March 17, 2017
First Out of the Box
Since activity around repealing and replacing the Affordable Care Act began in earnest a couple of months ago, hospital advocates have been proffering a smart and tempered response: don't get caught up in the politics of the debate; focus on securing an outcome that maintains people's coverage and supports hospitals in their mission of care.


The first proposal to be voted on, the American Health Care Act, falls short of that goal. According to this week's Congressional Budget Office analysis:

  • 14 million more people would be uninsured in fiscal year 2018
  • 24 million people would lose coverage over the next 10 years
  • $880 billion in Medicaid funding would be cut over 10 years
  • $300 billion cut from hospitals to help fund ACA coverage expansion would not be restored


Earlier this month, the American Hospital Association and other health care advocates shared these concerns with members of Congress.


"As organizations that take care of every individual who walks through our doors, both due to our mission and our obligations under federal law, we are committed to ensuring health care coverage is available and affordable for all," the letter states. "...we are deeply concerned that the proposed Medicaid program restructuring will result in both the loss of coverage for current enrollees as well as cuts to a program that provides health care services for our most vulnerable populations, including children, the elderly and disabled."


Powerful political forces are influencing this debate, and factions on both sides of the aisle have been critical of the proposed bill. That means the legislation likely will be amended, maybe significantly, in order to bring conservative and moderate Republicans together on an approach that will pass muster in the House and Senate.


MHA, working closely with our partners at the American Hospital Association, will continue to fight for the principles that can make a "new" health care act acceptable: broad-based, continuous coverage, high-functioning insurance markets, and a value-driven health care system. These tenets are the foundation of your ability to take care of people, which is why we stand firmly opposed to any proposal that violates them.

Spotlighting Some of the 100+ Bills MHA is Tracking This Session

The Budget
The House version of the budget, which includes a $5 million spend-down of the Medicaid tax in fiscal year 2018, was debated on the floor this week. On the Senate side, the Health & Human Services subcommittee voted to reject the House's recommendation to reduce the Medicaid tax, thereby maintaining the Governor's recommended delay of the entire $25 million spend-down for the coming fiscal year. After the budget bills are debated on the floors of each chamber and considered by the opposite chamber, the differences will be reconciled by a conference committee. MHA has been working on a conference committee strategy to secure at least a portion of the spend-down, which would help demonstrate to the federal Centers for Medicare & Medicaid Services Maryland's continued commitment to meeting the goals of the All-Payer Model.
MHA has participated in opioid work groups in both chambers of the legislature, which are deciding on provisions that will make up the Democratic leadership package to address the state's opioid crisis: The Heroin and Opioid Prevention Effort (HOPE) and Treatment Act of 2017. Several amendments have been proposed to the legislation: One would require hospitals in 2018 to report to MHA their protocols for discharging patients treated for a drug overdose; these protocols would be shared with certain legislative committees. 

At Work in Annapolis
Monday, March 20, will mark a significant legislative session milestone: Crossover Day. On this date, the House and Senate send to the opposite chamber the bills they intend to pass. The week before crossover is typically a flurry of activity, and MHA has been engaged with several subcommittees and work groups where relevant bills are being debated. One would require a fee and additional reporting requirements for hospitals in the case of conversion to a freestanding medical facility, merger or acquisition. Another would require hospitals to include in their community benefit reports to HSCRC the value of the tax exemptions (the House will take no further action on this bill). Links to bills and MHA's position papers can be found in this week's Advocacy Dashboard.

CMS Hosting Care Redesign Webinars
The Centers for Medicare & Medicaid Services will host two webinars for hospitals as part of the Care Redesign program. Both webinars will cover Medicare data that will be provided as part of participation in the CCIP or HCIP. The webinars are:

As you plan for CCIP and HCIP implementation, please continue to use  DRAFT Implementation Protocols available on the HSCRC Care Redesign web page as a guide. Final protocols for you to complete will be sent when CMS has approved their final format.

Bond Program Application Process Begins March 30
The 2017 MHA Bond Program application process will open on March 30. The Hospital Bond Program provides an opportunity to apply for state allocated funding to complete private capital projects. Hospitals should request correspondence for Certificate of Need non-coverage determination from HSCRC and Maryland Health Care Commission (MHCC) by Friday, April 28. Applications must be submitted by Friday, June 16, including HSCRC and MHCC correspondence and other letters of support. Application materials will be available soon on MHA's website, which will include updates to the project selection scoring guidelines and other application materials. Application forms and other supporting documentation are submitted via the hospital-specific SharePoint site. If you have questions, please contact Brett McCone at, Jennifer Witten at, or Jane Krienke at or call 410-379-6200.

MHA Sponsors Health IT Security Roundtable
MHA, along with the Maryland Health Care Commission, HSCRC, and the Maryland Chapter of the Healthcare Information and Management Systems Society, is sponsoring a Health IT Security User Education Roundtable: A Best Practices Symposium on March 27 from 8-10 a.m. CIO/CISO, Compliance, Operations, Provider and Nursing leaders are invited to attend the event at the MHA offices in Elkridge. Attendees will learn more about end-user behavior and knowledge gaps that directly impact security in their health care organization. Industry leaders will share insights and expertise on best practices based on real-life scenarios. This information can help health care organizations better plan for and implement a health IT security program to manage end-user risk. Click here to download the agenda. Please register here.

CEOs Invited to Cybersecurity Session
Maryland's hospital CEOs are invited to an American Hospital Association cybersecurity leadership session April 6in Washington, D.C. An AHA-members-only link to the registration page for the session can be found on AHA's special cybersecurity webpage at Leadership Matters: Managing Cybersecurity Risk in Health Care will be held at theLoews Madison Hotel at 1177 Fifteenth Street NW from 7 a.m. to 4 p.m. The session is tailored for hospital or health system presidents/CEOs in response to requests from AHA members for non-technical resources to help them understand and respond to increasing cybersecurity threats. While it is required that the president/CEO of the hospital or health system attend, he or she may be accompanied by the organization's designated cybersecurity lead. The focus of the session will be best-practice leadership to address an organization's risk and minimize the impacts of cyber-events. Registration is free; participants will cover their travel and lodging expenses (the rate at the Loews Madison Hotel is $339 per night). Registrations are accepted on a first-come, first-served basis, and is capped at 20 organizations. The program will feature experts from BDO Consulting USA, including John Riggi, former FBI special agent and Section Chief for Cyber Division Outreach, and AHA staff experts on cybersecurity policy. It also will allow attendees to meet with local law-enforcement officials who are focused on cyber-attack response. For more information, contact AHA's Assistant General Counsel Lawrence Hughes at, or 202-626-2346.  

Ensuring Readiness of ALL Leaders
MHEI has committed to a major change in our Annual Leadership Conference for 2017.  Instead of limiting the conference to just senior leaders, it is now open to ALL leaders in your organization. 

Improve Patient Access Management
With increasingly changing reimbursement models and high-deductible health plans forcing patients to shoulder more payment liability, health systems must improve their registration and financial clearance to ensure up-front cash collections, reduce front-end denials and improve patient registration efficiencies to maintain patient satisfaction.

AHA, Others Ask NQF to Extend, Refine Trial of Sociodemographic Risk Adjustment
The AHA, America's Essential Hospitals, Federation of American Hospitals, and Association of American Medical Colleges this week urged the National Quality Forum to extend the trial period for its policy allowing the performance measures it evaluates to be risk adjusted for sociodemographic status, and to refine how the policy change is evaluated. 

Tuesday, March 21
- MHA Council on Financial Policy meeting

Wednesday, March 22
- MHA Joint Quality-Finance Work Group meeting

The Baltimore Sun, By Jessica Anderson, March 11
The Frederick News-Post, By Kate Masters and Nancy Lavin, March 10
The Baltimore Sun, March 12
The Daily Record, By Tim Curtis, March 13
The Washington Post, By Associated Press, March 14
The Daily Record, By Tim Curtis, March 14
The Washington Post, By Associated Press, March 15