Maryland Health Services Cost Review Commission

This document details the final policy recommendations for the Maryland Hospital Acquired Conditions (MHAC) program for Rate Year 2028, outlining its strategic transition and alignment with federal healthcare models. Key priorities include utilizing Potentially Preventable Complication (PPC) composites and all-payer AHRQ Patient Safety Indicator 90 for assessing hospital-acquired complications. The plan also establishes standardized performance assessment methods, a balanced revenue at-risk model with both penalties and rewards up to 2 percent, and a commitment to integrating digital measures and evaluating other relevant complication metrics in the future. The overarching vision is to enhance patient safety and quality of care across Maryland hospitals, ensuring accountability within the evolving AHEAD Model (CY 2026-CY 2035) reimbursement landscape.

The meeting included public and closed sessions. Key discussions involved an update on the administration of Model - Authority General Provisions Article. The public docket covered closed cases (2685A, 2686A) and open cases (2687A through 2693A). General subjects included reports from the Executive Director on Model Monitoring, Policy Calendar Update, Inpatient Length of Stay Presentation, and Legislative Report. Final recommendations were discussed for the request to access HSCRC Confidential Patient Level Data from Johns Hopkins Bloomberg School of Public Health regarding guaranteed income's health impacts, and the MHAC - RY 2028 final recommendations. Detailed application reviews were presented for alternative methods of rate determination for Johns Hopkins Health System concerning cardiovascular services (Docket 2687A) and solid organ/bone marrow transplants, VAD and CAR-T services (Docket 2688A). The MHAC final recommendations focused on using Potentially Preventable Complication (PPC) composite and all-payer AHRQ Patient Safety Indicator 90, setting revenue at-risk at a maximum penalty of 2 percent and maximum reward at 2 percent, and stakeholder feedback highlighted general support for alignment with CMS programs but requested discontinuing the use of Solventum PPC measures.

This document outlines key policy recommendations and strategic adjustments by the Health Services Cost Review Commission and a multi-agency Regulatory Working Group to ensure the sustainability and adaptability of Maryland's healthcare payment system. It addresses five main pillars: implementing a cost-shifting policy to commercial rates to offset funding gaps under the AHEAD Model; stabilizing the Medicare Advantage market through rate adjustments; establishing principles for addressing hospital-based physician payment losses; refining the surge funding policy for respiratory volume increases; and updating the demographic adjustment methodology to account for population changes. The overarching goal is to balance equitable hospital funding, control healthcare costs, and improve quality and access to care within the evolving healthcare landscape.

The 638th meeting addressed numerous agenda items covering docket status, policy recommendations, and ongoing monitoring efforts. Key discussion points included the review of cases closed and open for Johns Hopkins Health System and University of Maryland Medical Center. Policy discussions centered on the Final Recommendations for the Multi-Agency Regulatory Working Group Proposal, Confidential Data Request, Surge Policy, Demographic Adjustment, and Quality Based Reimbursement (QBR) Policy. The Executive Director provided reports on Model Monitoring and a Policy Calendar Update, including physician costs and the Healthcare Outcome Payment Effort. Additionally, there was a presentation on the HCAHPS Learning Collaborative Panel, a Draft Recommendation on the Maryland Hospital Acquired Conditions (MHAC) Policy for RY 2028, and a Draft Recommendation to continue the Medicare Performance Adjustment (MPA) unchanged for the upcoming year, maintaining the existing cost-of-care risk structure.

This document outlines draft policy recommendations for the RY 2028 Quality-Based Reimbursement (QBR) program for Maryland hospitals. The plan focuses on aligning the state's QBR program with the CMS national Hospital Value Based Purchasing (HVBP) program across all payers. Key strategic areas include updating domain weighting for Person and Community Engagement, Safety, and Clinical Care, continuing collaboration on digital quality measures infrastructure, and maintaining a 2 percent inpatient revenue at-risk with a pre-set adjustment scale. The overall aim is to enhance quality of care, improve patient experience, and ensure alignment with national performance standards under the AHEAD Model.