Maryland HSCRC
HSCRC Policy Tracker
What has been decided, what is still a draft, and the dates that matter for Maryland hospitals through 2028. Last updated October 25, 2026.
The Health Services Cost Review Commission is rewriting hospital financial and quality policy for the move to CMS-designed Medicare global budgets on January 1, 2028. This page lists each change, whether it has been decided, and where to read more. It is built from HSCRC documents, and each row links to its source.
How to read the status column. “Approved” means the Commission voted. “Draft” means staff have proposed a policy that has not been voted on and may change. “In progress” or “Upcoming” means the item appears on the HSCRC workplan.
Decided or published
| Policy | Status | What it does | Our guide | Source |
|---|---|---|---|---|
| Shift of costs to commercial payers | Approved January 14, 2026 | Moves $435 million to commercial rates over seven years, starting in 2028 at $87 million per year. | 2028 and 2029 guide | January 2026 minutes |
| AHEAD transition funding | Distribution approved September 9, 2026 | $100 million one-time over RY 2027 and RY 2028; $500,000 to each acute care hospital plus the rest by gross patient revenue; CFO attestation due July 31. | 2028 and 2029 guide | October 2026 post-meeting materials |
| Quality Based Reimbursement, RY 2028 | Published March 2026 | Domain weights of 38, 31 and 31 percent with a preset cut-point; 2 percent of inpatient revenue at risk. | Quality programs guide | RY 2028 QBR memo |
| Rate year 2027 uncompensated care report | Presented September 9, 2026 | No methodology change; statewide UCC markup of 4.01 percent for RY 2027. | Uncompensated care guide | October 2026 pre-meeting materials |
Drafts and work in progress
| Policy | Status | What it does | Our guide | Source |
|---|---|---|---|---|
| Bridge Adjustment | Draft recommendation; comments due November 11, 2026 | Blends State and CMS Medicare global budgets in 2028 to 2030, capped at 30, 20 and 10 percent redistribution; two options and State weight ranges proposed. | Bridge Adjustment guide | October 2026 pre-meeting materials |
| Quality Based Reimbursement, RY 2029 | Draft recommendation; comments due October 29, 2026 | Minimal change from RY 2028: same domain weights and 2 percent at risk. | Quality programs guide | October 2026 pre-meeting materials |
| Adjustments and assessments report | Draft report (October 2026) | How assessments will work under split global budgets from fiscal year 2028. | 2028 and 2029 guide | October 2026 pre-meeting materials |
| Core volume policies (market shift, demographic, surge) | Upcoming draft | Listed in the October 2026 HSCRC workplan as upcoming. | Adjustments guide | October 2026 post-meeting materials |
| Hospital-acquired conditions policy (MHAC) | Upcoming draft | Listed as upcoming; staff are considering changes to the program for RY 2029. | Quality programs guide | October 2026 post-meeting materials |
| Rate model for multi-payer global budgets | In progress | Rate model work as Medicare’s portion moves to CMS’s method. | AHEAD guide | October 2026 post-meeting materials |
| Uncompensated care forward funding plan | In progress | Implementation plan listed in the October 2026 workplan. | Uncompensated care guide | October 2026 post-meeting materials |
Key dates through 2028
| When | What happens | Source |
|---|---|---|
| October 29, 2026 | Comments due on the draft RY 2029 QBR recommendation (hscrc.quality@maryland.gov) | October 2026 pre-meeting materials |
| November 11, 2026 | Comments due on the draft Bridge Adjustment (hscrc.payment@maryland.gov) | October 2026 pre-meeting materials |
| Mid-January 2027 | CMS finalizes its Medicare global budget specifications | October 2026 pre-meeting materials, AHEAD agreement |
| January to March 2027 | HSCRC final policy presentations | October 2026 post-meeting materials |
| June 2027 | Planned approval of the fiscal year 2028 update factor | October 2026 post-meeting materials |
| Late 2027 | State applies the Bridge Adjustment; CMS provides final CY 2028 hospital budgets by December 2027 | October 2026 pre-meeting materials |
| January 1, 2028 | CMS-designed Medicare global budgets take effect | AHEAD agreement |
Go deeper
Our Maryland HSCRC consulting page lists the guides behind this tracker, from the basics of the HSCRC and global budgets to the Bridge Adjustment and the 2028 and 2029 changes.
Frequently asked questions
What is the difference between a draft and an approved HSCRC policy?
A draft recommendation is a staff proposal published for public comment. It becomes policy only when the Commission votes to approve a final recommendation, and the final version can differ from the draft.
How do I comment on an HSCRC draft recommendation?
The HSCRC accepts written comments by email at the address printed on each draft. For the current drafts, quality comments go to hscrc.quality@maryland.gov and Bridge Adjustment comments go to hscrc.payment@maryland.gov.
How often is this tracker updated?
We review it after each Commission meeting and when new HSCRC materials are posted. The date at the top shows the last update.
Talk to us about your hospital’s 2028 plan
Tell us which of these changes matter most to your hospital and we will tell you how we would approach it.
This page is general information from public HSCRC documents, not legal or financial advice. Two Pillars & Co is independent of the HSCRC. Always check the HSCRC’s own site for the latest status. See our editorial policy.