[{"_1":2,"_88":-5,"_89":-5},"loaderData",{"_3":4,"_26":27},"root",{"_5":6,"_17":10,"_18":19,"_20":21,"_22":10,"_23":-5,"_24":-5,"_25":10},"user",{"_7":8,"_9":10,"_11":10,"_12":-5,"_13":-5,"_14":15,"_16":-5},"roles",[],"isAuthenticated",false,"isPremium","planName","subscriptionStatus","featureFlags",{},"insightsBudget","isDevelopmentHost","userPreferences",{},"recaptchaSiteKey","6LcvOJcUAAAAAHsB-gPGfGktcRlKpH7OTIU_dMTD","isImpersonating","impersonation","affiliateStatus","isFreedomPortal","routes/v2/article/layout",{"_28":29,"_30":31},"notFound",true,"relatedArticles",[32,76],{"_33":34,"_35":36,"_37":38,"_39":40,"_41":42,"_43":44,"_45":46,"_47":48,"_49":50,"_51":52,"_53":54,"_55":56,"_57":58,"_59":60,"_61":62,"_63":64,"_65":66,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},"mediaId",6373698,"mediaKeyId","2145622-42ad297ab581e5b917ba4c201aa9cd6e","parentId",2145622,"title","Hospitals and state agencies outline ED wait-time plan as lawmakers press for faster results","audioSeconds",113,"startMs",7284000,"endMs",7171000,"viewUrl","/Search/View?dp=1&key=2145622-42ad297ab581e5b917ba4c201aa9cd6e&start=7284&end=7171","thumbnailUrl","https://assets.pipeline.soar.com/2145622-42ad297ab581e5b917ba4c201aa9cd6e/thumbnail_7284000.jpg","articleUrl","/articles/6373698/Maryland/Hospitals-and-state-agencies-outline-ED-wait-time-plan-as-lawmakers-press-for-faster-results","mediaUrl","https://secure.pipeline.soar.com/6373698-c05eff3d722a63ac2507ea9fb0590515/orig.mp4?Expires=1771158833&Signature=kQKsKKFpYml1sbp4sUFVi0vi2AKhf2SbWLTmIwgmgFFhRwwpNtPEkt1GfvIUoxtxnKGGhFjB88bOWxdNtbWfJID7X6sZebpoZh6nvJHuGBNM3hlAoOMuJ23s5mpOwchBSJe34NL-F0T-LlAgw37YpnvHTlhfrLUolBHLOlqXWCYvyRIwktg9D078CbAc1vMtIN3uPlzAi8RKVK-Qfa290x72c~gf2H3spWYwjA8cRjL2lR7jgTs80IhRuGpoe3gXTBJ3eXgGLQ57~h-zDKjqW90OYCsoxdGd~0KEBcnMmC2CDF9j1JvvETN~mo5aRxVDCz5F9az8-V5kCQeSJVQOpA__&Key-Pair-Id=KUT5TJCACFTXG","author","Maryland General Assembly - Finance","date","2025-01-21T00:00:00Z","article","Maryland hospital leaders and state health officials told the Senate Finance Committee on Jan. 21 that emergency department wait times are a multifactorial problem driven by hospital throughput, workforce shortages, limited post-acute and behavioral-health capacity, and payer denials. The committee heard hospital best-practice proposals, a description of a newly formed ED Wait-Time Reduction Commission and state efforts to expand crisis services and targeted in-home supports.

Why it matters: ED length-of-stay affects patient safety, timely access to care and hospital capacity. Committee members noted Maryland ranks poorly on national ED wait-time metrics and pressed officials for near-term actions as well as longer-term capacity and workforce solutions.

Hospital-led process changes

Andrew, a Maryland Hospital Association representative, told the committee the association convened a hospital throughput collaborative to share operational fixes and identify reproducible best practices. Hospital tactics presented to the committee included streamlining ambulance offload and triage, separating low- and high-acuity intake pathways, full-capacity protocols that move admitted patients to prepped rooms rather than keeping them in ED bays, and discharge lounges to clear inpatient beds faster.

Regulatory and payment levers

HSCRC staff said ED length of stay has been added to the state hospital quality program so more revenue is at risk based on hospital performance on ED metrics. The HSCRC also described efforts to standardize reporting and to create a hospital best-practices performance incentive. Officials told the committee they are taking a cautious approach to financial penalties, noting that many drivers of wait times are outside hospital control.

Non-hospital causes and statewide interventions

Witnesses repeatedly identified behavioral-health capacity gaps as a major contributor to ED boarding. Secretary Laura Herrera Scott and HSCRC staff described expanded behavioral-health and community programs intended to reduce avoidable ED visits and improve discharge pathways:

- A substantially revised 1915(i)-style enhanced targeted case management program for youth with severe emotional disturbance. The secretary said the state expects to expand capacity from a few dozen participants to serve \"almost 3,000 children\" statewide if CMS approves the waiver amendment; the department targets a Q4 launch this year after public comment and federal approval.

- Expanded mobile crisis teams and crisis stabilization centers to stabilize people in the community without ED arrival, and an expanded 988 hotline as a first contact for crisis response.

- An Assistance and Community Integration Services (ACIS) amendment: the department reported a recent federal approval that allocates additional state general funds and federal match to expand community tenancy and wraparound supports statewide, adding roughly 1,240 new spaces in the program.

Payer denials and post-acute capacity

Hospital witnesses and committee members raised a sharp concern about rising insurer denials and limited post-acute placement options. Denials increase administrative work and can delay discharges; witnesses said denial rates and appeal outcomes are not consistently transparent across payers. Hospitals also described a shortage of appropriate skilled-nursing and behavioral-health post-acute placements, and the committee was told some solutions will require state policy and payer engagement.

The ED Wait-Time Reduction Commission

HSCRC associate director Tina Simmons, who is leading the commission work, described four subcommittees: access to non-hospital care (post-acute, primary care and behavioral health), data and reporting, ED throughput best practices, and hospital capacity/operations/staffing. The commission's statutory report deadlines are Nov. 1, 2025 and Nov. 1, 2026; the staff noted a packed 2025 meeting schedule and said working groups are already meeting. Simmons said the commission's data subgroup will gather cross-agency and hospital data to build an apples-to-apples view of ED performance and identify where non-hospital gaps most affect boarding.

Lawmakers pressed for faster results

Several senators noted Maryland's poor national rankings on ED wait times and pressed officials for near-term remedies. \"I just don't understand how Maryland, with the great health care system that we have, could be 50th on the list of ED wait times,\" one senator said during questioning. State and hospital witnesses said they would not wait for the final report to take actions and described several immediate steps already underway, but they also emphasized that building post-acute capacity and workforce will take longer.

Ending

Committee members asked for ongoing briefings and more transparent data on denials, appeals and post-acute capacity. Officials identified immediate process improvements hospitals can adopt, and they said the commission and state programs (mobile crisis, 1915(i) expansion and ACIS) are intended to relieve ED pressure over the medium term.

","mediaType","Video","parentTitle","FIN Committee Session, 1/21/2025 #1","oneSentenceSummary","Maryland hospital leaders and state health officials told the Senate Finance Committee on Jan. 21 that emergency department wait times are driven by hospital throughput, workforce shortages, limited post-acute and behavioral-health capacity, and payer denials, and they outlined a combination of hospital operational fixes and statewide behavioral-health and community supports intended to reduce long ED stays.","taxTitle","Finance Committee, SENATE, SENATE, Committees, Legislative, Maryland","taxId",15094,"location","Maryland","headline","","shortSummary",{"_33":77,"_35":36,"_37":38,"_39":78,"_41":79,"_43":80,"_45":81,"_47":82,"_49":83,"_51":84,"_53":85,"_55":56,"_57":58,"_59":86,"_61":62,"_63":64,"_65":87,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6373704,"Maryland outlines AHEAD model rollout; hospitals warn funding and workforce shortfalls threaten care access",1379,456000,1835000,"/Search/View?dp=1&key=2145622-42ad297ab581e5b917ba4c201aa9cd6e&start=456&end=1835","https://assets.pipeline.soar.com/2145622-42ad297ab581e5b917ba4c201aa9cd6e/thumbnail_456000.jpg","/articles/6373704/Maryland/Maryland-outlines-AHEAD-model-rollout-hospitals-warn-funding-and-workforce-shortfalls-threaten-care-access","https://secure.pipeline.soar.com/6373704-fbbd8f49fb67088703c6053f2b53d093/orig.mp4?Expires=1771158833&Signature=Im36w0OtKJlHAYAQ3TThdw2n2eaJ4GjEv-qgYxl34pnICGlKE~6CPz5eFebb8SZJCv9bq5IAH9PAiPNmQAa09rpEqA9EhiydUR9O3aMaoCK1u5pro3W0B2EVYR80GQt0WpxVb8Rf8vX-2fwDQlHG92oTIQZdSQuBuF2gDjqQkdn4oy0IxdQ7pl8SoMyImUkB56NU~OOL0MzqUP-LMA1YDQdIyy1a0Pql9I8SizSgk6JB0yysm8JVauToG0j8NGxCCMfptXdPoIA4eTb~Zxa5cnsEg8VHuZxqfOBwN~NWmK5h~AlcDmClzA0NI4wbGW8EW8X4kPlwLaxovX6uDN7yyA__&Key-Pair-Id=KUT5TJCACFTXG","Maryland health officials told the Senate Finance Committee on Jan. 21 that the state will implement the AHEAD (All-Payer Health Equity, Access and Development) model beginning in calendar year 2026, expanding the state's existing all-payer hospital rate-setting and total cost-of-care framework to bring Medicaid into the advanced primary-care payment structure and add statewide health-equity and population-health requirements.

Why it matters: The state's all-payer model brings substantial federal Medicare and Medicaid dollars into Maryland's hospital financing. Dr. John Krom of the Health Services Cost Review Commission (HSCRC) told the panel that preserving those federal flexibilities is central to maintaining equitable funding for uncompensated care and assuring hospital stability. Hospital leaders and other witnesses warned that several hospitals are operating with compressed margins and rising labor and physician costs, and they urged the state and HSCRC to adjust rate-setting and other policies during AHEAD implementation to avoid reduced access to care.

Department and HSCRC description of AHEAD

Secretary Laura Herrera Scott said the AHEAD model builds on Maryland's decades-old all-payer rate-setting and global-budget framework and aims to advance health equity, expand primary-care investments and better align public and private funds. \"We will be including Medicaid in the model,\" Herrera Scott said during her presentation, adding that the model directs new investments in primary care, behavioral health and community capacity building.

Dr. John Krom, speaking for the HSCRC, said an important element the state must preserve is the additional federal payments Maryland receives under its federal agreement. \"Maryland receives an additional $1,700,000,000 in federal payments for Medicare and Medicaid patients,\" Krom told the committee, and losing the waiver flexibilities would risk the financing that supports acute care and uncompensated-care funding.

Krom also cautioned that the AHEAD agreement does not solve every cost-pressure facing hospitals, singling out physician staffing costs as an example of a pressure that the model does not directly regulate. He said HSCRC and hospital partners are collecting data on physician cost growth to develop Maryland-specific policy responses.

Governance and data work

The secretary described a governance structure for the model that relies on an expanded Maryland Commission on Health Equity and a newly convened data advisory committee. Herrera Scott said the commission's membership was increased from 26 to at least 33 seats, including hospital representation and the Maryland Hospital Association. The data advisory committee will produce dashboards and race/ethnicity and geographic breakdowns to inform quality and equity measures.

Funding details and the population-health trust

When asked whether hospitals would bear incremental costs for AHEAD implementation, Herrera Scott said there are no net new recurring expenditures tied directly to the model but acknowledged a one-time, rate-based, statewide allotment. Dr. Krom described a one-time $25,000,000 tranche set in rates as a \"seed fund\" to support implementation (the secretary confirmed this and the committee clarified that the $25 million is included in hospital rates across payers and is a one-time addition). \"That's a one-time funding tranche,\" the secretary said, and when pressed a committee member responded, \"A grand total?\" to which HSCRC staff replied, \"A grand total. Yes.\"

Hospital leaders: sustainability, staffing and capital

Maryland Hospital Association (MHA) witnesses told the committee the state must take additional steps to protect hospital sustainability while pursuing AHEAD's equity and population-health aims. Tory Bayless, CEO of Luminis Health and vice chair of the Maryland Hospital Association, said hospitals face compressed operating margins and rising costs. \"Nineteen out of 42 are losing money right now,\" Bayless told the committee. She said labor costs and physician staffing expenses have risen much faster than rate updates: labor costs increased roughly 19% since 2019 statewide and at Luminis Health she reported a 38% increase in labor expense over six years.

Bayless and other hospital witnesses urged HSCRC to revisit how global budgets and rate updates account for inflation, demographic growth and physician costs. They also urged attention to deferred capital needs and workforce recruitment and retention as Maryland moves to AHEAD.

Committee questions and state response

Senators pressed state officials on the possibility that legislative or regulatory changes could jeopardize the federal agreement. HSCRC witnesses said the state agreement with the federal Center for Medicare & Medicaid Innovation (CMMI) includes explicit targets (notably a Medicare fee-for-service savings methodology) and that the AHEAD agreement provides additional flexibility and, if terminated by the federal government, a longer wind-down than under the prior model. On outreach, Secretary Herrera Scott acknowledged the department did not do enough formal briefings for the General Assembly in the months before the agreement was finalized and said the state will engage more closely with legislators during implementation.

What the committee will watch next

Officials outlined a schedule of work for the coming year: HSCRC policy review of core hospital global-budget rules, the commission's development of statewide health-equity and population-health measures, and a sequence of targets and milestones tied to AHEAD implementation in 2025 and the model's calendar-year 2026 start. Hospital leaders urged parallel work to ensure rate-setting and funding policies preserve hospital margins while the state pursues the population-health investments AHEAD requires.

Ending

State and HSCRC officials said they will continue stakeholder work on specific policy changes over the next year. Committee members asked for the prior agreement and for ongoing briefings as the state sets targets and updates global-budget policies ahead of AHEAD's implementation.

Speakers quoted or paraphrased in this article appear in the accompanying speaker list and provenance. All direct quotes in this report are taken from the committee transcript provided to the Senate Finance Committee on Jan. 21.

","Maryland health officials told the Senate Finance Committee on Jan. 21 that the state will implement the AHEAD (All-Payer Health Equity, Access and Development) model beginning in calendar year 2026, expanding the state's existing all-payer hospital rate-setting and total cost-of-care framework to bring Medicaid into the advanced primary-care payment structure and add statewide health-equity and population-health requirements.","actionData","errors"]

Article not found

Hospitals and state agencies outline ED wait-time plan as lawmakers press for faster results

Maryland outlines AHEAD model rollout; hospitals warn funding and workforce shortfalls threaten care access