On Thursday March 3rd, Dr. Brian Gibbs, Associate Dean for Diversity and Cultural Competency at Johns Hopkins School of Medicine, briefed the Legislative Black Caucus on Johns Hopkins Medicine�s commitment to diversity and inclusion and provided an overview of the Office of Diversity & Cultural Competence (ODCC). This was Dr. Gibbs second time briefing the Caucus, the first was in 2009 when he began at Johns Hopkins. Dr. Gibbs was able to highlight the progress that the ODCC has made over the last two years and its plan for the future in the areas of recruitment, retention, and promotion; promoting cultural competence; mentoring and reporting the state of diversity; and developing effective and sustainable collaborations and partnerships.


Hospital Assessment and Graduate Medical Education

There were several hearings relating to the hospital assessment and graduate medical education in Annapolis last week. The Administration has offered two amendments regarding the hospital assessment. The first imposes a flat assessment of 1.25% of hospital regulated net patient revenue for averted uncompensated care which would generate $42 million less than the original proposal. This has the effect of removing the prospective adjustment to hospital rates for averted uncompensated care with the subsequent reconciliation that occurs. The Maryland Hospital Association is supportive of this amendment.

The second amendment strikes the 2.5% Medicaid funding assessment and replaces it with a requirement that the HSCRC approve $372,325,000 in revenue through a combination of hospital remittances and assessments to support Medicaid in fiscal year 2012. An additional stipulation in the amendment requires hospitals to provide a similar amount of ongoing Medicaid support in the out-years. The MHA is opposed to this amendment and has highlighted the fact that this change from the original proposal is a more obvious attempt to use hospitals as the source to fund the state�s Medicaid deficit. MHA is instead proposing language that would create a Medicaid Sustainability Commission comprised of necessary state officials and stakeholders representative of hospitals, nursing homes, and managed care organizations to find cost savings within Medicaid and a long-term solution to the Medicaid deficit.

There were no Administration amendments addressing graduate medical education. However, leadership in the General Assembly has indicated that the Administration�s proposal to pool GME funding will be rejected by the General Assembly. The $17 million that would have been saved under this proposal is, instead, expected to be added to the assessment.

Stuart Erdman, who is well-recognized by leaders of the General Assembly for his expertise on hospital financing matters, came to Annapolis on March 3 to meet with several legislative leaders to discuss the impact that the assessment and GME will have on all hospitals throughout the State. Stuart was able to meet with the chairs of the Appropriations, Budget and Taxation, and Finance committees. He also met with the Speaker of the House and several other budget committee members.


Medicaid Budget

The Health Subcommittee of the House Appropriations Committee held a hearing on the Medicaid budget, which included a discussion of the HealthChoice program budget. The Department of Legislative Services proposed a number of cuts to the HealthChoice budget, including a $4.5 million cut to the MCO statewide incentive program and an additional 1% cut to MCO rates for calendar year 2011 (bringing the total cut to 2% for the year or $19 million). At the request of DHMH Secretary Josh Sharfstein, Senator Robert Neall, CEO of Priority Partners, testified in opposition to both of the DLS cuts. Priority Partners is one of two MCOs in the state that are considered statewide and receive a portion of the statewide incentive program. Sen. Neall offered that the legislature consider the profits made by other MCOs in the state before making across-the-board reductions or cuts to the statewide incentives.


Prohibition of Payments to Health Care Professionals

HB 818 prohibits manufacturers of prescribed products from making a gift or payment to health care professionals. There are several exceptions to the bill that permit appropriate interaction with industry. Johns Hopkins was asked to provide input on this bill during the drafting process. Many of the suggestions made by Hopkins were incorporated into the legislation. Julie Gottlieb, Associate Dean for Policy Coordination, testified on behalf of Johns Hopkins offering support with amendments. The bill, if amended, would be consistent with the policy currently in place at Johns Hopkins Medicine. University of Maryland School of Medicine offered written support for the bill, and the University of Maryland Medical System and LifeBridge have indicated they will support this bill. MedChi and several representatives from the pharmaceutical and manufacturing industry opposed the proposed legislation. Considering all of the opposition, it is uncertain whether this bill will move forward, however, Chairman Hammen did appreciate the support and comments from Johns Hopkins.


Workgroup on Legislation to Regulate For-Profit Higher Education Institutions

Last week, the Education Subcommittee of the Senate Education, Health, and the Environment Committee held a workgroup on a bill to clarify the Higher Education Article with the goal of ensuring that MHEC has the authority necessary to regulate for-profit institutions of higher education in the state. This bill has been supported by all segments of higher education and is very important to MHEC who has been concerned with the ambiguities in the current statute as they pertain to for-profit institutions. Another similar workgroup was held March 7.


Maryland Cardiovascular Patient Safety Act

The Maryland Cardiovascular Patient Safety Act requires cardiovascular catheterization laboratories to have certification by May 2014. This bill is promoted primarily by Accreditation for Cardiovascular Excellence. Consistent with the advice of its own Quality Council, MHA opposed this bill. They did, however, offer support for the intent, but concern that this accreditation process is premature. Both DHMH and MHCC also submitted letters of concern. Given the limited support and the reaction of the committee at the hearing, it is unlikely that the bill will move forward.


Medical Marijuana

The medical marijuana bills were heard before both the House Judiciary and Health & Government Operations Committees on Monday, and before the Senate Judicial Proceedings Committee on March 3.

Originally thought to have a better chance of passing this session after passing the Senate in 2010, the Medical Marijuana bills have stalled in committee. The two sticking points are the testimony of the Department of Health and Mental Hygiene and funding. The bill met an unexpected hurdle when the Health Secretary provided testimony that the Department was opposed to the bills and the Department of Legislative Services provided a fiscal note on the bills that shows that it will cost the state cost of more than $15.3 million in fiscal year 2012 to implement.

The DHMH Secretary, Dr. Josh Sharfstien, previously the Principal Deputy Commissioner at the Food and Drug Administration, said in his testimony that he has concerns about the negative effects of medical marijuana and would prefer a research program as opposed to legalizing the substance outright. He also said that he would be willing to work with the sponsors of the bill to address the Department�s concerns. It will be very difficult for the sponsors to address the issues raised by the Department in time to pass the bills out of both houses before the end of session.

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BILLS INTRODUCED

Behavioral Health

HB1150 Mental Hygiene Administration - Facilities - Trauma-Informed Care

This bill requires that all staff at mental health facilities receive training in trauma-informed care. Bill defines trauma informed care as mental health treatment that is focused around the trauma experienced by individuals receiving mental health services; the neurological, biological, psychological, and social effects of trauma and violence; and an awareness of the environment, practices, and treatment that may need to be modified to address trauma issues. Bill also requires that mental health facilities separate male and female bedrooms by a specified distance and provide barriers to prevent unauthorized access and establishes reporting requirements related to sexual abuse and sexual harassment.

Effective Date: October 1, 2011
For more information, please contact: Delora Sanchez

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General Business

SB0596 State Government - Human Relations - Discrimination in Housing, Employment, and Places of Public Accommodation

This bill expands the provisions of current law that provide protection against discrimination by a place of public accommodation to the website or business entity that (1) is a place of public accommodation or provides goods, services, entertainment, recreation, or transportation to any person in the state through the Internet; and (2) had gross revenue of at least $1.0 million in the entity�s most recently completed fiscal year. Websites that were created and made public before 10/1/11 must be made accessible to the blind or visually impaired by 10/1/12 and any websites that were create or substantially revised on or after 10/1/11 must be made accessible by 1/1/12.

Effective Date: October 1, 2011
For more information, please contact: Delora Sanchez

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Handgun

SB0311 Weapon-Free Higher Education Zones

Bill would prohibit the carrying or possession of firearms, knives, and deadly weapons on the property of public institutions of higher education with exceptions.

Effective Date: October 1, 2011
For more information, please contact: Delora Sanchez

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Health Care Facilities

SB0934 Nursing Homes - Staffing Requirements

This bill requires nursing homes (on or before May 1, 2013) to ensure that each resident receives at least 3.67 hours of direct care per day. The bill also requires nursing homes to maintain minimum shift staffing ratios with 1 registered nurse or licensed practical nurse to every 15 residents and 1 geriatric nurse to every 7 residents for the day shift, 1 registered nurse or licensed practical nurse to every 20 residents and 1 geriatric nurse to every 9 residents for the evening shift, and 1 registered nurse or licensed practical nurse to every 29 residents and 1 geriatric nurse to every 19 residents for the evening shift. The direct care and shift ratios are gradually increased to the 2013 levels in 2011 and 2012. Nursing homes are required to submit proposed shift schedules to the Office of Health Care Quality for approval. Nursing homes will also be required to employ full-time directors of nursing who are registered nurses, have worked for at least 2 years as a registered nurse in a long-term care facility and have completed a training program developed by DHMH.

Effective Date: June 1, 2011
For more information, please contact: Nicki McCann

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Health, General/Public/Environmental

SB0528 Health - Medical Procedures - Ultrasound Options

This bill requires physicians to provide a pregnant woman to the opportunity to view the active ultrasound image of the embryo or fetus and offer to provide a picture of the ultrasound image before an abortion.

Effective Date: October 1, 2011
For more information, please contact: Delora Sanchez

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Medical Liability/Tort Reform

HB1192 Health Care Malpractice - Expression of Regret or Apology - Inadmissibility

This bill would make an expression of regret or apology made in writing, orally, or by conduct to a victim of alleged health care malpractice, any member of the victim�s family or any individual who claims damages by or through that victim, inadmissible as evidence of an admission of liability or as evidence of an admission against interest.

Effective Date: October 1, 2011
For more information, please contact: Delora Sanchez

SB0895 Medical Professional Liability Insurance for Nonprofit Health Care Providers

This bill requires counties to provide nonprofit health care providers within its jurisdiction with medical professional liability insurance. The insurance must provide coverage of $200k per occurrence or claim; and $500k per total claims that arise from the same occurrence.

Effective Date: October 1, 2011
For more information, please contact: Delora Sanchez

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Workplace Regulation

HB0761 State Government - E-Verify Program

This bill prohibits state agencies from allowing unauthorized alien workers to work under state contracts and grants. Also requires state contractors, subcontractors and any person or business that receives a state grant to register and use the federal E-Verify program with few exceptions.

Effective Date: October 1, 2011
For more information, please contact: Delora Sanchez

HB0907 Employment Discrimination - Criminal Convictions

this bill prohibits an employer from discharging, refusing to hire, or discriminating against an individual because he or she has been convicted of a crime that is not directly related to his or her employment with the exception of sexual offenses or sexual abuse of a minor.

Effective Date: October 1, 2011
For more information, please contact: Delora Sanchez

HB0976 Displaced Building Service Workers Protection Act

This bill requires that successor employers that have been awarded a building or food service contract retain employers that the previous employer employed at the site for 90 days. The successor employer is required to make a written offer of employment to each employee. At the end of the 90 day period, the successor employer must perform a written performance evaluation for each employee. An employee that is not retained may bring an action in court for back pay, benefits, and reinstatement to the site.

Effective Date: October 1, 2011
For more information, please contact: Delora Sanchez

HB1002 The Religious Observance Accommodation Act

This bill requires employers that provide leave to allow employees to use any type of accrued leave for religious observance.

Effective Date: October 1, 2011
For more information, please contact: Delora Sanchez

SB0444 Labor and Employment - Employment Standards and Conditions - Definition ofEmployer

This bill adds a general definition of �employer� and alters and repeals definitions of �employer� in the law relating to employment standards and conditions. The bill defines �employer� as �a person engaged in a business, industry, profession, trade, or other similar enterprise in the State who employs an individual in the State.� The bill amends several sections of state law including: �Equal Pay for Equal Work� (Labor and Employment � 3-301); Maryland Wage and Hour Law (Labor and Employment � 3-401); Maryland Wage Payment and Collection Law (Labor and Employment � 3-501); �Lie Detector Tests� (Labor and Employment � 3-702);�Leave� (Labor and Employment � 3-801); and �Leave for illness of immediate family� (Labor and Employment � 3-802).

Effective Date: October 1, 2011
For more information, please contact: Delora Sanchez

SB0600 Labor and Employment - Abusive Work Environments - Employee Remedies

This bill aims to eliminate workplace bullying by prohibiting an employer from subjecting an employee to an �abusive work environment� that includes �abusive conduct�. Abusive conduct is defined as conduct that creates a hostile work environment and includes repeated verbal abuse; conduct of a threatening, intimidating, humiliating or cruel nature, or the sabotage or undermining of another employee�s work performance. An employee may seek civil remedies for violation of the bill.

Effective Date: October 1, 2011
For more information, please contact: Delora Sanchez

SB0660 Labor and Employment - Right to Work

Bill prohibits an employer from refusing or terminating employment because an individual is a member or is not a member of a labor organization. The employer must not require that an individual join, pay dues, fees or other charges to a labor union, nor may an employer prohibit an individual from joining a labor union.

Effective Date: October 1, 2011
For more information, please contact: Delora Sanchez

SB0807 State Procurement - Employment of Unauthorized Aliens and the Federal E-VerifyProgram

This bill requires that an employer use E-Verify to determine the employment eligibility for employees hired under a state procurement contract or grant. Prohibits and employer from knowingly hiring an unauthorized alien under a state procurement contract or grant.

Effective Date: October 1, 2011
For more information, please contact: Delora Sanchez


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