Managing Healthcare Compliance in Maryland

Maryland has a unique healthcare system with an all-payer model for hospital payments, which sets it apart from many other states. This model involves specific regulations and agreements with Medicare and Medicaid, impacting how healthcare providers in the state bill for services and receive payments. Additionally, Maryland has robust regulations related to hospital rate setting and certificate of need (CON) laws, affecting healthcare facility expansion and service offerings. 

To ensure full compliance, healthcare organizations and professionals operating in Maryland must be well-versed in these unique regulations while navigating the broader federal healthcare compliance landscape.

Maryland Healthcare Compliance Resources

Let’s start with the important state government agencies you’ll need to work with:

• The Maryland Department of Health (MDH) plays a crucial role in promoting the wellbeing of Maryland residents. 
• The Maryland Board of Physicians ensures that healthcare professionals in the state possess the necessary qualifications, competence, and ethical standards to provide safe and effective care to the public. 
• Both the Maryland Department of Health – Behavioral Health Administration and the Board of Physicians license medical and mental/behavioral health providers. 
• Maryland Hospital Association serves Maryland’s hospitals and health systems through collective action to shape policies, practices, financing and performance to advance health care and the health of all Marylanders.

Regulations Unique to Maryland

To meet the standards of healthcare compliance in Maryland, there are a few additional regulations. 

Total Cost of Care Model

Hospital rates in Maryland have been regulated by an independent state body to ensure all payers are charged the same rate for the same service at the same hospital. This is also known as the all-payer model or the total cost of care model. The model also includes other groups, such as physicians, skilled nursing facilities, and more, who are incentivized to coordinate care for patients.

Maryland Personal Information Protection Act (PIPA)

The Maryland Personal Information Protection Act is designed to reasonably protect consumers’ personal identifying information and if it is compromised, they are notified so they can take action to protect themselves. Health information (including mental health), health insurance policy information, or biometric data is considered personal information under Maryland law.

Tips To Manage Healthcare Compliance in Maryland

Effectively managing healthcare compliance in Maryland is a critical responsibility for healthcare organizations, as it ensures the delivery of high-quality care while adhering to legal and regulatory requirements. Here are some key strategies to help healthcare organizations manage compliance effectively:

• Conduct State-Specific Training: Provide ongoing training and education to staff that is customized to your state’s regulations as well as your facility. If using a learning management system, ensure the vendor offers Maryland-approved training.
• Organize Policies By Requirement: Including “MD” in every document that is required by the state will make it much easier for you to find these documents in an online system when a surveyor is onsite. It is also best practice to include the standard you are meeting for additional clarity.
• Establish a System for Monitoring Risk: Being able to identify compliance risks before they become incidents or violations can save the entire organization time and money. Identifying trends and consistently reviewing reports can signal issues, such as training not being completed or a large number of incidents in one location.
• Use Compliance Management Software: Accreditation surveyors say organizations that use compliance software are more prepared for onsite visits and surveys. The software helps to keep documents and policies organized, ensures training content is up to date, and makes reporting easy.

By implementing these strategies and fostering a culture of compliance within your healthcare organization, you can effectively manage healthcare compliance, reduce risks, and provide the best possible care to your patients while staying within legal boundaries.

Credentialing Compliance in Maryland

In addition to Maryland’s Total Cost of Care Model there are a few things that are required in Maryland that may be different from other states.

• Use of an online uniform application (UA) for licensure is required. The goal of the UA is to improve portability by eliminating the need for providers to re-enter information. 
• Maryland offers physician licensure by reciprocity with Virginia and D.C. licensees. 
• Beginning April 1, 2022, all healthcare practitioners applying for renewal of their license must complete an implicit bias training course. 

Meet Maryland Compliance Requirements With MedTrainer 

While the path may be complex, healthcare providers who prioritize compliance will not only avoid legal troubles but also enhance the quality of care they provide to their patients in Maryland. 

MedTrainer’s all-in-one compliance platform can streamline management of Maryland healthcare compliance. MedTrainer seamlessly consolidates your organization’s policies, incident reports, safety plans, HR documents, contracts, and more. This centralized repository ensures all employees have easy access to essential information. The course library is curated to align with regulatory and accreditation requirements, and courses are regularly added and updated to ensure the most current information. Learn more about MedTrainer today!