Mid-Atlantic Health Law TOPICS

1. In September, the Maryland Health Care Commission (HCC) announced that it has developed a website to assist small business owners (those with 2 - 50 employees) find health insurance for their employees at www.mhcc.state.md.us/smgrpmkt/index.htm. The guide includes a list of benefits that the insurance carrier must include in the small group standard benefit plan, information on how to purchase the coverage, a link to a list of participating carriers with sample rates, and a frequently asked questions section.

2. In September, the HCC denied Shady Grove Adventist Hospital's (SGAH) request to establish a 5-bed hospital and a 21-bed emergency department (ED) in an office building 8 miles from the hospital. SGAH proffered that 5 beds would be moved from the hospital's existing acute care service to the new location and that the project would alleviate capacity pressure until construction of its new ED was completed. SGAH planned to provide inpatient care exclusively to patients admitted through the satellite ED and to license the proposed facility as an acute general hospital subject to the Health Services Cost Review Commission's (HSCRC) rate setting authority. The HCC stated that the development of a new 5-bed hospital at an off-campus location would establish a bad precedent that would lead to the proliferation of small, specialty hospitals providing limited services, thereby adding unnecessary costs to the health care system. The HSCRC's analysis of the project's estimated revenues/expenses showed that SGAH's proposed project would not be financially viable.

3. In October, the Governor named a new Chairman of the HCC, and appointed two new commissioners. Stephen J. Salamon, a commissioner since 2003 who has 22 years of experience in the insurance industry, is the HCC's Chairman. Gail T. Wilensky, PhD, a Senior Fellow at Project Hope and former Administrator for HCFA, will serve as Vice Chair. Andrew N. Pollak, MD, an associate professor of Orthopaedics at the University of Maryland School of Medicine and part-time instructor at Johns Hopkins University School of Medicine, will join the Commission. The commissioners who rotated off the HCC are Chairman Donald Wilson, MD, George Malouf, MD, Walter Chase and Marc Zanger.

4. In October, the HSCRC approved modifications to the Inter-Hospital Cost Comparison (ICC) methodology, used for full rate reviews, and to the Reasonableness of Charges (ROC) methodology. The changes include: minor changes to the HSCRC's Capital Policy, revising the policy on financing graduate medical education, developing a methodology to account for urban costs, making a few changes to the uncompensated care policy, including a proxy for additional monies added or subtracted to annual rate updates, and 3 case mix measurement changes. The HSCRC rejected a request to expense interest during the construction of a CON-approved project.