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Maryland Regulatory News - Spring 2011


1. In January, the Maryland Insurance Administration finalized changes to the Comprehensive Standard Health Benefit Plan regulations, bringing Maryland law into alignment with federal health care reform. Changes include a ban on applying preexisting condition provisions to minors, mandatory coverage for certain preventative care services, and an increase of the maximum age of a "dependent child" from 25 years old to 26 years old. The changes apply for plan years beginning after September 23, 2010.

2. In January, Dr. Joshua Sharfstein replaced Mr. John M. Colmers as Secretary of the Department of Health and Mental Hygiene.

3. In January, the Maryland Health Care Reform Coordinating Council released its recommendations to the Maryland General Assembly. In part, the Council recommended that the General Assembly establish a health insurance exchange that meets the requirements of the Patient Protection and Accountable Care Act. The Council suggested that the Exchange take the form of a quasi-public entity with an independent board of directors. The Council also recommended that an executive Office of Health Reform inherit the Council's functions as health care reform moves from planning to execution.

4. In January, the Maryland Health Care Commission voted to permit Holy Cross Hospital to build a ninety-plus bed hospital in Montgomery County over the objection of Adventist HealthCare, approving Commission Chair Marilyn Moon's December recommendation. Adventist had desired to build a similarly sized hospital in the County.

5. In January, the Health Services Cost Review Commission (HSCRC) adopted a Template for Review and Negotiation of an Admission-Readmission Revenue (ARR) Hospital Payment Constraint Program. The program recognizes that many patients are readmitted to a hospital soon after they are discharged, that readmissions are costly, and that there is evidence that spending more time with a patient during discharge and arranging for effective and prompt post-hospital follow-up care reduces readmissions. Under the program, a Maryland hospital may volunteer to become an ARR hospital for three years. If an ARR hospital then lowers its readmissions, the ARR hospital will be permitted to raise its rates to other patients by the amount the ARR hospital would have charged the patients who were not readmitted. On the other hand, if an ARR hospital increases its readmissions, then the ARR hospital must lower its rates to other patients by the amount it charges in regard to such increased readmissions. HSCRC Staff may also permit an ARR hospital to raise its inpatient rates up to .5% to cover the ARR hospital's investment in people and processes that will hopefully result in lower readmissions. Such upfront money is to be repaid after two years via a reduction in the ARR hospital's rates.

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Date

03.15.11

Type

Publications

Authors

Rosen, Barry F.

Teams

Health Care