Maryland Legislative Update 2017

Transcription

1 Maryland Legislative Update 2017

2 Format for Today Introductions Overview Panel discussion Audience questions and answers 2

3 Our Expert Panel Michael Poku, MD, Moderator, Resident in Internal Medicine and Urban Health, Johns Hopkins Hospital Brian Frazee, Director of Government Relations, Maryland Hospital Association Ryan O Doherty, Vice President of Marketing and External Affairs, Mercy Medical Center 3

4 2017 Session Landscape Third year of Governor Hogan s term Very busy - nearly 3,000 bills introduced Partisan politics peak Gearing up for 2018 election National changes lead to state-level political posturing Budget $544 million shortfall coming into session Committee changes Lost a champion in former House Health & Government Operations Chair, Pete Hammen Rank and file members given new committee assignments 4

5 MHA Legislative Priorities 2017 Reduce Maryland s $364 million tax on hospital care Control Maryland s health care liability costs Develop an integrated behavioral health system 5

6 Medicaid Hospital Tax Began in 2009 as a temporary $19 million fix to backfill state s Medicaid budget; in recent years ballooned to nearly $400 million annually The tax cumulatively added $2.1 billion to hospital bills over seven years, inflating hospital bills for all patients by nearly 3 percent Artificial increase makes meeting new All-Payer Model spending targets more difficult 6

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8 MHA Outcome Reduce Medicaid hospital tax Governor s 2018 budget did not include a promised $25 million reduction of the $365 million tax General Assembly maintained the Governor s delay of the spend down MHA secured a General Assembly commitment to increase the spend-down to $35 million over each of the next two fiscal years ( ) to compensate 8

9 Control Health Care Liability Costs Litigious medical malpractice environment hinders efficient, low-cost health care Maryland ranks ninth in the nation in per capita medical malpractice payouts In Maryland, 13% of hospital costs are due to defensive medicine about $2.1 billion 9

10 MHA Outcome Control out-of-control liability costs Blocked trial lawyers attempts to triple the cap on non-economic damages in cases of wrongful death and catastrophic injury Advanced support for no-fault birth injury fund Would quickly compensate families for the 6 to 7 birth injury cases eligible annually for the program Mitigate litigious environment for families New bill sponsors are bipartisan Positive feedback following public bill hearings 10

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13 Develop an Integrated Behavioral Health System Between 2013 and 2015, behavioral health visits to emergency departments rose 18 percent Readmissions rate for mental health and substance use disorder patients was 16.3 percent in 2015, nearly 4 percentage points higher than for non-behavioral health patients In 2015, nearly 1,300 Marylanders died from drug or alcohol intoxication 13

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15 MHA Outcome Secured full funding for Maryland s Institutions for Mental Diseases an additional $7 million for the current fiscal year and $35 million for fiscal year 2018 Expanded Medicaid s telehealth program to include coverage for remote-patient-monitoring for certain patients who have two hospital visits with chronic conditions and for services provided by communitybased substance use disorder programs Comprehensive, bipartisan legislation passed the General Assembly, to address the opioid crisis Keep the Door Open Act provides $100 million in additional funding for community-based behavioral health providers HOPE & Treatment Act comprehensive package that expands substance use disorder care programs, establishes a crisis hotline and increases availability of opioid treatment prescribers Prescriber Limits Act of 2017 requires providers, when treating pain, to prescribe the lowest effective dose of an opioid and a quantity that is no greater than needed for the expected duration of the pain, based on clinical judgment 15

16 Removing Barriers to Alignment Hospital/Physician Financial Collaboration Passed the General Assembly unanimously Legislation is the result of several years of work with stakeholders and state agencies Represents a major advancement in modernizing Maryland s patient referral law Allows hospitals to implement approved care redesign programs 16

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18 Other Key Issues- Bills Passed A bill that brings Maryland into compliance with federal law and clarifies the chain of custody for evidence, removing liability for hospitals An appropriation bill that will establish a commission to identify funding for systems serving victims of sexual assault A bill requiring DHMH to provide hospitals information about the signs and symptoms of postpartum mental health disorders A bill requiring private insurance carriers to cover counseling services delivered via telemedicine for substance use disorders. This bill also changed the definition of telemedicine to telehealth Secured $5.5 million through the Capital Bond Program for 11 hospital capital projects across the state 18

19 Other Key Issues- Bills Blocked An attempt to lower the 20% rule for expert witnesses, essentially creating professional witnesses Efforts by trial lawyers to triple the cap on non-economic damages in cases of wrongful death and catastrophic injury, and lower the standard for an award of punitive damages A measure requiring that hospitals show the value of their not-forprofit tax exemptions alongside their community benefits contributions A bill that would have duplicated standards established by state law and The Joint Commission, by creating a state patient s bill of rights Efforts to exempt one for-profit oncology practice US Oncology from the state s self-referral law, diluting patient protections An attempt to modify the Hospital Employee Retraining and Economic Fund by adding an assessment and changing the threshold A bill which would have merged MHCC and HSCRC. MHA showed willingness to discuss improving efficiency and streamlining the Certificate of Need process 19

20 Next Steps Advocate that the Governor uphold the Medicaid tax spend down Promote patient engagement through outreach to hospitals and community stakeholders, and staff training on patients rights Ensure that DHMH maintains the agreement to expand Medicaid s telehealth program based on established timelines MHA s Behavioral Health Task Force will conduct a study to identify opportunities to support a comprehensive treatment continuum for hospital patients with substance use disorders MHA will provide representation on commissions and work groups established by 2017 legislation: Community Health Workers Advisory Committee Maryland Health Insurance Coverage Protection Act Commission Work Group on Health in All Policies Maryland Sexual Assault Evidence Kit Policy and Funding Committee 20

21 Panel Question How does the birth injury fund really work? 21

22 Panel Question How will the hospital/physician financial collaboration bill that passed allow for better alignment of physicians with hospitals? 22

23 Questions?

24 Next MAHCE Event Emergency Preparedness July 20, 2017 Columbia, Maryland