The Contractor shall complete the following tasks. 2.3.1 Task 1: Provide an analysis and conclusions responsive to item (3) in the legislation – “the magnitude and impact of hospital facility fee charges for hospitals, payers, and consumers”. The following descriptions provide general guidance on the approach the contractor should take to addressing this analysis. The contractor is responsible for using their expertise to determine the appropriate final content to address this topic in the Brief. If the contractor anticipates material departures from the approach outlined, they should discuss their reasoning in their response. 2.3.1.1 The contractor will utilize Case mix to quantify the amount of hospital charges billed for Facility Fees by HSCRC regulated hospitals. The contractor will use Case mix, other data sources and their judgment to add to the initial amount an amount for fees paid by/on behalf persons receiving care in Maryland that meet the facility fee definition but are not billed by Maryland regulated facilities and therefore are not included in Case mix. 2.3.1.2 The contractor will translate the charge amount developed above into a hospital revenue amount using charge to allowed ratios, this amount will represent the magnitude of Facility Fees to hospitals. The HSCRC can assist with developing charge to allowed ratios for HSCRC regulated facilities, which will represent the bulk of the spending. The contractor will express these amounts as a % of total hospital revenue and provide relevant break outs of this information, for example by hospital, by service, and/or region and/or hospital type. 2.3.1.3 The contractor will assess the magnitude of facility fees for payers and consumers by using data on cost sharing ratios to translate the allowed amounts calculated above into relevant costs for payers and consumers. The contractor will express these amounts as a % of an appropriate denominator (e.g. total premiums, total out-of-pocket costs) and provide relevant break outs of this information, for example by service, and/or region and/or coverage type. 2.3.2 Task 2: Provide analysis and conclusions responsive to item (6) in the legislation - “the interaction of the alternative mechanisms or revisions studied under item (5) of this subsection with the State’s Total Cost of Care model obligations to the federal government, including any impact on Medicare total cost of care savings if outpatient facility fees are eliminated or reduced”. The following descriptions provide general guidance on the approach the contractor should take to addressing this analysis. The contractor is responsible for using their expertise to determine the appropriate final content to address this topic in the Brief. If the contractor anticipates material departures from the approach outlined, they should discuss their reasoning in their response. 2.3.2.1 In conjunction with the workgroup the HSCRC will develop up to four alternative mechanisms or revisions related to Facility Fees to be studied (the Scenarios). The HSCRC will provide the contractor with a written list of the Scenarios and answer questions regarding the Scenarios, as needed by the contractor, to develop modeling around these scenarios. The Scenarios are currently unknown but the HSCRC anticipates the scenarios might include: (i) the elimination of facility fees on certain services with costs shifted to other services, (ii) the capping of facilities fees with costs shifted to other services, (iii) interventions related to insurance design that would protect consumers from high facility fees or (iv) interventions related to Maryland’s Uncompensated Care Policy that would treat some facility fees as uncompensated care. Note these examples are provided to support the contractor's response to this proposal and do not reflect any bias by the HSCRC on the direction of this process.
