April 7, 2017
Countdown to Sine Die
"A river cuts through rock, not because of its power, but because of its persistence." - Jim Watkins
There are just three days left until Sine Die, the official close of the 2017 session of the Maryland General Assembly, and this year has proven to be a political roller coaster. Of course, things can change at the last minute, but we have a pretty good sense of how the issues of greatest importance to hospitals are shaping up.
All in all, this is closing out as a very successful General Assembly session for hospitals. Here's a quick overview of how hospitals fared on the three top priorities for the field:  
  • Behavioral health - Significant progress was made on Maryland's behavioral health crisis: funding increases for community-based behavioral health providers; full funding (an additional $7 million this year and $35 million next year) for the state's three Institutions for Mental Diseases; and expansion of Medicaid's telehealth program, along with several other changes to address the crisis in Maryland.
  • Medical liability - We turned back bills that would have tripled the cap on non-economic damages and expanded the cases in which punitive damages could be awarded. We also expanded support for the creation of a no-fault birth injury fund, a good accomplishment for a very tough haul.
  • Medicaid tax - This was a tough year for the state spending plan, and elected officials had many budget gaps to fill. After Governor Hogan delayed the promised $25 million spend-down of the $365 million tax for fiscal year 2018, we secured a $70 million commitment over the next two fiscal years to help make up the difference. 
And how we did on some other key issues:  
  • Physician alignment - Hospitals can now collaborate financially with physicians, an essential component for success under the care redesign programs in the All-Payer Model
  • Tax-exemption - Legislators rejected legislation that would have required hospitals to display the value of their not-for-profit tax exemptions alongside the value of their community benefits contributions, a threat to hospitals' tax-exempt status. 
These are just a handful of the more than 200 bills MHA, along with your hospitals' legislative teams, has been engaged with this session. As we do each year, we'll send out at midnight Monday a quick summary of where we ended up, which will be followed by a post-session hospital action plan, a detailed session summary, and a PowerPoint presentation so you can share outcomes of the session with your board, staff and the public.
This was a challenging but fruitful session. The physician alignment legislation is a major step toward success under the All-Payer Model, and while the delay of the Medicaid tax spend-down was disappointing, the additional commitment in the budget's out years offers some measure of security.

As we begin to digest the proceedings and politics of the past 90 days, it reminds me that our state's lawmaking process is quite deliberative, with big changes rarely occurring in a single year. Instead, it's steady persistence over time that effects transformation, and taken as a whole, this year's movement has been in the right direction.

Spotlighting Some of the 200+ Bills MHA is Tracking This Session

Sexual Assault Victims' Rights - Disposal of Rape Kit Evidence and Notification (SB 349/HB 255)
Numerous bills were introduced to support survivors of sexual assault with additional funding and by promoting best practices in care for victims. SB 349/HB 255 addresses the preservation of rape kits and would bring Maryland into compliance with federal law, which recommends evidence be kept in the custody of law enforcement for 20 years. MHA worked with stakeholders to clarify chain of custody provisions and remove liability for hospitals providing these services. This bill aligns the state with national standards and gives survivors time to decide whether they wish to pursue legal action.
Behavioral Health Community Providers - Keep the Door Open Act (SB 476/HB 580)
Tucked into the Democratic opioid leadership package, SB 476 is expected to pass this year after failing on the last day of the 2016 session. The Keep the Door Open Act requires the governor to include an annual rate increase in the state budget for behavioral health providers until a rate study is completed. This bill is a long-term investment in the community behavioral health infrastructure, promoting partnerships among hospitals and community providers and improving access to critical services for the estimated 1.5 million Marylanders with behavioral health needs.
At Work in Annapolis
The 2017 legislative session will draw to a close Monday night. With the budget wrapped up and several wins recorded, several bills are still in play. One bill we are fighting is of particular concern. This bill would weaken Maryland's physician self-referral law to allow oncologists to have an ownership or financial interest in the radiation therapy services and self-refer to that service, thereby removing critical safeguards for patients. At midnight on Sine Die, we will send a Member Alert with an At-a-Glance summary of the 2017 session. Links to bills and our position papers can be found in this week's Advocacy Dashboard.
Today is Deadline for Threat Center Info on Medical Countermeasures Solicitations
MHA this week sent a Member Alert to hospitals noting that the Washington Regional Threat Analysis Center is asking hospitals for information about solicitations from foreign entities into health care facilities' medical countermeasures protocols or supplies. This request stems from a local incident in which an individual was soliciting information about a hospital's protocols, inventory, and funding streams for a chemical antidote. The center wants to determine whether other health care facilities in the National Capitol Region received similar inquiries between January and March 2017. MHA's Senior Vice President of Operations Meghan Allen will be collecting responses. Please email summaries of any incidents to mallen@mhaonline.org by 2 p.m. today.
Following are the types of information the threat center is seeking:  
  • Solicitor's name
  • Solicitor's follow-up contact information (email or phone number)
  • Characteristics of the caller's voice
  • Voice familiarity
  • Background sounds
  • Type of language or identifiable accent
  • Did the person sound well-versed on the topic at hand?
  • Name of company the solicitor is associated with
  • Time the call was received and time the call ended
Hospital Bond Program Application Process Underway
Applications for the 2017 MHA Hospital Bond Program are due Friday, June 16. Please make note the deadline for hospitals to request correspondence for Certificate of Need non-coverage determination from the Health Services Cost Review Commission and Maryland Health Care Commission has been extended to Friday, May 19. A playback of a webinar explaining the application process can be found here. All application materials can be found on our website at www.mhaonline.org/bond. If you have questions, please contact Brett McConeJennifer Witten, or Jane Krienke.
MHA Executive Committee Minutes Available
The minutes from the March MHA Executive Committee meeting are available on the Governance page on our website. Members must be logged in to download the minutes.
DHMH Extends Deadline for Input on Primary Care Model
The Department of Health & Mental Hygiene has extended the deadline for hospital input on the Maryland Comprehensive Primary Care Model. Input should be based on an Environmental Scan of organizations interested in the proposed model's practice transformation feature known as Care Transformation Organizations. Hospitals are asked to review the scan and respond to dhmh.pcmodel@maryland.gov by April 14.
Care Redesign Webinars Scheduled
The Care Redesign Amendment to Maryland's All-Payer Model is expected to receive final CMS approval shortly. At that time, final participation agreements and program templates/protocols will be provided to hospitals. The two new Care Redesign Programs - the Hospital Care Improvement Program and the Chronic and Complex Care Improvement Program - are expected to begin on July 1, 2017. The Health Services Cost Review Commission is holding two webinars this month on the Care Redesign Programs. The first, originally scheduled for April 5, has been moved to Wednesday, April 12 at 9 a.m. This webinar is "CMS Care Redesign Program Data: Q & A Session." If you have already registered for the original webinar date, you may use the same link and dial-in details you were given. If you have not registered, you can do so here. The second webinar will answer questions about the draft Participation Agreement. It is scheduled for April 13 at 9 a.m. You can register here. The slides and a recording of the previous webinar "CMS Overview of Data Provided to Care Redesign Program Participant Hospitals" are available on the HSCRC Care Redesign webpage.
Cyber Security Resources Available
In an effort to keep hospitals informed of threats and vulnerabilities that may affect them, the American Hospital Association is working with the Federal Bureau of Investigation and other agencies to share important cybersecurity intelligence. The FBI has asked AHA to share the document Intrusions Affecting Multiple Victims Across Multiple Sectors, which AHA members can access by logging in to the AHA cybersecurity webpage. In addition, AHA and its Association for Healthcare Resource and Materials Management will host a webinar on Tuesday, April 11 at 2 p.m.on "Medical Device Cybersecurity and the Supply Chain." Increasingly, medical devices are connected to both the Internet and to hospital networks. During the webinar, leaders from Mayo Clinic will describe how they are taking steps to identify standards that it uses to evaluate the security of devices before procurement. Register here. You will receive the access link for the webinar and audio dial-in information closer to the date of the webinar. AHA also is hosting four regional forums on how CEOs can help manage cyber risks. The first will be held April 6 in Washington, D.C., while the second will take place May 18 in Dallas, Texas. Details regarding the last two forums will be posted soon. Click here for more information or to register.
For additional AHA resources on cybersecurity, visit www.aha.org/cybersecurity. Questions should be directed to AHA Assistant General Counsel Lawrence Hughes at lhughes@aha.org or (202) 626-2346, or AHA Vice President of Policy Chantal Worzala at cworzala@aha.org or (202) 626-2313.
Building Physician
Leadership Talent
An article in the March 25, 2017, edition of Modern Healthcare extols the virtues of teaching physicians how to lead, with the idea that more organizations are looking to medically trained individuals to fill top leadership slots.

Prime Presents
Revenue Opportunity
The Mainsail Group helps clients find new and significant means of revenue and cost containment. They help hospitals form strategic partnerships with consumer brands in a manner that is supportive of a health system's mission of care.

Free AHA Webinar April 26 on Hospital-Led Effort to Combat Violence
The AHA's Hospitals Against Violence initiative will host an April 26 webinar on a hospital-led effort to prevent violence in Chicago. 

Tuesday, April 11
MHA Council on Clinical and Quality Issues meeting

Wednesday, April 12
Health Services Cost Review Commission meeting

Friday, April 14
MHA meeting with hospitals, 3M and HSCRC to discuss hospitals' potentially
  preventable complications (PPC) concerns
The Baltimore Sun, By Ian Duncan, March 31
The Frederick News-Post, By Natalie Schwartz, March 31
The Baltimore Sun, By Erin Cox and Michael Dresser, April 3
The Daily Record, By Tim Curtis, April 4
Baltimore Business Journal, By Morgan Eichensehr, April 4
WMDT, By Brandon Bossert, April 5