Mid-Atlantic Health Law TOPICS

1.  The Health Services Cost Review Commission (HSCRC) voted during its January 2026 Public Meeting to use private health insurance plans to make up for an expected loss in funding under the Achieving Healthcare Efficiency through Accountable Design (AHEAD) Model that sets hospital rates for Medicare services in Maryland. The HSCRC developed this “Cost Shifting Policy,” to help meet AHEAD required Medicare savings by replacing lost Medicare revenue with commercial funding, likely increasing commercial hospital rates by $87 million per year from 2028–2032, for a total estimated 1.8% increase to private consumers’ premiums. The HSCRC also tried to prevent Medicare Advantage insurers from pulling out of the State due to expensive hospital rates by letting Medicare Advantage plans reimburse Maryland hospitals at 11.55% less than they now pay, starting as early as 2027. To offset the financial loss to hospitals, the HSCRC plans to raise rates for other private insurers by approximately 0.75%. Total increases to commercial rates across both proposals will amount to 2.55% by 2032, according to the Maryland Department of Health.

2.  In September 2025, the Maryland Board of Physicians (Board) approved new regulations to govern employer reporting requirements for licensees regulated by the Board. The new regulations expand the scope of reporting requirements to various entities, clarify the actions that require a report to the Board, and provide new detailed requirements for the format of mandated reports, among other changes. For example, the old regulations basically only required hospitals and health care providers with privileging committees to report to the Board regarding changes to privileges or employment of physicians under certain circumstances, while the new regulations basically apply to all employers who employ health care professionals. Therefore, all health care providers must now report to the Board when: (a) professional privileges or employment are reduced, suspended, revoked, restricted, denied, involuntarily terminated, conditioned or not renewed, or voluntarily resignation is requested during an investigation, due to reasons that constitute disciplinary grounds, unprofessional conduct, or risk patient safety; (b) professional privileges are altered because the licensee may have harmed or placed one or more patients or the public at unreasonable risk of harm by engaging in an act that creates an immediate or continuing danger; or (c) a licensee is professionally incompetent or a licensee is suffering from a physical or mental condition that affects his or her ability to perform medical duties, except for a licensee with a substance use disorder, if strict program criteria are met and no harm to patients has occurred.

3.  For 2026, the Maryland Department of Health is entitled to receive over $168,000,000 as part of the new Rural Health Transformation Program (RHTP), which in turn is part of the One Big Beautiful Bill Act, and more 2027 RHTP funds are projected to be available to Maryland in the Fall of 2026. Health care providers servicing Maryland’s 18 rural counties are eligible to receive portions of such funding to improve rural health care by, among other things, improving the rural health care workforce, promoting access to primary care, disease management and behavioral health, and increasing access to nutritious foods that impact chronic diseases.

Kennedy M. Hagens
410-576-4146 • khagens@gfrlaw.com