5 Things in Maryland: Department of Health RFPs, Q&As with Joe DeMattos, Hospital Pricing Transparency - State of Reform

5 Things in Maryland: Department of Health RFPs, Q&As with Joe DeMattos, Hospital Pricing Transparency – State of Reform

In this month’s newsletter, we feature two new tenders from the Maryland Department of Health, a video interview with HFAM CEO and President Joe DeMattos, and a conversation about efforts to improve the implementing certified community behavioral health centers in the state.

Thanks for the reading!

Emilie Boerger
State of reform

1. MDH releases two Medicaid-related tenders

The Maryland Department of Health this month issued an RFP seeking a contractor to administer dental benefits to eligible Medicaid recipients. The search for a dental benefits administrator or dental administrative services organization follows the passage of Senate Bill 6/Bill 150 in the last legislative session, which mandates the assistance program Medical School of Maryland to provide dental services to eligible adults beginning January 1, 2023.

Also this month, MDH released an RFP for a statewide non-emergency medical transportation contractor for Medicaid enrollees. The RFP states: “…the most basic functions of a NEMT broker are to be a single point of contact for beneficiaries to request transport assistance and to directly arrange the type of transport least costly and most appropriate for each beneficiary.” Proposals are due November 1 at 4 p.m. EST.

2. Experts discuss CCBHC implementation

In an effort to further improve the implementation of certified behavioral health community clinics in the state, the Institute for Innovation and Implementation at the University of Maryland held a meeting last week to discuss improving the quality of CCBHC and reporting measures. The meeting brought together representatives from several States to discuss lessons learned during the implementation of CCBHCs.

A key lesson discussed was the importance of using evidence-based data and treatments to improve outcomes. Specifically, experts highlighted the importance of program evaluations, data sharing, and developing new partnerships within the health system. “As we continue to move forward through the mental health crisis we currently find ourselves in, we need to pay attention to two things in particular,” said Keri Virgo of Tennessee. “The first is that we need to be able to partner with anyone and everyone to give people what they need. The second is services and supports that are well measured and show that the improvement should be our standard of care.

3. What They’re Watching: Joe DeMattos, HFAM

As President and CEO of the Health Facilities Association of Maryland, Joe DeMattos is focused on improving care integration for the state’s long-term care facilities. In this edition of “What They’re Watching,” DeMattos discusses what can be done to improve access to care, especially for underserved communities.

“Here in Maryland, we have outstanding teaching hospitals and outstanding medical centers,” says DeMattos. “We have great nursing homes and assisted living centers, but those dots are often not connected. Sometimes they are connected – in communities which are more difficult – by dotted lines which must be filled in. Much of our work right now is about connecting the dots, but also recognizing the work we need to do to reach the underserved. , communities most at risk.

4. Hilltop researchers to launch hospital pricing studies

Researchers at UMBC’s Hilltop Institute have received a $282,412 grant from the National Science Foundation to launch a large project to collect data on hospital pricing behaviors. As of 2021, hospitals are required by federal law to provide standard rates for their services, as well as negotiated rates for each payer. By gathering and evaluating this new data from a nationwide sample of hospitals, the researchers hope to open a new field of research on hospital pricing and payer negotiation.

“We feel like being in Maryland (with its all payers model) gives us this very unique and objective perspective because in pretty much every other state we’ve seen tremendous price variability for the same procedure between payers within a hospital,” said Dr. Morgan Henderson, Senior Data Scientist at Hilltop. “…there is a lot of interesting research to be done on hospitals on either side of Maryland and other state lines. This in itself will be a fantastic study.

5. Maryland excels in Medicaid reviews

States continue to prepare for the outcome of the federal public health emergency and subsequent re-determinations of Medicaid eligibility that must take place. A new report from CMS studied each state’s ability to process Modified Adjusted Gross Income (MAGI) claims within Medicaid and CHIP, and found that Maryland processed almost all claims in less than 24 hours, only 2nd behind Oklahoma.

Maryland has prepared for the unfolding of PHE throughout the pandemic, in part through constant communication with its managed care organizations, local health departments, and community organizations. Following the release of the report, a spokesperson for the Maryland Medicaid administration said they were awaiting further guidance on the conduct of PHE from the US Department of Health and Human Services.

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