In February, the Maryland Health Care Commission (MHCC) issued a 58-page White Paper on Maryland Acute Psychiatric Hospital Services. The MHCC has regulatory oversight of certain health care facilities and services development, including development of psychiatric hospital services, through its Certificate of Need (CON) program. Historically, CON regulation has primarily focused on: (1) assuring that the health care system has available and accessible service capacity for the patient care demand that is likely to be expressed, avoiding development of excess capacity; (2) that the facilities will be developed by qualified organizations; (3) that they will be sustainable; and (4) that they will have, on balance, a positive impact on the health care system. Due to the range of symptoms and diagnoses that may require inpatient psychiatric services, and the range of medication and other services that these patients may receive, CON regulation is not designed or equipped to assess the efficacy of specific services for specific subgroups of patients that may require hospital services.
In 2018, MHCC developed a report, at the direction of the Senate Finance and House Government Operations committees, examining CON regulation and recommended reforms intended to better align this program with changes in regulation of hospital charges and to streamline its operation. The Modernization of the Maryland CON Program report was forwarded to the legislative committees in December 2018. MHCC recommended statutory changes, requiring legislative action, and changes in the State Health Plan (SHP) and procedural regulations that guide decisions on proposed projects and shape the project review process. The report identified COMAR 10.24.07, the SHP regulations for psychiatric services, as a top priority for updating. It also recommended that the scope of CON regulation in Maryland law be amended to eliminate the requirement that hospitals currently providing inpatient psychiatric services obtain a CON for capital projects that change hospital psychiatric bed capacity.
The Maryland Psychiatric Society has been asked to nominate a representative for the MHCC workgroup that will update the State Health Plan for psychiatric services, which is available here.