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Bills would help modernize Md. certificate of need process

Del. Nicholaus Kipke. (File Photo)

A bill submitted by Del. Nicholaus Kipke, R-Anne Arundel and House minority leader, would streamline the certificate of need process. (File Photo)

Maryland legislators will hear Wednesday the first proposals to come out of the Maryland Health Care Commission’s certificate of need modernization work group last year.

Proposals that will help streamline the certificate of need process and help align the state health plan with the Total Cost of Care Model will be heard in the House Health and Government Operations Committee.

“These all are a largely an outgrowth that the commission undertook at the direction of the chairs of Health and Government Operations and Senate Finance last year, which directed the commission to come up with recommendations on updating the certificate of need process,” Ben Steffen, the executive director of the health care commission, said.

Health care facilities in Maryland go through the certificate of need process to receive regulatory approval for changes to their facilities, to move their facilities or to build new facilities.

Many hospital officials and regulators believe certificate of need review can be an expensive and time-consuming process while also serving important functions like ensuring equitable access to care and serving as a gatekeeper for the market.

Randolph Sergent, a member of the Maryland Health Care Commission and vice president and assistant general counsel at CareFirst BlueCross BlueShield, led the work group last year that included recommendations that could be implemented by the commission on its own, through legislative changes and ideas that warranted future study.

Proposals in the House Wednesday are based on the work group’s recommendations.

One bill, from Del. Shane E. Pendergrass, D-Howard and the committee’s chair, would require the commission to annually establish priorities for reviewing the state health plan’s chapters, ensuring that the plan is consistent with the Total Cost of Care Model.

“We wanted that to be consistent with Maryland’s all-payer model contract,” Brett McCone, vice president for rate setting at the Maryland Hospital Association. “We do believe that the commission should look at and set priorities for the staff to look at.”

McCone served on the work group and the hospital association worked with Pendergrass on the legislation.

The legislation would also raise the capital threshold for renovation projects above which hospitals need a certificate of need from $10 million to $50 million.

Another bill, sponsored by Del. Nicholaus Kipke, R-Anne Arundel and House minority leader, would work to streamline the certificate of need process.

The legislation would allow some smaller projects — those that do not involve moving or closing a hospital or which are not contested — to move through the certificate of need process more quickly.

It would also allow ambulatory surgical facilities with three or less operating rooms to be exempt from the certificate of need process. The hospital association and the health care commission said they are working to get an amendment to bring that down to two rooms.

The last bill to be considered Wednesday, from Del. Susan Krebs, R-Carroll, would allow facilities that offer substance use disorder treatment, hospice care or psychiatric care to change their bed capacity without a certificate of need.

In addition to the legislative efforts, the health care commission is also working on recommendations that it could implement on its own, which include reviewing the state health plan and making alterations to certificate of need docketing requirements.

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