MHA Update Newsletter
March 27, 2015
Save the Dates!

 June 1 and 2, 2015

MHA Annual Meeting
Four Seasons

Hotel Baltimore


MHEI Programs & Webinars

March 31

11th Annual Maryland Patient Safety Conference



April 2

Environment of Care Update 2015


Quick Links


Home Stretch

Hard to believe that the Maryland General Assembly is scheduled to adjourn just two weeks from Monday. It's been a hectic but important legislative session for hospitals and, while a lot can happen between now and April 13, hearings are finished and we have a pretty solid idea of where we will end up on our key priorities.


Medicaid tax

The state's budget typically isn't wrapped up until the very last day, but the Senate version we're supporting includes language that mandates a $25 million per year spend-down of the $400 million annual Medicaid hospital tax, beginning next year. We will fight hard to make sure that provision holds, because it is a significant step toward elimination of this tax.


Budget cuts

Our work to manage the governor's proposed $25 million reduction in hospital Medicaid reimbursement has yielded flexibility in the Budget Reconciliation and Financing Act that allows the Health Services Cost Review Commission to take those reductions in ways that will not trigger an across-the-board rate cut resulting in more than $410 million in lost hospital revenue. For the current fiscal year, the budget allows a proposed $8 million reduction to be taken from the Maryland Health Insurance Plan's surplus.


Behavioral health

Our efforts to establish a Blue Ribbon Commission to address the state's behavioral health needs have generated an even more promising solution: Senate Finance Committee Chairman Thomas "Mac" Middleton and House Government Operations Committee Chairman Pete Hammen have agreed to combine our commission bill with other legislation addressing behavioral health, and create a "Legislative Committee," with key lawmakers from both committees. This is good news, because it means that this work will start rapidly and receive the high level attention it needs.


Caregiver designation

We've blocked a proposal backed by the state's chapter of the AARP that would have created redundant, burdensome requirements for hospitals regarding caregiver designation, aftercare training and discharge planning. The bill would have mandated that hospitals provide multiple opportunities to designate a caregiver, assess the capabilities and limitations of that caregiver, provide a live demonstration of aftercare tasks, and more - all within specific time constraints. Maryland's hospitals already do much of this work and these mandates would have done little more than prolong the discharge process.



Maryland's hospitals have also blocked a push to water down the state's self-referral laws, which prevent physicians from referring patients to services in which they have a direct financial interest. There were two efforts to loosen these regulations, one focused on oncologists and the other more broadly on MRIs and CT services. We can expect a hard barrage of advocacy for these exceptions to be aimed at legislators again next year, with plenty of "softening up" efforts during the interim. This work will not stop for us.


Birth injury fund

While a proposal to create a birth injury fund was not successful, MHA is working closely with key senators and delegates to convene a legislative group over the summer, potentially staffed by the Maryland Health Care Commission, to maintain momentum on this initiative and to lay the groundwork in advance of another push next year.



Work to expand the federal 340b discount prescription medication program has proved successful. The bill is expected to add eight hospital outpatient programs to the current 12 that offer medication through 340b.


Of course, things can still change between now and Sine Die on April 13, but on many of the issues most important to you we've made significant progress. Beyond these victories, this session provided a forum to educate dozens of new legislators in Annapolis about the challenges and opportunities hospitals face. That foundation will make for a smoother road in coming sessions.
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In This Issue
At Work in Annapolis

Monday marked the official day of "crossover" in the General Assembly's 2015 legislative session, the day when bills that failed to move across chambers would no longer be considered unless specifically excepted under the rules.Our continued efforts will focus on securing the gains we have achieved thus far; the remaining weeks will include hearings hearings on bills that did move from one chamber to the other, subcommittee work groups and management of floor votes. 


Earlier this week, MHA supported and offered oral testimony for SB607-HB 896-Joint Committee on Behavioral Health and Opioid Use Disorders,which incorporates our legislation addressing the Blue Ribbon Commission on Behavioral Health. This bill specifies the purposes of the Joint Committee to review the final report of the Governor's Heroin and Opioid Emergency Task Force, review and monitor the activities of the Governor's Inter-Agency Heroin and Opioid Coordinating Council, evaluate the effectiveness of specified programs, policies and practices, review compliance with specified federal and state laws by health insurance carriers; identify areas of concern and corrective measures, evaluate the state's behavioral health system and identify needed funding. This commission will be a legislator-led initiative which is beneficial for several reasons, including early buy-in from key stakeholders and efficient proceedings. MHA, of course, will be a critical voice during these discussions.


MHA continues to follow the debate and secure provisions within the governor's budget and the Budget Reconciliation and Financing Act of 2015 that affect our members. Both the House and Senate continue work on their versions of the state budget, which will then go to conference committee for approval by April 6. There are slight differences in the House and Senate recommendations regarding the budget language. We will continue efforts to capture savings to apply toward the deficit assessment, give HSCRC flexibly in identifying savings and monitor provider rate changes.


Budget - Our work on the budget to manage the governor's proposed $25 million Medicaid reimbursement reduction for hospitals has yielded flexibility in the Budget Reconciliation and Financing Act that allows for those reductions to be derived from other sources (like the Maryland Health Insurance Plan) rather than force an across-the-board cut that would turn a $25 million reduction into more than $410 million in lost revenue. 

  • Restorations - House decided and Senate modified: The House proposed increasing to 93 percent a proposed cut of 87 percent of Medicare rates for evaluation and management codes for primary care providers and psychiatrists. The Senate proposed an equal increase to all (including specialty) providers for E&M codes to approximately 90.9 percent, by applying that 6 percent increase to all providers.
  • Capital Bond - Hospital Programs: We expect full support this week from the House Appropriations Capital Budget Subcommittee for the five capital projects recommended by MHA's Hospital Bond Project Review Committee; the full committee is expected to approve this Friday afternoon. The Hospital Bond Project Review Program is a process to allocate state funds to private hospital capital projects. Each project undergoes an application and screening process and then a scoring and ranking process by a committee composed of hospital trustees and executives from around the state. Applications for 2016 were mailed last Friday to hospital CEOs. Additional information can be found on the Advocacy page on MHA's website.  

Contact: Jennifer Witten
Report Shows Progress on Quality

This week, MHA released its annual quality report to the public and distributed copies to members electronically and through traditional mail. The report, which received coverage in the Baltimore Business Journal and Modern Healthcare, highlights the myriad strategies Maryland's hospitals are deploying to improve patient safety.


Contact: David Simon

MHA Seeking Comment on Work Group Definitions

Clinical and quality leaders on Monday received a request for comment on proposed definitions for Pneumonia, Aspiration Pneumonia and Respiratory Failure. This request is part of an effort to address the variability in clinical criteria used to define certain diagnoses. Standardization of these definitions will support hospitals' ability to effectively collaborate on care improvement as well as facilitate accurate measurement of improvement under the new hospital waiver and the Maryland Hospital Acquired Conditions (MHAC) payment policy. To support this work, MHA convened four multidisciplinary work groups from a cross-section of Maryland's community and teaching hospitals and health systems. In addition to the work group that is addressing these respiratory conditions, other work groups are developing definitions on urinary tract infections, obstetrical hemorrhage, obstetric laceration, and acute renal failure/acute kidney injury. Final definitions will be disseminated in late April to all hospitals with the request that Medical Executive Committees consider them for adoption. Materials from each of the work groups can be found here.


Contact: Justin Ziombra

Joint Commission Seeks Nominees for Tobacco Task Force
The Joint Commission, under a contract to the Centers for Medicare & Medicaid Services, is working to re-engineer three tobacco treatment measures as electronic Clinical Quality Measures (eCQMs). A call for nominations for volunteers to participate on a Tobacco Treatment eCQM Task Force has been posted. Nominations will be accepted through 11:59 p.m. Sunday, April 5. This is part of a new approach by the commission to incorporate vendor and hospital input throughout the eCQM development process. They are specifically seeking individuals with expertise in health IT, including clinical informaticists, EHR vendor staff, clinical vocabulary experts, and workflow and implementation specialists. In the nomination form, the commission is asking hospitals to indicate whether they would like to be considered as a candidate test site. The commission also is encouraging hospitals and health systems to volunteer as test sites if they are not interested in participating in the eCQM Task Force.
Mandatory Reporting Training Scheduled

The Maryland Board of Physicians will hold a training session on Mandated Reporting for Hospitals, Related Institutions and Alternative Health Systems on Thursday, May 7. The session, from 8:30 a.m. to 3 p.m., will be held at The Eastern Shore Hospital Center (English Hall), 5262 Woods Road in Cambridge. The training is designed to provide greater clarity for entities required to submit reports including information on: 

  • Reporting requirements
  • Statutorily mandated 6-month reports and 10-day reports
  • Required and necessary information for reports
This session will provide information that has been covered previously; if someone from your organization has attended previous trainings, this one may not be necessary. To attend, RSVP by Monday, April 23, to Myesha McQueen at or 410-764-4770. For more information, contact Kim Jackson at: or 410-764-4767.
MHEI Services Available to Hospital's Community Partners
MHEI new logo

Success under the new Maryland waiver requires hospitals to partner with other providers, whether they be long-term care facilities, physician offices or therapy clinics. The Maryland Healthcare Education Institute is expanding its reach to include non-hospital providers in its program offerings. Any non-hospital provider organization can become a MHEI associate member and enjoy the same programming and on-site services currently utilized by current MHEI hospital members. This opportunity encourages the interaction of hospital staff with those in other care settings and allows for smaller providers to access information, programming and consulting services that otherwise would not be available. This will benefit our current members and move us closer to the collaboration needed in our new environment.


Contact: Mark Rulle
The Week Ahead

Wednesday, April 1

Updating Readmission Strategies for 2015 - A Focus on Medicaid - statewide meeting,
  Turf Valley

In Case You Missed It

CMS Proposes Rule for Stage 3 Meaningful Use

The Centers for Medicare & Medicaid Services (CMS) has released a proposed rule defining "meaningful use" of electronic health records (EHR) for Stage 3 of the Medicare and Medicaid EHR Incentive Programs. At the same time, the Office of the National Coordinator (ONC) for Health Information Technology released a proposed rule that sets certification criteria, standards and implementation specifications for EHR technology beginning in 2017. CMS proposes an optional start date for Stage 3 in 2017. Beginning in 2018, however, all eligible hospitals, critical access hospitals and eligible professionals would be required to report on the same eight objectives of meaningful use that incorporate 21 specific measures, many with higher thresholds than in Stage 2. All providers, even those new to the program, would have to meet Stage 3 beginning in 2018. The proposed rule does not include any of the flexibility provisions CMS has indicated it will provide for 2015, such as shortening the meaningful use reporting period from 365 to 90 days. In a statement, the American Hospital Association said the proposed rules demonstrate that CMS "continues to create policy for the future without fixing the problems the program faces today," and urged CMS to release rules immediately to provide much-needed flexibility for the 2015 reporting year.


Click here for an AHA Special Bulletin with highlights of the proposed rules.

Top News from This Week


Hospital Health Plans Heighten Tensions with Insurers
Modern Healthcare, By Melanie Evans, March 20


One Year Later, Ebola Outbreak Offers Lessons for Next Epidemic
The New York Times, By Sheri Fink and Pam Belluck, March 22


How Does Obamacare Help Low-Income Diabetes Patients? First, It Finds Them.
The Washington Post, By Lena H. Sun, March 23


Millennials Aren't as Bad at Health Care Management as We Thought
Baltimore Business Journal, By Sarah Gantz, March 24


Federal Healthcare Officials Have Ignored Watchdog Ideas Worth Billions
Washington Examiner, By Alicia Hesse, March 24


Hospitals Bless 'Doc Fix' Deal, But Approval Still Dicey
Modern Healthcare, By Paul Demko, March 24


Maryland Hospitals See Impressive Gains in Patient Safety
Modern Healthcare, By Sabriya Rice, March 25


Obama Promotes Health-Care Payments Based on Outcome, Not Volume
The Wall Street Journal, By Stephanie Armour, March 25