Maryland’s congressional delegation is calling on the state to act on an innovative health care model

November 04, 2022

The total cost of care model has allowed Maryland hospitals and providers to continue providing quality care while others across the country have cut back

U.S. Senators Chris Van Hollen and Ben Cardin and Congressmen Steny Hoyer, Dutch Ruppersberger, John Sarbanes, Kwesi Mfume, Andy Harris, MD, Anthony Brown, Jamie Raskin and David Throne today wrote to Governor Larry Hogan urging the state to work with stakeholders countries to protect Maryland’s unique, innovative and effective health care model. Members of Congress stressed that the state is at risk of failing to meet its contractual obligations to the Centers for Medicare and Medicaid Services (CMS).

“We are writing to express our concern that the state is expected to fail to meet three of the six goals of the Maryland Total Cost of Care (TCOC) model in calendar year (CY) 2022. members wrote. “As you know, the model is an important part of our state’s health care system, especially during the COVID-19 pandemic, providing much-needed financial stability to health care providers while driving a population health response to drive more good health outcomes for Marylanders. Although the Centers for Medicare and Medicaid Services (CMS) will not make a formal decision on whether a state has failed to meet the model’s requirements until the summer of 2023, we urge you to work closely with the Health Care Expenditure Review Commission (HSRCC), Maryland Health care stakeholders and the federal delegation to take decisive action to ensure the long-term sustainability of Maryland’s TCOC model.”

The full text of the letter is available here and below.

Dear Governor Hogan:

We are writing to express our concern that the state is projected to fail three of the six goals of the Maryland Total Cost of Care (TCOC) model in calendar year (CY) 2022. As you know, the model is an important part of our the state’s health care system, especially during the COVID-19 pandemic, providing much-needed financial stability to health care providers while driving population health to achieve better health outcomes for Marylanders. Although the Centers for Medicare and Medicaid Services (CMS) will not make a formal decision on whether a state has failed to meet the model’s requirements until the summer of 2023, we urge you to work closely with the Health Care Expenditure Review Commission (HSRCC), Maryland health care stakeholders and the federal delegation to take decisive action to ensure the long-term sustainability of Maryland’s TCOC model.

Since the early 1970s, Maryland has operated a unique health care delivery system promoting access to care, equity, financial stability and hospital accountability. In 2014, the state replaced the 36-year-old Medicare waiver with Maryland’s all-payer model by contracting with CMS. In 2018, Maryland and CMS entered into a new agreement to test the Maryland TCOC model, which is based on Maryland’s all-payer model and is the first CMS model to hold a state fully at risk for the total cost of care for beneficiaries of Medicare. Maryland’s TCOC model is now in its fourth year of what has been a successful eight-year arrangement.

In its contract with CMS, Maryland agreed to meet six goals of the TCOC model. Although the reasons are still being determined, for CY 2022, Maryland is projected to fall short of three targets: (1) annual Medicare TCOC savings; (2) TCOC guardrail test; and (3) reducing Medicare readmission rates. Failure to meet these goals could result in the loss of Maryland’s ability to continue to operate our unique health care delivery system, especially as the state prepares to begin negotiations for the next phase for the state after TCOC’s model contract expires in 2026 .

Our state and nation are facing enormous challenges as a result of the COVID-19 pandemic, and our health care system continues to deal with the impact of this public health crisis. Amid these challenges, the entire state is benefiting from Maryland’s TCOC model, which allows hospitals and providers to maintain high-quality health care services while hospitals across the country are shrinking. Despite the critical role played by the TCOC model, the State is at 1 risk of failing to meet its contractual obligations to CMS required under the TCOC model. We urge you to collaborate with stakeholders across the state to ensure that Marylanders can continue to have access to high-quality, affordable and equitable health care across the state.

At your disposal,



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