2015 Legislative Session Outcomes and Priority Issues

Jennifer Witten, Government Relations DirectorModerator

Maryland Hospital AssociationAugust 21, 2015

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Agenda

• Panel Introduction• Panel Discussion

– Political Environment– 2015 Legislative Outcomes – 2016 Priorities

• Audience Questions

Panel

• Delegate Nicholaus R. Kipke-District 31B, Anne Arundel County

• Senator Delores G. Kelley-District 10, Baltimore County

• Senator Catherine Pugh-District 40, Baltimore City

• Pegeen Townsend-VP of Government Affairs, MedStar Health

• Nicole McCann-Director of Health Policy for Johns Hopkins State Affairs

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New Players

• Governor Hogan• Key health care personnel

– Van Mitchell, Secretary, DHMH• Former legislator; health lobbyist

– Bobby Neall, Fiscal Advisor• Former legislator; CEO Priority Partners

– Al Redmer, MD Insurance Comm• Former legislator; Coventry Health Care

– Craig Williams, Chief of Staff

• Govt’ Affairs Amgen

• 70+ new legislators

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Session Challenges • Many new players

– Administration

– Legislature

• Key committee member changes• Education

– Basics – Medicare vs. Medicaid

– Complex health care issues – waiver

• Significant budget debate– Eliminate state structural deficit; reduce taxes

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State Budget-Healthcare Impact

• Health Care – all Medicaid provider payments cut• Physicians

– Medicaid fees cut from 100% to 92% Medicare rate

• Nursing Homes– Medicaid payments cut to 2014 levels

• Pharmacists– Medicaid dispensing fees cut

• Managed Care Organizations– 2% rate cut

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State Budget

• Hospital Impact• $16.7 million cut for 2016

• Original proposal would have effect of greater financial impact across-the-board rate cut for all payers

• Secured fix to implement differently, more efficiently resulting in greater savings

• Secured ability to “count” toward total savings pending HSCRC action to cut uncompensated care funds

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Hospital Legislative Priorities

• Reduce, eliminate Medicaid hospital tax

• Restrain out-of-control liability costs

• Improve care for people suffering from mental health, substance abuse problems

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Medicaid Hospital Tax

• Began in 2009 as a “temporary” $19 million tax to backfill state’s Medicaid budget – has ballooned to nearly $400 million annually

• Inflates hospital bills by 3% - revenue goes to state special Medicaid fund, not hospitals

• Makes meeting new waiver spending targets more difficult

• Maryland has an opportunity to reduce tax burden on patients and their families

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Outcome: Medicaid Hospital Tax

• State budget now includes a $25 million hospital tax “spend down” each year

• Supported by Governor, Budget Secretary Brinkley and legislature

• Opportunity to seek an increase in the spend down amount as state budget improves

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Restrain High Liability Costs• Progress:

• No-fault birth injury compensation fund• Held: Committee of legislators to address over interim; excellent step toward new

bill next year

• Access to obstetrical services• Passed: MHA to lead study; connect to need for no-fault birth injury fund

• Health Courts• Interim study

• Blocked:– Tripling of cap on non-economic damages from $750,000 to $2.4

million

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Joint Committee on Behavioral Health and Opioid Use Disorder (HB896/SB607)

–Built broad-based coalition of support

–Incorporated with other behavioral health bills to create one effort to address issues

–Committee of 10 legislators will address over 6 years

–Hogan administration interest – connection to heroin initiative

–First briefing Sept 9, HGO

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Maryland Emergency Department Opioid Prescribing Guidelines

• MHA took the lead in drafting standardized opioid prescribing guidelines for hospital emergency departments based on current crisis.

• The guidelines are informed by the work of the Massachusetts Hospital Association, as well as a patient-focused brochure developed by the Maryland Chapter of the American College of Emergency Physicians (MDACEP) and released in 2014.

• The Maryland Heroin and Opioid Emergency Task Force will release its comprehensive plan to address the state’s heroin/opioid misuse epidemic this fall and MHA’s guidelines will be included in those recommendations.

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Additional Legislation-Policy Issues

• (SB297-Ch.155) Task Force on Family Caregiving and Long-Term Supports

• (HB1101) Department of Health and Mental Hygiene-Health Program Integrity and Recovery Activities

• (HB05-Ch.56) Department of Health and Mental Hygiene - Newborn Screening Program Fund

• (SB606-Ch.372) Health Insurance - Abuse-Deterrent Opioid Analgesic Drug Products - Coverage

• Telehealth

• Medicaid Redetermination

• Other issues?

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2016 Legislative Outlook

• What priority issues will each of you focus on for 2016

• What efforts over the interim will move issues forward?

• What might be introduced or reintroduced in the next legislative session?

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Audience Questions

Thank You

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