Maryland Rates

Maryland hospitals utilize an All-Payer Model that is unique when compared to negotiated rates for the remaining 49 states.

According to CMS, "Maryland operates the nation’s only all-payer hospital rate regulation system. This system is made possible, in part, by a 36-year-old Medicare waiver (codified in Section 1814(b) of the Social Security Act) that exempts Maryland from the Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS) and allows Maryland to set rates for these services. Under the waiver, all third parties pay the same rate."¹

The Maryland Hospital Association offers similar guidance on how claims in Maryland are paid: "For four decades in Maryland, hospital rates have been regulated by an independent state body, and all payers—private, commercial, Medicare, Medicaid, self-pay—are charged the same rate for the same service at the same hospital."²

When it comes to reporting Maryland rates in an MRF, CMS offered specific guidance in their MRF FAQ document:

At Turquoise, our understanding is that rates paid per the All-Payer Model do not meet the definition of "payer-specific negotiated charge" as defined above. Both CMS and the Maryland Hospital Association confirm that "all third parties pay the same rate" and thus, there is no negotiated rate to display for items and services reimbursed by the All-Payer Model.

When Turquoise reports rates for hospitals in the state of Maryland, our focus is on the list price and the self pay/cash price to fulfill the remaining requirements of the Final Rule.

¹ source

² source