Mid-Atlantic Health Law TOPICS

1. In October 2022, the Health Services Cost Review Commission (HSCRC) announced emergency regulations that place a moratorium on hospital applications for full rate reviews for 180 days. A full rate review allows a hospital to increase its rates more than the annual update affecting all hospitals. The moratorium is to allow the HSCRC time to determine whether the data it relies on to evaluate hospital rates has been substantially affected by the COVID-19 pandemic. Hospitals may continue to apply for rate adjustments under any other administrative remedy currently available in the law. By adopting emergency regulations, the HSCRC was allowed to implement the moratorium without providing for public notice and comment. However, the HSCRC submitted identical proposed permanent regulations at the same time as the emergency regulations, which do provide a notice and comment period, and if adopted, would allow the moratorium to remain in place until June 30, 2023, at the latest.

2. On October 22, 2022, the Maryland Department of Legislative Services, Office of Legislative Audits, released an audit report finding that the Maryland Department of Health (MDH) mismanaged its Administrative Services Organization (ASO) contract with Optum Maryland, the United Behavioral Health Inc. entity that administers Maryland Medicaid’s behavioral health services. The report states that MDH did not thoroughly vet Optum Maryland’s claims processing subcontractor prior to awarding Optum Maryland the ASO contract, even though other jurisdictions have had issues with this subcontractor. The report also found that issues resulting from this subcontractor’s inability to process behavioral health claims for Maryland Medicaid has resulted in potentially millions of dollars of overpayments and denied or under-reimbursed claims.

Darci M. Smith
410-576-4153 • dsmith@gfrlaw.com