Some under-the-radar health topics for the next Md. legislature

When the Maryland General Assembly meets next month it will consider a wide range of health care issues, but not all of them will grab headlines. Here are a couple of wonkier issues that hospitals and doctors are watching closely.

Certificate of need modernization

Maryland’s hospitals have long complained that the state’s process of approving hospital construction and services has been too complicated and burdensome. This year they could push for a modernization of the process.

While the Maryland Health Care Commission has been looking at what can be done to modernize the process, the Maryland Hospital Association has also been looking into modernizing the certificate of need.

“The commission, as I understand it, may not be in a position to submit their own legislation,” said Bob Atlas, president and CEO of the hospital association. “We are contemplating the possibility of submitting some modest legislation to make sure that CON does get modernized where it is most important.”

Some of the items the hospital association wants to look at include raising the threshold for what needs to go through the certificate of need process. That could allow hospitals to do more simple renovations without having to go through the certificate of need process.

Another change hospitals want would simplify how the process works. It often takes more than a year for a certificate of need application to be approved.

“These processes can be long and drawn out,” Atlas said. “It’s very expensive for hospitals to prepare their cert of need applications.”

Medicare/Medicaid reimbursement parity

The state’s doctors would like to see reimbursement levels for Medicaid patients reach the same levels as reimbursement for Medicare patients. Right now there is about a 6 point difference between the two reimbursements (Medicare is higher), said Gene Ransom, CEO of MedChi, Maryland’s medical society.

Ransom said the state has been “heading in the right direction” toward parity. But he wants to see it even out.

“It’s a pretty principle thing that people who are poor should receive the same level of care as people who are on Medicare,” he said. “Just because somebody has insurance doesn’t mean they have a doctor.”

Medicaid assessment spend-down

The Maryland Hospital Association would also like to reduce what it has called the “sick tax.” It is an assessment on patients, paid through their hospital bill, that helps to pay for Medicaid.

“One of our top aims is to have an additional spend-down of what’s called the Medicaid hospital assessment,” Atlas said.

The assessment originally provided funding of $19 million, he said, but it grew to around $400 million a year. The hospital association has been slowly working with lawmakers on a spend-down of that tax and it wants to ensure that that spend-down is in the budget every year.

Last year the spend-down was around $30 million. This year it is scheduled for $40 million.

“While it’s just a pass-through for us, it just adds to the hospital costs and makes people more unhappy about the costs of health care,” Atlas said.