1. 2015 Legislative Session Outcomes and Priority Issues Jennifer Witten, Government Relations Director Moderator Maryland Hospital Association August 21, 2015

2. 1 Agenda Panel Introduction Panel Discussion –Political Environment –2015 Legislative Outcomes –2016 Priorities Audience Questions

3. Panel Delegate Nicholaus R. Kipke-District 31B, Anne Arundel County Senator Delores G. Kelley-District 10, Baltimore County Senator Catherine Pugh-District 40, Baltimore City Pegeen Townsend-VP of Government Affairs, MedStar Health Nicole McCann-Director of Health Policy for Johns Hopkins State Affairs 2

4. New Players Governor Hogan Key health care personnel –Van Mitchell, Secretary, DHMH Former legislator; health lobbyist –Bobby Neall, Fiscal Advisor Former legislator; CEO Priority Partners –Al Redmer, MD Insurance Comm Former legislator; Coventry Health Care –Craig Williams, Chief of Staff Govt’ Affairs Amgen 70+ new legislators 3

5. Session Challenges Many new players –Administration –Legislature Key committee member changes Education –Basics – Medicare vs. Medicaid –Complex health care issues – waiver Significant budget debate –Eliminate state structural deficit; reduce taxes 4

6. State Budget-Healthcare Impact Health Care – all Medicaid provider payments cut Physicians –Medicaid fees cut from 100% to 92% Medicare rate Nursing Homes –Medicaid payments cut to 2014 levels Pharmacists –Medicaid dispensing fees cut Managed Care Organizations –2% rate cut 5

7. State Budget Hospital Impact $16.7 million cut for 2016 Original proposal would have effect of greater financial impact across-the-board rate cut for all payers Secured fix to implement differently, more efficiently resulting in greater savings Secured ability to “count” toward total savings pending HSCRC action to cut uncompensated care funds 6

8. Hospital Legislative Priorities Reduce, eliminate Medicaid hospital tax Restrain out-of-control liability costs Improve care for people suffering from mental health, substance abuse problems 7

9. Medicaid Hospital Tax Began in 2009 as a “temporary” $19 million tax to backfill state’s Medicaid budget – has ballooned to nearly $400 million annually Inflates hospital bills by 3% - revenue goes to state special Medicaid fund, not hospitals Makes meeting new waiver spending targets more difficult Maryland has an opportunity to reduce tax burden on patients and their families 8

10. Outcome: Medicaid Hospital Tax State budget now includes a $25 million hospital tax “spend down” each year Supported by Governor, Budget Secretary Brinkley and legislature Opportunity to seek an increase in the spend down amount as state budget improves 9

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12. Restrain High Liability Costs Progress: No-fault birth injury compensation fund Held: Committee of legislators to address over interim; excellent step toward new bill next year Access to obstetrical services Passed: MHA to lead study; connect to need for no-fault birth injury fund Health Courts Interim study Blocked: –Tripling of cap on non-economic damages from $750,000 to $2.4 million 11

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14. Joint Committee on Behavioral Health and Opioid Use Disorder (HB896/SB607) –Built broad-based coalition of support –Incorporated with other behavioral health bills to create one effort to address issues –Committee of 10 legislators will address over 6 years –Hogan administration interest – connection to heroin initiative –First briefing Sept 9, HGO 13

15. Maryland Emergency Department Opioid Prescribing Guidelines MHA took the lead in drafting standardized opioid prescribing guidelines for hospital emergency departments based on current crisis. The guidelines are informed by the work of the Massachusetts Hospital Association, as well as a patient-focused brochure developed by the Maryland Chapter of the American College of Emergency Physicians (MDACEP) and released in 2014. The Maryland Heroin and Opioid Emergency Task Force will release its comprehensive plan to address the state’s heroin/opioid misuse epidemic this fall and MHA’s guidelines will be included in those recommendations. 14

16. Additional Legislation-Policy Issues (SB297-Ch.155) Task Force on Family Caregiving and Long-Term Supports (HB1101) Department of Health and Mental Hygiene-Health Program Integrity and Recovery Activities (HB05-Ch.56) Department of Health and Mental Hygiene - Newborn Screening Program Fund (SB606-Ch.372) Health Insurance - Abuse-Deterrent Opioid Analgesic Drug Products - Coverage Telehealth Medicaid Redetermination Other issues? 15

17. 2016 Legislative Outlook What priority issues will each of you focus on for 2016 What efforts over the interim will move issues forward? What might be introduced or reintroduced in the next legislative session? 16

18. Audience Questions Thank You 17