December 16, 2018
Undaunted by Threat to ACA
By now you know that a federal district court judge in Texas ruled Friday that the entire Affordable Care Act (ACA) was rendered unconstitutional when Congress eliminated the individual mandate penalty in last year’s tax act. (For more information, see the Coverage and Access section of this newsletter).

If this judge’s ruling stands, it would undermine major pillars of health coverage and care transformation in Maryland: Medicaid expansion, the individual marketplace, and our one-of-a-kind health care financing arrangement.

We at your MHA have been in touch with state officials over the weekend, and we’ve been following media reports. All indications — including from the federal Department of Health and Human Services—are that no changes to ACA-enabled programs will take effect until all legal appeals have been exhausted. That could take some time.

The newest iteration of Maryland’s financing innovation — the Total Cost of Care Model — will launch on January 1. It offers great opportunity for Maryland hospitals and health systems to demonstrate leadership in managing the care of the whole person and in improving the health of whole populations.

We will not squander this opportunity. In every corner of the state, we will stay focused on our missions of caring and on furthering the measures already begun to make the new model a roaring success.
Bob Atlas
President & CEO
Commissioners Approve Public Payer Differential Change
HSCRC commissioners approved a change in the Medicare/Medicaid payer differential from 6 percent to 7.7 percent, effective July 1, 2019, at this month’s public meeting. As more fully reported in this month’s edition of Newsbreak commissioners also received a draft recommendation on providing Medicare Advantage plans the 2 percent sequestration adjustment and took final action on the fiscal year 2021 Quality-Based Reimbursement policy. 
CMS Price Transparency Requirements Take Effect January 1
Hospitals will be subject to new price transparency requirements beginning January 1. Under the new rules, hospitals must post a list of their current standard charges online — in a machine-readable format — at least annually. These new requirements were included in the Centers for Medicare & Medicaid Services’ fiscal year 2019 IPPS final rule. Inpatient prospective payment system hospitals continue to be required to make available charges for diagnosis-related groups.

For more information, click here .
Hospital Collaborative Supports Mothers With Substance Use Disorders
The Maryland Patient Safety Center (MPSC) is participating in the collaborative — Obstetric Care for Women with Opioid Use Disorder — in collaboration with the Alliance for Innovation in Maternal Health. MPSC’s goal is for all of the state’s 32 birthing hospitals to participate. The deadline is December 31 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.
MHA Hosts Legislative Preview
On Thursday about 50 hospital executives and government affairs and public relations leads attended a preview of the upcoming session of the Maryland General Assembly, where your Maryland Hospital Association’s (MHA’s) government affairs team shared its new advocacy priorities and strategies. MHA began educating new legislators right after the primary election and will continue to educate all legislators on the value of the Maryland’s unique model and the important ways hospitals and health systems are transforming care in their communities. That includes how Maryland’s move to the Total Cost of Care Model inevitably will lead to right-sizing of hospital and health care services. Five hospital leaders participated in a panel discussion to share their experiences and lessons learned in communicating effectively with elected officials, the media, and the community. Their advice: frame a clear, compelling story and stick to it; emphasize quality and safety of care, not costs; educate hospital staff early; and ensure that physicians are bought in and enlist their aid in messaging. MHA will continue to create opportunities for all Maryland hospitals and health systems to leverage the benefits of collective engagement.
MHA Contact: Nicole Stallings , Senior Vice President, Government Affairs
MHA Comments on CON Draft Recommendation
The Maryland Hospital Association (MHA) submitted consensus hospital recommendations on the Maryland Health Care Commission’s (MHCC’s) Final Report on Modernization of the Maryland Certificate of Need (CON) Program. The MHA offered its guidance in a letter sent to commissioners and commission staff. MHA staff will provide comments in person at the MHCC’s December 20 hearing. MHA staff would like to thank our hospital work group members for their time and effort in shaping these recommendations over the last year.

Click here to access a CON fact sheet prepared by MHA staff.
HSCRC Offers Guidance on Year Two MPA
The Health Services Cost Review Commission sent a letter last week to hospital CFOs to offer data submission guidance and documentation requirements for the year two (rate year 2021) Medicare Performance Adjustment (MPA) program. The letter also details the voluntary information needed for the provider-to-hospital linkages in the MPA attribution algorithm.

This information also is included on the TCOC WG page on the HSCRC website.

MHA Contact: Traci La Valle , Vice President, Rate Setting
CMS Adds Maryland Model to QPP Website
The Centers for Medicare & Medicaid Services updated its Quality Payment Program (QPP) website to officially recognize Maryland’s all-payer model, as well as the Maryland Primary Care Program.
This confirms that physicians who participate in the Maryland All-payer model Care Redesign Program or the Maryland Primary Care Program are eligible for the MACRA 5 percent payment bonus for participating in an advanced alternative payment model.

For more information, click here .

MHA Contact: Nicole Stallings , Senior Vice President, Government Affairs
What ACA Ruling Means for Maryland
Friday’s ruling from a Texas district court finding the Affordable Care Act (ACA) unconstitutional sent shock waves across the country. The judge’s ruling against the individual market provisions of the ACA was anticipated, but his determination that the entire statute is unconstitutional was not. In Maryland, officials’ immediate focus is to let consumers know that the decision does not impact this year’s open enrollment, and contracts will be good at least through 2019.
Since 2014, the ACA has provided coverage to over 400,000 individuals via Medicaid expansion and subsidized private plans.
Maryland has worked over the past few years to codify some of the ACA reforms and coverage protections into state law. For example, provisions prohibiting coverage denials based on pre-existing conditions and premium ratings based on health status are now explicitly in state law. Other protections, however, remain codified only by reference to federal statutes enacted under the ACA.
Given Friday’s ruling, there may be a renewed push to amend state law to incorporate protections mirroring those in the ACA. It is widely known that legislative leaders are focusing on the adoption of a state-level individual mandate this upcoming session. Of course, the largest impact of the ACA is the additional federal funding provided for coverage expansions.
Maryland’s attorney general filed a suit in September to seek a declaratory judgment that the ACA is constitutional. That case will be heard this Wednesday. With the Maryland suit, and an expected appeal of the decision in the Texas case, it’s likely that the issue of ACA constitutionality is headed back to the U.S. Supreme Court.
Your Maryland Hospital Association will continue to deliver both federal and state-level updates on this issue as events unfold.
MHA Contact: Maansi Raswant , Vice President of Policy & Data Analytics
MHA Hosts Call on 340B Drug Pricing
The federal 340B drug pricing program allows about half of Maryland’s hospitals to purchase outpatient drugs at discounted rates. Hospitals can use those savings to reduce avoidable utilization and improve outcomes for patients. The Maryland Hospital Association hosted a call Wednesday to share information about the program and a new set of principles — released by the American Hospital Association — aimed at ensuring good stewardship of the program. During the call, MHA Vice President of Rate Setting Brett McCone and Vice President of Government Affairs Jennifer Witten discussed strategies for communicating the value of 340B and some reasons why hospitals should sign onto the principles, as well as some of the risks involved.

Click here and here to access additional resources shared during the call.

MHA Contact: Brett McCone , Vice President, Rate Setting
MHA Report Considers ED Protocols for Patients with Substance Use Disorders, Opioid Overdoses
The Maryland Hospital Association (MHA) submitted a report entitled Emergency Discharge Protocols for Patients with Substance Use Disorders and Opioid Overdoses in Maryland’s Hospitals to The Maryland General Assembly and to the Maryland Department of Health. The report includes the results of MHA’s review of emergency department (ED) discharge protocols for patients treated for an overdose or identified as having a substance use disorder from our acute care inpatient hospitals with emergency room departments.

Over the past year, MHA collected and reviewed the discharge protocols of 45 hospitals for four recommended elements: universal screening, naloxone access, facilitated referrals, and peer recovery services. MHA also reviewed the protocols for medication assisted treatment initiation in the ED. Through a series of MHA-led forums, hospital representatives formed a consensus on those recommended protocol elements for this patient population by sharing evidence, challenges, and lessons learned associated with each. As such, the report also includes highlights from these discussions.

This initiative was part of MHA’s efforts to support and encourage our hospitals in complying with, and going beyond the requirements of the Heroin and Opioid Prevention Effort (HOPE) and Treatment Act of 2017. MHA will use this report in its advocacy efforts to address the barriers that remain in treating this patient population on behalf of Maryland’s hospitals and health care providers.

To read the full report, click here .

MHA Contact: Shamonda Braithwaite , Director of Policy & Data Analytics

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