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MARYLAND S HEALTH CARE REFORM IMPLEMENTATION Status and Update October 18, 2013 Governor s Office of Health Care Reform Carolyn A. Quattrocki, Executive Director – PowerPoint PPT presentation

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Title: Governor


s and UpdateOctober 18, 2013
  • Governors Office of Health Care Reform
  • Carolyn A. Quattrocki, Executive Director

Scope of Presentation Impact of Health Reform
on Behavioral Health
Four Pillars of Affordable Care Act
Stronger, Non-Discriminatory Insurance Coverage
Expanded Access to Health Insurance and Health
More Affordable Insurance Coverage
Cost Control and Improvement in Outcomes
Bringing These Benefits To Maryland
Patients Bill of Rights Stronger,
Non-Discriminatory Coverage Chapter 4 2011 Laws
of Maryland Chapter 368 2013 Laws of Maryland
  • Young adults can stay on parents insurance plan
    until age 26 52,000 in MD 2.5 million
  • No children denied coverage because of
    pre-existing condition.
  • No lifetime limits on benefits and harder to
    rescind policies when people get sick 2.25
    million Marylanders benefiting, including over
    one half million children.
  • In 2014, no exclusions for pre-existing
    conditions or annual limits on benefits.
  • Women no longer paying higher premiums because
    they are women.

  • Preventive services
  • ACA requires coverage of many preventive services
    at no cost
  • Examples include mammograms and other cancer
    flu shots and other vaccines, tobacco cessation
  • Services designed for women, like well visits,
    contraception, breastfeeding equipment, and
    domestic violence and counseling
  • 1.2 million Marylanders covered with no
    cost-sharing 554,000 on Medicare have received
    at no cost 797,185 eligible.
  • Carriers rating factors limited to
  • Age bands no greater than 31
  • Family size and geography
  • Tobacco use no greater than 1.51
  • Maryland Health Progress Act directs State to
    study whether tobacco use rating should be
    eliminated or narrowed.
  • Limits on out-of-pocket costs - 6,350 for
    individual 12, 700 for family lower on sliding
    scale for consumers below 400 of federal poverty
  • New 80/20 Medical Loss Ratio
  • 141,000 Marylanders received 28 million in
    rebates in 2012
  • Average of 340 per family.

  • Beginning in January, 2014, all plans offered
    in small group and individual markets inside and
    outside exchanges must cover essential health

  • HCRCC solicited stakeholder input and expert
    consultants comparative analysis, and on
    December 17, 2012
  • Made selection of States small group plan as
  • Retained all existing mandates in markets in
    which currently applicable
  • Substituted more comprehensive and parity
    compliant federal employee (GEHA) behavioral
    health benefit
  • Added adult component to existing child
    habilitative services benefit in parity with
    current rehabilitative services benefit.
  • HCRCC decision preserves stability in small group
    market while offering robust, comprehensive
    benefit coverage and open drug formulary.

  • Inpatient Services
  • Inpatient hospital and inpatient residential
    treatment centers (RTC) MH/SUD/BH services
  • Room and board, such as ward, semiprivate, or
    intensive care accommodations general nursing
    care meals and special diets
  • Services provided by a hospital or licensed
    residential treatment center (RTC).
  • Outpatient Services
  • Outpatient hospital and emergency room
    (non-accidental injury) MH/SUD/BH services
  • Services such as partial hospitalization or
    intensive day treatment programs and
  • Outpatient services and supplies billed by a
    hospital for emergency room treatment.

  • Professional Services
  • Diagnostic evaluation
  • Crisis intervention and stabilization for acute
  • Medication evaluation and management
  • Treatment and counseling (including individual or
    group therapy visits)
  • Diagnosis and treatment of alcoholism and drug
    abuse, including detoxification, treatment and
  • Professional charges for intensive outpatient
    treatment in providers office or other
    professional setting
  • Electroconvulsive therapy and
  • Inpatient professional fees.
  • Diagnostics
  • Outpatient diagnostic tests provided and billed
    by licensed mental health and substance abuse
  • Outpatient diagnostic tests provided/billed by
    lab, hospital or other covered facility
  • Psychological and neuropsychological testing
    necessary to determine appropriate psychiatric

  • Exclusions
  • Services by pastoral, marital, drug/alcohol and
    other counselors including therapy for sexual
  • Treatment for learning disabilities and mental
  • Telephone therapy
  • Travel time to the members home to conduct
  • Services rendered or billed by schools, or
    halfway houses or members of their staffs
  • Marriage counseling and
  • Services that are not medically necessary.
  • Strong stakeholder consensus in support of GEHA
  • Parity-compliance built into design
  • Most comprehensive and easy to administer,
    thereby less vulnerable to discriminatory
  • Specificity helps consumers understand what is
    covered and how to make claims.

Pillars II and IIIExpanded Access to Care and
More Affordable Coverage
  • Medicaid Expansion
  • MAGI - New eligibility rules based on modified
    adjusted gross income standard
  • Uses income tax rules regarding household
    composition, income and deductions
  • Same standard in all states
  • Same standard used to determine eligibility for
    subsidies in Exchange.
  • Expanded eligibility - All citizens at or
  • below 138 of federal poverty level
  • No longer specific categories,
  • e.g. pregnant women,
  • parents, for income-based
  • eligibility
  • About 16,000 for individual
  • 33,000 for family of four.

2013 Federal Poverty Level Guidelines
Pillars II and IIIExpanded Access to Care and
More Affordable Coverage
  • Medicaid Expansion
  • Primary Adult Care (PAC) program will convert
    to full Medicaid benefits 1/1/14.
  • 75,000 currently on PAC outreach opportunity
    between now and January.
  • Foster care Children who age out of foster care
    can retain Medicaid to age 26.
  • Paradigm shift new assumption that all citizens
    qualify for health care
  • Issue no longer preventing erroneous eligibility
  • Instead, in which program does the person
  • Federal support for 2014-16, 100 federally
    funded tapers to 90 by 2020.
  • One-stop eligibility and enrollment through
    Health Benefit Exchange.
  • Projections
  • 2014 110,000
  • 2015 135,000
  • 2020 190,000 (including current PAC population)

Pillars II and IIIExpanded Access to Care and
More Affordable Coverage
  • Health Benefit Exchange
  • Transparent, competitive marketplace where
    consumers will compare private health benefit
    plans based on quality and price.
  • Federal subsidies on sliding scale for low-income
    people between 133 - 400 FPL.
  • Small business tax credits
  • 50 of employers
  • contribution to premium
  • Projections
  • 2014 147,000
  • 2015 170,000
  • 2020 284,000

Single Person FPL Annual Income Maximum Premium (as of income) Enrollee Monthly Share
133 15,281 2.00 25.47
150 17,235 4.00 57.45
200 22,980 6.30 120.65
250 28,725 8.05 192.70
300 34,470 9.50 272.89
400 45,960 9.50 363.85
Pillars II and IIIExpanded Access to Care and
More Affordable Coverage
  • Effect on Marylands Rate of Uninsured
  • 750,000 Marylanders currently uninsured (12.7)
    13th among states
  • By 2020, uninsured rate cut in half
  • Medicaid expansion and Exchange enrollment will
    cover 350,000, or about 6.5
  • Remaining uninsured will be undocumented
    immigrants, individuals with affordability
    exemption, those choosing penalty, etc.

Maryland Health Insurance Program
  • High risk pool - 20,000 Marylanders no longer
    medically uninsurable as of 1/1/2014.
  • Members receiving subsidies will transition
    immediately to Exchange.
  • Remaining two-thirds will transition gradually
    over next several years.

Closing the Donut HolePrescription Drug Savings
to Maryland Seniors
Pillar IIIMore Affordable Coverage
  • 55,107 Maryland seniors received 250 rebate in
  • 49,000 saved 37.5 million in 2012.
  • Overall savings to Maryland seniors to date
    84.1 million.
  • Projected savings through 2020 400 million.

  • Economic Stimulus
  • Independent analysis by Hilltop Institute at
    University of Maryland Baltimore County found
    that full implementation of the Affordable Care
    Act will
  • generate 3 billion in additional economic
    activity annually
  • create 26,000 new jobs by end of decade
  • have net positive impact on States budget
    through 2020
  • protect safety net and other health care
    providers and
  • reduce hidden uncompensated care tax in insurance

Source Maryland Health Care Reform Simulation
Model Hilltop Institute, University of Maryland
Baltimore County (July 2012)
Economic Benefit 2104 2015 2020
Federal Subsidies 254 Million 607 Million 1.3 Billion
Increase in Funds to Providers 682 Million 1.2 Billion 2.3 Billion
Increase in Health Expenditures 1.06 Billion 2.08 Billion 3.9 Billion
Number of New Jobs 9,000 16,000 26,000
Reduction in Uncompensated Care 118 Million 306 Million 714 Million
Additional State and Local Taxes 61 Million 140 Million 237 Million
Development of the Maryland Health Benefit
  • Hybrid Model of Governance
  • Public Corporation
  • Transparency, openness, and accountability of
  • Hiring and contracting flexibility of private

BOARD OF DIRECTORS Joshua Sharfstein, Secretary,
Maryland Dept. of Health Mental Hygiene Therese
Goldsmith, Commissioner, Maryland Insurance
Administration Ben Steffen, Executive Director,
Maryland Health Care Commission Kenneth Apfel,
Professor, University of Maryland School of
Public Policy Georges Benjamin, M.D., Executive
Director of American Public Health
Association Darrell Gaskin, Ph.D., Professor,
Johns Hopkins Bloomberg School of Public
Health Jennifer Goldberg, J.D., LL.M., Assistant
Director, Maryland Legal Aid Bureau Enrique
Martinez-Vidal, M.P.P., Vice President at
AcademyHealth Thomas Saquella, M.A. retired
President, Maryland Retailers Association
Name/Branding of Exchange Maryland Health
Connection Consumer Portal
 Welcome to Maryland Health Connectiona new
marketplace opening in October 2013.
  • Developments Leading up to October 1, 2013
  • Plans certified for offering on Maryland Health
    Connection 45 medical plans
  • offered by 4 carriers (CareFirst, Kaiser,
    Evergreen, and United HealthCare) and
  • 20 stand-alone dental plans .
  • 5 Star Quality Ratings, Summary of Benefits, and
    provider search available to consumers for plan
    comparison collaboration with CRISP (Health
    Information Exchange)
  • Connector entity awards and navigator
    certification MHBE began
  • navigator and assister training and
    certification in September, 2013.
  • Consumer Support Center Began operations in
    August, 2013
  • Advertising campaign Began early fall, 2013.
  • Open enrollment October 1, 2013 March 31,

Exchange Qualified Health Plans by Carrier Exchange Qualified Health Plans by Carrier Exchange Qualified Health Plans by Carrier Exchange Qualified Health Plans by Carrier
Parent Company Licensed Entity of Plans Metal Levels
CareFirst CareFirst Blue Choice CareFirst of Maryland Inc. Group Hosp. and Medical Services Inc. 11 2 2 1 platinum, 3 gold, 3 silver, 3 bronze, 1 catastrophic 1 platinum, 1 bronze 1 platinum, 1 bronze
Evergreen Evergreen Health Cooperative 9 4 gold, 4 silver, 1 bronze
Kaiser Permanente Kaiser Foundation Health Plan 9 2 gold, 3 silver, 3 bronze, 1 cat.
UnitedHealthcare All Savers Insurance Co. 8 1 gold, 4 silver, 2 bronze, 1 cat.
CareFirst (Multi-State Plan) CareFirst of Maryland Inc. Group Hosp. and Medical Services, Inc. 2 2 1 gold, 1 silver 1 gold, 1 silver
Total Total 45 45
Metal levels correspond to the plan actuarial
value Bronze 60 (/- 2) Silver 70
(/- 2) Gold 80 (/- 2) Platinum
90 (/- 2)
  • 36 include embedded pediatric dental
  • 24 plans offer statewide coverage
  • Product types
  • PPO 8 POS 9 HMO 20 EPO 8

Stand-Alone Dental Plans by Carrier Stand-Alone Dental Plans by Carrier Stand-Alone Dental Plans by Carrier Stand-Alone Dental Plans by Carrier
Parent Company Licensed Entity of Plans Tier
Delta Dental Alpha Dental Programs Delta Dental of PA 4 4 2 low (pediatric and family), 2 high (pediatric and family) 2 low (pediatric and family), 2 high (pediatric and family)
DentaQuest DentaQuest Mid-Atlantic 4 2 low (pediatric and family), 2 high (pediatric and family)
Dominion Dental Dominion Dental Services 4 2 low pediatric, 2 low family
United Concordia United Concordia Life and Health 4 2 low (pediatric and family), 2 high (pediatric and family)
Total Total 20 20
  • 8 plans offer pediatric benefits only
  • 12 plans offer family coverage
  • All plans are offered statewide

Metal levels do not apply to stand-alone dental
plans instead, new tiers that correspond to
the plan actuarial value have been created.
Low Tier 70 (/- 2) High Tier 85 (/-
Components of Consumer Assistance Program
  • Six Connector Entities
  • Partner with community-based organizations, local
    health departments
  • Navigators provide full range of services from
    eligibility determination to enrollment in
    Medicaid or qualified health plan certification
  • Assisters provide education, outreach, and
    eligibility determinations
  • 24 million in grants 330 navigators and
    assisters 1,250 case workers.
  • Application Counselors
  • Provide assistance with eligibility
    determinations and enrollment into QHPs
  • Sponsoring entity required (e.g. hospital,
    community health center)
  • Training required no compensation from Exchange.
  • Insurance Producers
  • Training and authorization to sell in the
    Exchange required
  • Enrollment into QHPs only 1,800 authorized for
    Individual Exchange.
  • Consumer Support Center
  • Contract awarded in June, 2013 opened August,
  • 125 employees to provide full services to
    consumers technical assistance to navigators and

  • Accessibility and Cultural Competency
  • Section 508 compliant to make accessible for
    persons with disabilities
  • Spanish version website and materials
  • Cultural competency training for navigators,
    assisters, and call center employees
  • Cultural competency testing of website and all
    materials, outreach toolkits, etc.

Connector Regions and Entities
  • Updates Since October 1, 2013 Launch
  • Ongoing upgrades to IT System IT team working
    around the clock to address
  • website performance and software glitches.
  • Website visits, consumer accounts and
    enrollments As of 10/11/13,
  • hundreds of thousands website hits 217,000
    unique visitors over 26,000
  • accounts created over 17,000 eligibility
    determinations 1,120 enrollments.
  • Consumer assistance Over 19,000 calls
    answered by Consumer Support
  • Center DHR and DHMH caseworkers and
    navigators being provisioned for
  • access to internal portal paper
    applications available as back-up.
  • Communications Regular reports released by
    MHC with updates on numbers
  • and consumer advisories regarding use of the
  • Consumer resources page Plan comparisons
    links to provider search and
  • sample rate scenarios guide to consumer
    assistance services enrollment
  • checklist.

  • 10/1 10/10 Geographic Breakdown

  • 10/1 10/10 Age Distribution

Figure 4 Age Distribution of First 25,000
Account Holders with Verified Identity in Maryland
  • Landing Page

  • Consumer Information Update Page

  • Prepare for Enrollment
  • Before creating an account, visitors can view
  • Summaries of plan benefits and coverage
  • Provider directories
  • Plan quality reports
  • Managed Care Organization comparison chart
  • Sample rate scenarios
  • Visitors can also find information on
  • Local events
  • In-person assistance
  • What documentation to have available before
    beginning an application

  • Provider Search

  • IT Next Steps
  • IT team working around the clock to improve the
    performance of
  • System software will be updated and additional
    steps taken to improve website performance and
    consumer experience.
  • Enrollment open until March 31, 2013.
  • Enrollment by 12/18 for coverage to be effective

Pillar IVCost Control and Quality Improvement
Save Money While Making People Healthier
Keeping people healthy Investments in wellness
and prevention
Higher quality and more efficient care delivery
models Pilots and demonstration projects with
leadership from health care providers
Health Information Technology Support ongoing
efforts to develop Health Information Exchange
and meaningful use of Electronic Health Records
Health Care Delivery and Payment ReformMovement
from Fee-For-Service to Population, Value-Based
Reimbursement Models
  • Develops new payment and service delivery models
    under Social Security Act and ACA in seven
    categories of reform.
  • Accountable Care
  • Bundled Payments for Care Improvement
  • Primary Care Transformation
  • Initiatives focused on Medicaid and CHIP
  • Initiatives focused on Dual-Eligibles, or
    Medicaid/Medicare enrollees
  • Acceleration of Adoption of Best Practices
  • Acceleration of Development and Testing of New
    Payment and Service Delivery Models

Health Care Delivery and Payment Reform
  • Progress
  • HCRCCs Health Care Delivery and Payment Reform
  • Identifies and supports successful clinical
    innovations, financial mechanisms and integrated
    programs underway in private sector to promote
    delivery system reform
  • Website,
  • Health Quality Cost Council
  • Public-private Partnership to address chronic
    disease management, wellness and prevention, and
    other quality and cost control measures
  • Healthiest Maryland
  • Cultural Competency
  • Evidence-based medicine

Health Care Delivery and Payment Reform
  • Health Enterprise Zones (Health Improvement and
    Disparities Reduction Act of 2012)
  • Community (or contiguous cluster) of 5,000 or
    more residents with economic disadvantage and
    poor health outcomes
  • 4-year, 4 million/year pilot to invest in local
    community plans to improve primary care and
    address underlying causes of health disparities
    using direct grants, property and income tax
    incentives, loan repayment, and other tools
  • 5 HEZ designations 1) MedStar - St. Marys
    Hospital Greater Lexington Park 2) Dorchester,
    Caroline County Health Dept. 3) Prince Georges
    County Health Dept. Capitol Heights 4) Anne
    Arundel Health System Annapolis and 5) Bon
    Secours West Baltimore Primary Care Collaborative.

Health Care Delivery and Payment Reform
  • Health Services Cost Review Commission
    (Hospital-rate setting entity)
  • Total Patient Revenue
  • Revenue caps for hospitals to create incentives
    to reduce unnecessary admissions and ED visits
  • In 3rd year of 3-year pilot evaluation underway
  • In process of renegotiating for FY 2014 new TPR
    program to accrue shared savings to all payers.
  • Admission-Readmission Revenue Structure
  • Hospitals and patients accrue financial benefits
    from reduced readmissions and improved post-acute
  • In 2nd year readmissions declining
  • Commission has issued draft recommendation to
    establish new agreements for FY 2014 that
    include shared savings to all payers.
  • Quality Based Reimbursement and Maryland
  • Hospital Acquired Conditions
  • Modernization of Medicare waiver submitted to
  • CMS on 10/11/13.

Health Care Delivery and Payment Reform
  • Chronic Health Home initiative
  • ACA option to amend State Medicaid plan to offer
    health homes that provide comprehensive,
    coordinated care to patients with, or at risk of,
    chronic conditions.
  • Community First Choice Program
  • 6 enhanced federal match to provide personal
    care services to maintain care in community
    setting new assessment tool more uniform
    provider requirements and payment rates 1/1/2014
  • Consolidation of Living-At-Home and Older Adults
  • To provide seamless services as individuals age
    January 1, 2014 launch.
  • Balancing Incentives Payment Program
  • 106 million grant to provide more care in
    community settings
  • Grants to be awarded late October, 2013 for
    innovative demonstration proposals for new
    approaches to services keeping people at home.

Patient Centered Medical HomeNew care delivery
model anchored in primary care
  • Accessible - first contact care point of entry
    for new problem
  • Continuous - ongoing care over time
  • Comprehensive - provides or arranges for services
    across all patients health care needs
  • Coordinated - integration of care across
    patients conditions, providers and settings,
    with patients family, caregivers, and community
  • Improvements - through a systems-based approach
    to quality and safety and
  • Patient Centered - needs and wishes of patient
    and family are consciously considered.
  • Payment Model
  • Fee-For-Service - practices continue to be
    reimbursed under their existing fee-for-service
    payment arrangements with health plans
  • Fixed Transformation Payment - practices
    receive per patient/per month fee (paid
    semi-annually) between 3.50 and 6.00 and
  • Incentive Payment (Shared Savings) - practices
    receive share of any actual savings generated by
    reducing total cost of care through
  • improved patient outcomes.

Marylands PCMH Pilot Programs
  • State multi-payer and private single payer
    authorized by 2010 legislation.
  • State multi-payer
  • 5 commercial carriers, 6 MCOs, some self-funded
    employees, and TRICARE (7/13)
  • 52 practices with 250,000 attributed patients
    330 providers
  • Practice transformation through Maryland Learning
  • Practices must deliver team-based care with care
    coordinator, obtain NCQA recognition as PCMH, and
    report on quality and performance
  • In 2012, approximately 900,000 in shared savings
    issued to 23 practices
  • Model to be evaluated to determine whether
    achieves savings, increased patient and provider
    satisfaction, and reduced health disparities.
  • Two single payers authorized as of 3/13 1.1
    million patients.

ACA Promotion of Accountable Care Organizations
  • New health care delivery model where groups of
    doctors, hospitals, and other providers work
    together to
  • provide coordinated, high quality care to their
    Medicare patients which
  • ensures care at the right time and place and
  • avoids duplication or services and medical
  • reduce the rate of growth in health care spending.
  • Medicare Shared Savings Program
  • Uses 33 performance measures for patient safety,
    preventative health services, care for at-risk
    populations, care coordination, and patient
  • If the cost of care is below the anticipated
    cost, ACO receives portion of savings.
  • Maryland ACOs 9 approved by CMS to date
    covering every region of State

  • Accountable Care Coalition of Maryland,
    Hollywood, MD, 109 physicians
  • Greater Baltimore Health Alliance Physicians,
    partnerships between hospital and ACO
    professionals, 399 physicians.
  • Maryland Accountable Care Organization of Eastern
    Shore, National Harbor, 15 physicians.
  • Maryland Accountable Care Organization of Western
    MD, National Harbor, ACO group practices and
    networks of individual ACO practices, 23
  • AAMC Collaborative Care Network
  • Lower Shore ACO - Med-Chi Network Services
  • Three ACOs overseen by Universal American
  • Maryland Collaborative Care LLC, serving Carroll,
    Montgomery, Frederick, Calvert and Anne Arundel.
  • Northern Maryland Collaborative Care LLC, serving
    Baltimore and Washington metro areas.
  • Southern Maryland Collaborative Care LLC, serving
    Montgomery, Prince Georges, and Anne Arundel.

State Innovation Models AwardCommunity-Integrated
Medical Home
  • CMS initiative to develop, implement and test new
    payment and delivery models
  • Maryland received 2.37 million Model Design,
    6-month planning award
  • Opportunity for Model Testing award up to 60
    million over 4 years.
  • Community-Integrated Medical Home (analogous to
    Accountable Care Community)
  • Integration of multi-payer medical home with
    community health resources
  • Four components primary care, community health,
    strategic use of new data, and workforce
  • Governance structure and public utility to
    administer payment and quality analytics
    processes (analogous to concept of wellness
  • Use of expanded Local Health Improvement
    Coalitions, community health workers, and data
    and mapping resources for hot-spotting high
  • Stakeholder engagement planning process with
    payers, providers, and local health improvement
    coalitions from April to September, 2013.
  • Next Steps Innovation Plan due to CMS 12/31/13
    Model Testing application due Spring 2014
    Summer/fall 2014 Model Testing period begins 6
  • ramp-up period, followed by 3 years of

Marylands Health Information Exchange
  • Chesapeake Regional Information System for our
    Patients (CRISP) is State-designated HIE
  • State invested 10 million in startup costs to
    leverage 17.3 million in federal assistance
  • Maryland is first state to connect all 46 acute
    care hospitals to common platform 41 hospitals
    providing some clinical data
  • Launched ENS (patient hospital encounter
  • notifications system) in late 2012
  • sends out 12,000 notifications a month to
  • primary care clinicians when patients seen
  • hospital
  • State also using HIE to map hot spots of
  • preventable hospitalizations and
  • poor outcomes.

Goal Interconnected, consumer-driven electronic
health care system aimed at enhancing quality and
reducing costs.
Public Health, Safety Net, and Special
  • 4 Develop state/ local strategic plans for
    better health outcomes.
  • 5 Encourage participation of safety net
    providers in health reform.
  • 6 Improve coordination of behavioral health
    and somatic services.
  • 7 Promote access to quality care for special
  • State Health Improvement Process
  • Local action and accountability to improve
    population health and reduce disparities
  • 39 measures of population health outcomes and
    determinants, e.g. rate of ED visits, low-birth
    weight, obesity, smoking, etc.
  • Establish leadership coalitions, county baselines
    and targets.
  • Behavioral Health Integration
  • Merger of Mental Hygiene Administration and
    Alcohol and Drug Abuse Administration into single
    Behavioral Health Administration
  • Substance use and mental health integrated
  • Community Health Centers
  • Federal grants totaling 17.7 million

Public Health, Safety Net, and Special
  • Community Health Resources Comm. Safety Net
    Provider Assistance Plan
  • Maryland Health Access Assessment Tool survey
    of uninsured, projected supply and demand
  • Development of relationships for contracting
    between essential community providers and
    carriers/MCOs Access to Care Program
  • State and Local Health Departments assistance
    with business planning, contracting,
    credentialing, and billing
  • Community-based Health Center Voluntary
    Certification and
  • Health Access Impact Fund public/private
    partnership with philanthropic community to
    leverage dollars for capacity building and
    technical assistance 3 million grant
    solicitation announced late October/early
    November, 2013.
  • Community Transformation grant for chronic
    disease prevention
  • Addressing root causes of chronic disease, like
    smoking, poor diet, and lack of physical
    activity 3.89 million grant award to Maryland
  • Enhanced public health funding (9.7 M in FY13
  • Maternal, Infant and Early Childhood Home
    Visiting, teen pregnancy reduction, Coordinated
    Chronic Disease, and Enhanced HIV prevention

Workforce Development
  • Governors Workforce Investment Boards
  • Preparing for Health Reform Health Reform
  • Strategic plan to increase Marylands primary
    care workforce capacity by 10-25 over next
  • Need for significantly larger primary care
    workforce - greater demand for services from
    aging population and increased insurance
  • Recommends 3 Major Interventions
  • Strengthen primary care workforce capacity, e.g.
    pipeline educational programs
  • Address primary care workforce distribution and
    reduce service shortage areas, e.g. financial
    assistance to serve in medically underserved
  • Re-examine practitioner compensation for
    high-quality care, e.g. increased payment for
    primary care services.
  • 4.98 million in ACA funding to support training
    of providers to improve preventive medicine,
    health promotion and disease prevention.

Workforce Development
  • EARN program (Employment Advancement Right Now)
  • 2013 bill which provides grant dollars to match
    Marylanders seeking new or better jobs with the
    workforce needs of Maryland employers.
  • Businesses, government, and educational
    institutions will create training programs for
    jobs in high-demand fields, including health
  • SIM Model Design planning
  • Use of community health worker
  • Identification of best practices and inventory of
    training models
  • 2013 Maryland Healthcare Workforce Study
  • Assess quality and utility of data available to
    study health care work force
  • Identify types of data needed to assess current
    and future adequacy of supply of services and
  • Assess data availability, identify current gaps,
    and possible solutions
  • Report on workforce characteristics and current
  • Make recommendations to professional licensure
    boards to enhance collection of needed data and
    to support changes to licensure applications.
  • CCIIO Cycle III Grant award to expand All-Payer
    Claims Data Base

  • Telehealth use of electronic information and
    telecommunications ies to technologies
    to support long-distance clinical health care,
    patient and l health-professional
    health-related education, public health, and
    health administration.
  • Leading challenges include
  • Developing interoperable networks capable of
    communicating/connecting to CRISP
  • Determining actual cost-effectiveness and
    appropriate Medicaid reimbursement.
  • Telemedicine in Maryland
  • Medicaid reimburses for telemental health
    services in rural geographic areas
  • 2013 legislation expanded Medicaid reimbursement
    to cardiovascular or stroke emergencies, where
    procedure is medically necessary and specialist
    is not on duty
  • Bill also directed continued study of
    telemedicine through Telemedicine Task Force to
    identify opportunities to use telehealth to
    improve health status and health care delivery,
    with final report and recommendations due
    December, 2014
  • DHMH supports expanding to hub and spoke model
    that connects primary care to specialists, and
    continues to study store and forward and home
    health telemonitoring for cost-effectiveness.

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