIP user group will be held at MHA’s offices in Elkridge December 13 at 2 p.m. Another ECIP user group meeting will be scheduled in the first quarter of 2019.
MHA To Host Forum Ahead of Legislative Session
Your Maryland Hospital Association (MHA) will host a statewide forum for government affairs and public relations leads on December 13 to preview the 2019 session of the General Assembly. The forum will include an executive panel discussion on how to effectively communicate with lawmakers, the media, and the community about capacity changes at your hospitals, an overview of the MHA’s advocacy agenda, and a discussion on the post-election political landscape. There also will be an open forum on the state’s new Total Cost of Care Model.
DLS Predicts Structural Deficit Beyond FY2020
The Maryland General Assembly’s Spending Affordability Committee, which is charged with recommending the state’s fiscal goals and spending limits for the fiscal year 2020 budget that will be considered during the upcoming legislative session, met last week for a briefing from the Department of Legislative Services (DLS). DLS reported that while the state’s fiscal 2020 budget landscape is positive, there continues to be a significant structural deficit in the out years and urged the committee to recommend a multi-year approach to address future deficits. DLS also reported that the Medicaid program will need additional state funding due to a decrease in the federal share of the ACA expansion population and CHIP program. The committee will make their official recommendations in late December. Your Maryland Hospital Association continues its advocacy to secure a Medicaid Deficit Assessment (“sick tax”) reduction in the state’s next budget.

To view the full report, click here .

MHA Contact: Brian Frazee , Vice President, Government Affairs
Cardiovascular Invasive Specialists Work Group Issues Report
The Maryland Board of Physicians convened the Cardiovascular Invasive Specialists (CIS) work group following the 2018 Maryland General Assembly session to study a possible new licensure category of CIS under the board. The evaluation included applying a standardized set of criteria and considerations — as other states have done — before recommending licensure of a health profession. The CIS work group members agreed on a set of consensus points and voted to recommend an exception to licensure for registered CIS (RCIS) in Maryland. The proposed exception to licensure would allow a physician to delegate certain duties to an RCIS assisting with the physician's performance of fluoroscopy in a hospital cardiac catheterization laboratory under narrow circumstances. The Maryland Hospital Association (MHA) was represented on the work group along with other hospital members. MHA will support legislation during the state’s 2019 legislative session to implement the work group recommendations.

A full list of recommendations and considerations are noted in the report
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