414th MEETING OF THE - Maryland State Archives



416th MEETING OF THE

HEALTH SERVICES COST REVIEW COMMISSION

November 2, 2005

Chairman Irvin W. Kues called the meeting to order at 9:35 a.m. Commissioners Raymond J. Brusca, Michael J. Eusebio, Trudy R. Hall, M.D., William H. Munn and Kevin J. Sexton were also present.

Chairman Kues introduced the two new Commissioners, Raymond J. Brusca, Vice President of Benefits for the Black and Decker Corporation and William H. Munn, President of BG&E Home Products and Services, and welcomed them to the Commission.

ITEM I

REPORT ON THE EXECUTIVE SESSION OF NOVEMBER 2, 2005

Brian Jacque, Chief – Information and Program Administration, summarized the minutes of the November 2, 2005 Executive Session.

Chairman Kues asked the Commission for a motion to ratify the vote taken in Executive Session to grant the Comfort Order request of The Adventist Healthcare System regarding their Series 2005 bonds. A motion was made and seconded, and the comfort order was unanimously ratified.

REVIEW OF THE MINUTES OF THE OCTOBER 12, 2005 PUBLIC SESSION

The Commission voted unanimously to approve these minutes.

ITEM II

DOCKET STATUS – CASES CLOSED

1876R – Anne Arundel Medical Center

ITEM III

DOCKET STATUS – CASES OPEN

MedStar Health – 1889A

MedStar Health submitted a renewal application on July 29, 2005 on behalf of Franklin Square Hospital, Good Samaritan Hospital, Harbor Hospital, and Union Memorial Hospital for the continued participation of Helix Family Choice in the Medicaid Health Choice Program. Previously, the Commission approved participation for the period January 1, 2005 through December 31, 2005 under proceeding 1854A. The renewal request is for one year beginning January 1, 2006.

After reviewing the application, staff presented a recommendation approving the alternative rate application for one year beginning January 1, 2006 with the understanding that sustained losses over an extended period of time may necessitate termination of the arrangement. Staff further recommended that interim financial performance be reported to the Commission at its July 2006 meeting, and that approval is contingent upon the execution of the standard Memorandum of Understanding.

The Commission voted unanimously to approve the staff recommendation.

Maryland General Hospital, Saint Agnes Hospital, Western Maryland Health and Washington County Hospital – 1890A

Maryland General Hospital, Saint Agnes Hospital, Western Maryland Health, and Washington County Hospital submitted a renewal application on August 24, 2005 for the continued participation of Maryland Physicians Care in the Medicaid Health Choice Program. Previously, the Commission approved participation for the period January 1, 2005 through December 31, 2005 under proceeding 1856A. The renewal request is for one year beginning January 1, 2006 contingent upon final approval by the Board of Directors of Maryland Physicians Care to continue participation in the Health Choice Program.

After reviewing the application, staff presented a recommendation approving the alternative rate application for one year beginning January 1, 2006 with the understanding that sustained losses over an extended period of time may necessitate termination of the arrangement. Staff further recommended that actual CY 2005 and interim 2006 financial performance be reported to the Commission at its July 2006 meeting, and that approval is contingent upon the execution of the standard Memorandum of Understanding.

The Commission voted unanimously to approve the staff recommendation.

Johns Hopkins Health System – 1891A

Johns Hopkins Health System submitted a renewal application on behalf of Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center, and Howard County General Hospital for continued participation of Priority Partners, Inc. in the Medicaid Health Choice Program. Previously, the Commission approved participation for the period January 1, 2005 through December 31, 2005 under proceeding 1855A. The renewal is for one year beginning January 1, 2006.

Robert Murray, Executive Director, presented the staff’s recommendation on this application. He noted that Priority Partners is a joint venture among Johns Hopkins Hospital, The Johns Hopkins University, and the Maryland Community Health System, a group of Federally Qualified Health Clinics. Mr. Murray stated that Priority Partners has failed to generate a profit over the span of the operation of the managed care program. Staff views this as a highly problematic situation, given that an entity related to a hospital is accepting risk with related losses, which may be viewed as a potential discount or cross subsidization of that entity.

Mr. Murray highlighted the fact that Priority Partners has made many changes over the years to improve its financial performance; however, it remains unprofitable. Staff remains concerned about Priority Partners’ long term viability in managing its profitability adequately over the next number of years. As a result, Mr. Murray stated that staff recommends disapproval of this application.

Chairman Kues asked the Commissioners if there was a motion to approve that staff’s recommendation. Hearing none, Chairman Kues stated that the Commission would not be accepting the staff’s recommendation. Chairman Kues offered an alternative recommendation to the Commissioners, i.e., that the Commission grant conditional approval to Priority Partners for the application for 2006. The conditional approval would be dependent upon a year end audit that would be presented to the Commission in February 2006. If the audit shows that there was a profit for calendar year 2005, then the Commission will grant final approval of the application for 2006. If the audit shows no profit for calendar year 2005, then the application is denied. If approval is given, the Commission will require Priority Partners to report its financial condition to the Commission not only in February 2006, but also July and October 2006. Accompanying this recommendation is the standard Memorandum of Understanding, a requirement of all approved MCO applications.

The Commission voted unanimously to approve the Chairman’s alternative recommendation.

UNIVERSITY OF MARYLAND MEDICAL CENTER – 1894A

University of Maryland Medical Center requested approval to participate in a global rate arrangement for solid organ transplants and blood and marrow transplants for two years with United Resources Network. University Physicians will be the risk bearing related entity and pay the Hospital’s approved rates. This arrangement includes global rates for hospital and physician services and includes outlier provisions. Staff has reviewed the Hospital’s work papers and recommends approval for one year beginning November 1, 2005.

The Commission voted unanimously to approve the staff recommendation.

JOHNS HOPKINS HEALTH SYSTEM – 1895A

The Johns Hopkins Health System filed a renewal application on behalf of The Johns Hopkins Bayview Medical Center for continued participation in a capitation arrangement with Baltimore Mental Health Systems. The Johns Hopkins Health System will assume the risk under this arrangement, and the Hospital’s services will be reimbursed based on approved HSCRC rates. The staff recommends approval effective November 1, 2005, for o

ne year, based on favorable contract performance as well as projections for the upcoming year.

The Commission voted unanimously to approve the staff recommendation.

Chairman Kues asked if there was any other business regarding the docket.

William Kessler, Chief of Hospital Rate Regulation, noted that University of Maryland Medical System was withdrawing its application, proceeding 1887A. Secondly, Johns Hopkins Health System has requested two additional years under its application in proceeding 1858A, which staff has reviewed and granted. Finally, Johns Hopkins Health System requested temporary extensions for proceedings 1786A and 1787A in order for the System to renegotiate its contracts. Staff granted that temporary request.

No action on these items is required on the part of the Commission.

Mr. Dennis Phelps, Associate Director, Audit and Compliance, pointed out the need for thirty day extensions for the review of proceeding 1896R, Fort Washington Medical Center and for The Western Maryland Health System whose application, proceeding 1892R, will be withdrawn, and a replacement application docketed.

Chairman Kues asked if the hospitals were in agreement with the extensions.

Mr. Phelps responded affirmatively.

The Commission voted unanimously to grant the extensions.

ITEM IV

FINAL RECOMMENDATION ON CASE MIX GROWTH IN FISCAL YEAR 2006

Patrick Redmon, Ph.D., Deputy Director for Methodology and Research, presented the final

staff recommendation on case mix growth in fiscal year 2006. Dr. Redmon reminded the audience that the Commission was moving to a refined grouping system, APR-DRGs, departing from the historical use of the modified Maryland CMS grouper. Dr. Redmon further stated that a major transition of this type is usually accompanied by a significant improvement in the coding of medical records. As the industry geared up for the grouper change in rate year 2007, it was anticipated that some coding improvements would appear in rate year 2006, which would influence the levels of case mix change. In response to this phenomenon, the Commission imposed a case mix growth limit of 1.5%, as it anticipated that in preparing for the new grouper, resource utilization may be over stated since it was not reflected in the coding of the comparison base year. This is an important consideration because case mix growth may not be entirely real but does carry with it revenue implications as it delivers more revenue to a hospital for a higher case mix index.

Dr. Redmon stated that for these reasons the staff proposed, and the Commission approved, a case mix governor for fiscal year 2007 based on one half of the fiscal year’s actual growth for 2005, under APR-DRGs, of 2.8%, which would deliver a total case mix growth of 1.5% statewide. The proposed governor would have been calculated as follows:

ORIGINAL PROPOSED GOVERNOR

|MEASURED CASE MIX GROWTH |AMOUNT RECOGNIZED |

| 4% |25% |

The final case mix growth for fiscal year 2005 under APR-DRGs was 4.02%, a figure much greater than the anticipated 2.8% growth with its associated governor as approved by the Commission. Under the same governor methodology, the statewide case mix increase would be 2.31%. Dr. Redmon further stated that this growth is not necessarily a bad thing as the fiscal year 2005 base is higher, and that leaves less room for growth from coding improvements in fiscal year 2006. Dr. Redmon noted that what was disturbing is that three hospitals have been on APR – DRGs for a number of years, and their case mix has continued to grow. The two academic medical centers, representing two of the three hospitals, have had case mix growth of approximately 4%. Dr. Redmon said that this situation suggests that there is a risk to the system that revenue would continue to grow much more rapidly than anticipated, posing two consequences. The first consequence would be that the public pays more for their health care, and secondly, that the increase in case mix could erode the waiver test cushion and other internal growth targets established by the Commission. Dr. Redmon stated that staff proposes tightening the governor on case mix growth for fiscal year 2006 to reflect the uncertainty surrounding these issues. Several scenarios were modeled; however staff has chosen one for proposal. The original thoughts were that the growth be limited to a range of 1% to 1.1%. Dr. Redmon noted that MHA and individual hospitals thought this to be too conservative. However, given the volatility of the potential case mix growth amounts, staff is proposing a governor that would limit statewide case mix growth to 1.37% as follows:

REVISED CASE MIX GROWTH GOVERNOR

|MEASURED CASE MIX GROWTH |AMOUNT RECOGNIZED |

|4% |10% |

Robert Murray asked Dr. Redmon to also mention the issue of programmatic changes should the State come under the governor threshold.

Dr. Redmon responded that any hospital that had a new program coming on board, a dramatic example being an open heart surgery program, would clearly have real case mix growth which would be recognized. Dr. Redmon added that the update factor in place for fiscal year 2006 recognizes .25% for case mix growth associated purely with programmatic change. Staff has been asked to develop a formula to calculate a provision for such changes but remains hesitant to do this. There are circumstances that cannot be anticipated, and formulas tend to lock one in with no exceptions. A general approach would be look to programmatic change under the CMS DRGs to see if there are case mix growth implications, because if this produces a similar case mix growth result, it is arguably real and not the result of coding improvement. Similarly, cross DRG changes under APR – DRGs, not those associated with severity, may indicate programmatic shifts. Finally, Dr. Redmon noted that changes between medical and surgical volumes and some other basic measures would be reviewed to identify shifts and associated case mix growth for eligibility for a part of the set aside amount of .25% for programmatic case mix growth.

Mr. Murray commented that the staff’s strategy is to set a reasonably conservative screen, governor, or restriction on case mix growth, and beyond that, on an exception basis, look at programs that were being unfairly limited in their case mix growth based on established criteria, recognizing the appropriate individual programs. This approach is intended to be based on an objective rather than subjective determination.

Dr. Redmon noted for the current fiscal year, if case mix growth were greater than 1.5%, targets for fiscal year 2006 would be adjusted for the excess. MHA noted in their letter to the Commission that this methodology should be symmetrical, that is, if the State comes under the case mix growth target, this should be restored to hospitals. Dr. Redmon stated that the staff would agree to this approach.

Chairman Kues asked Dr. Redmon if along with the staff recommendation, staff is incorporating MHA’s recommendation for a symmetrical adjustment.

Dr. Redmon responded affirmatively.

Commissioner Sexton asked if the target was 1.5% or 1.7%.

Dr. Redmon responded that it was 1.5% for fiscal year 2005 and 1.7% for fiscal year 2006.

Commissioner Sexton asked if the case mix growth of 4.02% equates to 1.37%.

Dr. Redmon responded that would be correct if the governor were applied to any case mix growth of 4.02%.

Commissioner Sexton asked what the case mix growth would have to be for the governor to limit growth to 1.7%.

Dr. Redmon responded that the particular issue raised had not been modeled in the different scenarios that had been calculated for the governor.

Mr. Murray stated that it would have to be above 4.02%, closer to 5%.

Dr. Redmon added that a back of the envelope calculation indicated that it would have to be substantially larger growth.

Commissioner Sexton stated that it would have to be10% percent marginal recognition from 2004.

Dr. Redmon concurred, adding that in the fiscal 2005 data there were hospitals with substantial case mix decreases, and if all these had positive case mix growth in fiscal year 2006, it would eat up some of the margin.

Mr. Murray added that a key distinction is that in fiscal 2005, APR – DRGs were not being used for reimbursement, but for fiscal year 2006 they are; therefore, the behavioral response is not known. For example, last year staff looked at case mix growth for six months and calibrated the governor to deliver 1.5% when, in fact, it would have come in at 2.3%, an error margin of .8%. This is the reason staff has proposed a governor that is conservative, with an error margin closer to .3% or .4%.

Dr. Redmon added that to the industry’s credit, there had been significant coding improvement in fiscal year 2005 without corresponding payment. However, the improvement was not uniform across all hospitals, suggesting that those hospitals that did not improve their coding in the base year may, benefit from case mix growth in 2006.

Mr. Murray reminded the Commission that if the governor were too restrictive, there was a provision to restore case mix growth held back in the subsequent year, so that the industry would achieve the established targets. Additionally, it is important to remember that focus should also be on new program case mix change, for which .25% was being set aside.

Dr. Hal Cohen, representing Care First and Kaiser Permanente, addressed Commissioner Sexton’s question, stating that if all hospitals had a case mix increase of approximately 4%, then the governor would limit growth to approximately 1.5%. Dr. Cohen emphasized that hospitals had both increases and decreases in case mix, which obviously influences the overall growth and thereby making the prediction more difficult. Dr. Cohen stated that he supported the staff’s recommendation.

Chairman Kues asked MHA for their comments.

MHA requested a panel presentation.

Chairman Kues asked the panel members to introduce themselves.

Raymond Grahe, Chief Financial Officer of Washington County Health System in Hagerstown, Maryland, introduced himself and his fellow panel members, James Lee, Chief Financial Officer of The Adventist Health Systems and Jack Cook, Ph.D., principal with Cohen, Rutherford and Knight. Mr. Grahe stated that they were speaking on behalf on 14 community hospitals which have provided input into the information they will present. Mr. Grahe said that these hospitals have supported the transition to ARP – DRGs, and that they believe the new methodology provides equity within the system. Further, this group was supportive of the case mix governor that is currently in place and suggested different weighting methodologies that could have been used in the process. Today, they will address the tightening of the case mix governor proposed by staff and before the Commission and to express their opposition. Mr. Grahe stated that there are two ways to look at the issue, and that staff is concerned that it will see continued escalation in case mix indexes. Mr. Grahe stated that the group of 14 hospitals he represents embraced the methodology, “hit the ground running”, and, recognized that there is a significant increase in the case mix which has occurred within the past year. As such, the base has been raised, and increases at a higher level will be difficult to obtain. On behalf of the 14 community hospitals, they do not believe a change to the governor is necessary. Mr. Grahe suggested that case mix change be allowed to go both ways, that is, if there is a decrease, make the industry whole, and if there is an increase, allow it and adjust the inflation factor for the subsequent year, rendering the change to the governor unnecessary.

Dr. Cook mentioned that staff met with him, and he shared with them the results that he is now presenting to the Commission. Dr. Cook felt that the meeting was worthwhile, and that staff’s review and critique of the results of his work would be very useful in informing the Commission on how the case mix governor should be formulated. Dr. Cook stated that his presentation involves three ideas, the first being a way of conceptualizing how case mix is driven by coding increases. Secondly, this concept gives rise to a way of projecting future case mix increases. In particular, this approach suggests that the assumptions that the staff has built into their modeling of the governor are, perhaps, a bit grim. Finally, Dr. Cook stated he wanted to focus on a fundamental equity question and expand on Dr. Redmon’s earlier comments.

Dr. Cook stated that the essential idea is that coding induced case mix increases result almost entirely from the addition of a secondary diagnosis on the patient’s medical record. That is to say, if in one year a hospital codes at a certain levels such as five diagnoses per case, and the next year codes six diagnoses per case, then that change in diagnoses is a very powerful and reliable predictor of how much the hospital’s APR – DRG case mix will increase. However, Dr. Cook pointed out that this was a highly simplified approach to the measurement, and that as a hospital moves to more and more coding of diagnoses, the less impact it will have on case mix increase, e.g., coding 5 diagnoses and moving to coding six will have a greater impact than coding 13 diagnoses and moving up to 14.

Dr. Cook presented his first hypothesis, that over the next two years, all hospitals could get their coding to the current levels of the Academic Medical Centers, with the assumption that there is no diseconomies of scale, e.g., 4 to 5, 6 to 7, etc., thus having the same effect on case mix. In this hypothesis, Dr. Cook predicted a statewide case mix increase of 3.25% or 85% of this year’s growth.

Dr. Cook’s second hypothesis assumes that this year’s growth continues next year, with an impact on case mix of 3.26%, including diseconomies of scale. Dr. Cook further noted that half of the growth in case mix from 2001 to 2005 occurred in 2005.

Dr. Cook’s final comment was that the appeal procedure needs to be clarified and formulated as a pre condition of a rational evaluation of the proposed governor.

Mr. James Lee commented that he believes that the increases experienced in fiscal 2005 have been substantial, but not likely to be repeated in fiscal 2006; therefore, the current governor should stay in place and not be made more stringent. The appeal process is very important and needs clear guidelines, and while he understands the urgency staff feels for getting this issue resolved, he believes it prudent that the Commission take the appropriate time to understand the impact rather than making a change at this point. In general, Mr. Lee indicated that MHA was supportive of the staff and hoped the requests of the MHA would be heard. Mr. Lee thanked the Commission for its time.

Chairman Kues asked for questions from the Commissioners and then comments from Dr. Redmon and Mr. Murray regarding the MHA presentation.

Commissioner Sexton asked Dr. Cook to explain the actual column in his hand out.

Dr. Cook answered that the actual column represented the case mix increase based on the current Maryland CMS grouper and case mix weights in effective in fiscal year 2005.

Chairman Kues stated that the MHA presentation made him feel encouraged about the transition to the APR – DRG grouping system. He reviewed several data elements in Dr. Cook’s presentation. Chairman Kues asked Dr. Cook what he thought the level of coding increase would be next year.

Dr. Cook estimated .7% or .8%, calling it high, but less than last years.

Chairman Kues asked if the increase was diagnoses based.

Dr. Cook responded affirmatively.

Chairman Kues asked how close that would be to the upper limit.

Dr. Cook responded that if you assume the current relationship, it would mean an APR – DRG increase in the low threes.

Mr. Grahe commented that the general understanding in the industry is that hospitals have educated their coders, as this is a new system, and that the new system is being taken very seriously.

Chairman Kues asked Dr. Cook if he felt the transition would be over by fiscal year 2007.

Dr. Cook responded affirmatively; he thought based on this year’s experience and growth that the transition would be completed by fiscal year 2007.

Chairman Kues asked Dr. Cook if his hypotheses meant an increase of over three percent per year for two years.

Dr. Cook responded affirmatively.

Dr. Redmond commented that Dr. Cook’s presentation deals with averages, so he reiterated that all hospitals are not at the same point. Also, the incentive for coding improvement actually occurs in fiscal year 2006; therefore, he cautioned that when incentives change, relationships change, making future predictions difficult. He stated that Dr. Cook’s analysis was elegant and was in keeping with what staff has also seen.

Chairman Kues asked for the due dates for coding.

Dr. Redmon replied at the end of each quarter, the hospitals have 45 days to report and another quarter for corrections.

Mr. Murray commented that Mr. Lee’s assertion that fiscal year 2005 growth was unique and not likely to be repeated, is the same assertion that has been made over the last several years, particularly with the Academic Medical Centers, thereby reinforcing staff’s caution. In response to Mr. Grahe’s point of overage and underage relative to budgeted case mix growth, Mr. Murray stated that, indeed, Mr. Grahe was correct that if the industry was over, staff would look to make a correction in 2007. As a practical matter, however, it is difficult to recoup after the fact, again noting issues with the Academic Medical Centers. Finally, Mr. Murray stated that if there is an overage, it is an overcharge to the public which raises concern in an environment where rates are already high. Mr. Murray stated that he had concerns in regard to equity issues that could develop in the next year due to inappropriate limits on legitimate case mix growth. He noted that staff needs to articulate in the next month or two criteria that will be used to evaluate growth so that the industry is aware of the evaluation tools.

Chairman Kues asked Dr. Redmon about fiscal year 2005 case mix data.

Dr. Redmon stated that the data were closed.

Chairman Kues stated that there were two proposals, one for 1.37% and one for 1.5% for case mix growth.

Paul Sokolowski, with the MHA, referred to the letter he submitted to the Commission staff. He referred to the specific calibration of the governor in the letter and noted that it produced 1.5%, but with updated data it is closer to 1.8%. Mr. Sokolowski outlined the position of the MHA Counsel on Financial Policy. Mr. Sokolowski stated that according to the counsel, there is a provision for 1.7% for case mix growth within the update factor calculation. As part of the original agreement to put a governor in effect, there was the conscious decision to test the governor that translated to 1.5%. The counsel would like the governor to remain at the 1.5% level. Further, if there is an underage, it should go back to the industry. Another item of concern is the mix of patients changing from year to year, so that a hospital cannot get back to zero. Additionally, a listing of required data elements should be compiled so that hospitals requesting relief for case mix growth will all submit the same information.

Chairman Kues requested clarification of the counsel’s position. Mr. Sokolowski stated that 1.37% was close enough to 1.5%, but that the greater concern centered on the equity issue and programmatic change.

Dr. Cohen supported the reasonableness of the staff recommendation. Dr. Cohen also stated that during the year, the staff will have more information; the hold-back of .25% may be too little, and more may be available as the year progresses. Dr. Cohen noted that case mix was contributing to hospital profitability to the extent that some of the case mix growth was not real. Finally, Dr. Cohen referred to Dr. Cook’s presentation and cautioned on the use of averages.

Robert Murray stated that the staff recommendation was amended to indicate that any overage or underage would be restored or taken away in fiscal year 2007 with the issuance of the Charge per Case Targets in October or November of 2006. The staff recommendation is further amended that over the next couple months, specifications for the evaluation criteria for programmatic change along with a template of required information for submission to the Commission of applications by individual hospitals will be developed.

Commissioner Sexton asked if the .25% for programmatic change was part of the target of 1.37%, and if the industry came in at 1.37%, would the .25% be spread to all hospitals.

Mr. Murray responded that the proportions specified last year with a limit of 2.35% were being followed, but that if actual experience warranted, this issue would have to be revisited.

Commissioner Sexton asked if the industry came in under 1.7% would the money be rolled over.

Mr. Murray responded that potentially that would happen, but at this point in time, he was not looking to change the recommendation. He indicated staff willingness to revisit this issue as warranted.

Commissioner Sexton asked what would be known about the first quarter case mix by November 15, 2005.

Mr. Murray stated that nothing would be known.

The Commission voted unanimously to approve the amended staff recommendation.

Mr. Murray informed the new Commissioners that most issues are usually debated and protracted in this manner.

Chairman Kues reminded everyone that staff has been surprised by the recent case mix movement over the last 18 months. The staff’s observations motivate the Commission to proceed cautiously for 2006. If there is an underage, it will be reinstated.

ITEM V

PRESENTATION OF THE DRAFT FINANCIAL ASSISTANCE APPLICATION

Valerie Shearer, Associate Director for Methodology and Research, presented a draft of the uniform financial assistance application in response to House Bill 627 from the 2005 Legislative Session. This bill directed the Commission to create a uniform hospital financial assistance application for providing free and reduced cost care to low income patients who lack health care coverage under a hospital’s financial assistance policy. Ms. Shearer pointed out that the new law allows hospitals to continue to retain flexibility to construct their own unique financial assistance policies. Although not specified in detail, it was clear that the General Assembly wanted to simplify and standardize the process of applying for financial assistance. The form was drawn from both the National American Association of Health Care Administrative Management Forms and applications currently in use at Maryland hospitals. The form was approved by the MHA financial technical issues task force. Comments may be submitted to the Commission until November 28, 2005, and if the form is approved at the December 2005 Commission meeting, hospitals will be advised to begin using the form January 1, 2006.

Commissioner Sexton questioned why physicians should be notified to begin using the form.

Ms. Shearer responded that staff physicians will use the form only if they are employees of the hospital, and the form will be used for reimbursement issues for both the hospital and the physician.

Commissioner Sexton suggested removing the wording “privileges,” as this would include all physicians.

Chairman Kues stated that his understanding was that there would be no statewide definition of low income patients, and that each hospital may develop its own definition.

Ms. Shearer replied affirmatively.

Commissioner Hall suggested that in the area of the form that asks if the applicant has applied for Medical Assistance, that the date of the Medical Assistance application be added.

ITEM VI

LEGAL REPORT

Regulation

Proposed

Rate Application and Approval Procedures – COMAR 10.37.10.26(B) Section 4-1

The Hospital Financial Assistance Responsibility will be put into regulation to conform to the new law. In addition to developing written financial assistance policy, hospitals also will have to post a notice that will be conspicuous in places throughout the hospital describing the policy and how to make application for free and reduced care. In addition, hospitals will have to use the form to determine eligibility for free and reduced care and also establish a mechanism to provide the application to patients who do not indicate that they have public or private health care coverage.

Staff requested permission to submit the regulation to the AELR for comment and publication in the Maryland Register.

The Commission voted unanimously to authorize the proposal’s submission.

Regulation

Proposed

Uniform Accounting and Reporting System for Hospitals and Related Institutions – COMAR 10.37.01.03

The purpose of this regulation is to update the Accounting and Reporting Manual.

The Commission voted unanimously to approve the staff recommendation.

Regulation

Final Action

Types and Classes of Charges Which Cannot Be Changed Without Prior Commission Approval – COMAR 10.37.01.09

The regulation clarifies that when a hospital service is provided to a hospital inpatient offsite from the hospital, the hospital charges the patient for the service at a Commission approved rate.

Chairman Kues asked if any comments had been received on the proposed regulation.

Counsel responded that there were no comments.

The Commission voted unanimously to approve the staff recommendation for adoption.

HEARING AND MEETING SCHEDULE

December 7, 2005 Time to be determined, 4160 Patterson Avenue

HSCRC Conference Room

January 11, 2006 Time to be determined, 4160 Patterson Avenue

HSCRC Conference Room

There being no further business, the meeting adjourned at 11:07 am.

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download