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Maryland Regulatory News - Spring 2013

1. In January, the Maryland Health Care Commission released its yearly quality performance report for Maryland's commercial health plans. The report compared Maryland plans' aggregate performance against national benchmarks (and plans' individual performance against each other) in fields such as primary care services, care coordination, disease prevention, and health status. Among other findings, the Commission reported that Maryland's commercial health plans outperformed national benchmarks in measures related to prenatal health, while Maryland's plans struggled to meet national benchmarks for measures related to management of adult asthma and arthritis.

2. In January, Maryland's Health Services Cost Review Commission (HSCRC) outlined how its Maryland Hospital Acquired Condition (MHAC) and Quality-based Reimbursement (QBR) initiatives will impact hospital inpatient rates in future years. These initiatives tie a portion of an individual hospital's inpatient rates to the hospital's ability to reduce hospital acquired complications and to achieve positive outcomes on specific conditions, such as pneumonia and septicemia. A Maryland hospital that does well relative to other Maryland hospitals is allowed to charge patients more, and a Maryland hospital that does poorly must charge patients less, scaled such that there is no net impact on inpatient rates across Maryland hospitals. The HSCRC approved a plan to continue to tie up to 2% of a hospital's revenue to its MHAC performance in fiscal years 2013 and 2014, before increasing this percentage to 3% in 2015 and future years. The plan also calls for changes to the ratio of hospital performance to rate adjustments to create a more linear relationship between rate changes and performance.

3. In January, Maryland's Board of Physicians finalized new regulations governing its discipline of Maryland's physicians. The regulations create a scale of sanctions short of revocation of license, impose new fines for failure to meet continuing medical education requirements, and adjust various rules governing formal administrative proceedings before the Board.

4. In December, the federal government approved the Maryland Health Benefit Exchange as a state-based exchange under the Affordable Care Act. Under the Affordable Care Act, each state is to establish an online marketplace through which individuals and small businesses may obtain coverage under compliant health care plans, and under which purchasers may obtain subsidies for acquiring such coverage. The Maryland Exchange will begin enrolling consumers in health plans in October 2013, for plan years beginning January 2014. Federal approval was conditioned on the Exchange demonstrating by May 2013 that, among other things, the Exchange has a sustainable funding source to replace existing federal grants designed to help Maryland establish and begin operation of the Exchange.

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Date

03.22.13

Type

Publications

Authors

Rosen, Barry F.

Teams

Health Care