Mid-Atlantic Health Law TOPICS
Maryland Regulatory News Fall 2007
1. In May, the Maryland Health Care Commission (HCC) released its Practitioner Utilization Report which pertains to health care practitioner services received by privately insured, nonelderly Marylanders. The report, based on 2004-2005 encounter data, shows an overall 3% increase in spending for practitioner services, from $880 per user in 2004 to $904 in 2005. While the per user spending increased by about 5% in the Baltimore area, the increase was 2% in other parts of the state. Public employer plan user spending in the state was higher than private employer plan users - $1,027 compared to $996. The report notes that about 13% of all fee-for-service practitioner relative value units (RVUs) are provided by out of network health care providers.
2. In June, the Health Services Cost Review Commission (HSCRC) approved a new Ambulatory Surgery Guaranteed Revenue System. The system seeks to curb the increase in ambulatory surgery revenue by establishing limits on the rate of increase in the revenue per case-mix adjusted ambulatory surgery case for each hospital. The new system, implemented in FYE 2008, will also provide better incentives to control utilization. Using FYE 2007 as the base year, the HSCRC will calculate an ambulatory surgery case mix index and a charge per outpatient case for each hospital.
3. According to new regulations issued by the Board of Nursing, an applicant who has completed a nurse anesthetist program after January 1, 2008, and who applies to the Board for certification, must provide to the Board verification of his/her completion of a nurse anesthetist program with a master's degree or higher. Previously, the Board required a nurse anesthetist to have a master's degree solely from a school of nursing.
4. The new chairman of the HSCRC is Donald A. Young, M.D. Most recently, Dr. Young was the acting Assistant Secretary of Planning and Evaluation at the U.S. Department of Health and Human Services. Prior to that position, he was Executive Director of the federal Prospective Payment Assessment Commission, and earlier in his career he was the President of the Health Insurance Association of America, a trade association representing the private health care system. Also, the Governor appointed C. James Lowthers, President of the United Food and Commercial Workers Union Local 400, to the Commission. Mr. Lowthers previously served as an HSCRC Commissioner during the 1980s and 1990s.
5. In August, the HSCRC appointed a nine-person corrective action task force to address new information indicating that Maryland hospital rates are rising faster than expected when compared to Medicare inpatient rates elsewhere in the country, which situation will put Maryland's waiver from Medicare rates in jeopardy if the trend is not abated. The nine-person task force includes three HSCRC Commissioners, three hospital representatives, and three payor representatives.
September 22, 2007