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The Department of Health and Mental Hygiene

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DHMH : Medicare Waiver Modernization

Maryland Submits Proposal to Modernize All-Payer System

On January 10, 2014, CMS announced its approval of the proposal to Modernaze Maryland's all-payer system. For more information, visit:


Maryland is the only state with an all-payer system of hospital finance, which is overseen by the Health Services Cost Review Commission (HSCRC). Maryland is pursuing efforts to modernize this system to enhance patient experience, improve outcomes, and lower health care costs. This requires a model proposal to be accepted by the Center for Medicare and Medicare Services (CMS) in the U.S. Department of Health and Human Services. 

Read testimony from Secretary Joshua Sharfstein and HSCRC Chairman John Colmers explaining the modernization process here.

Read the state's initial model proposal here.        

Read the state’s revised model proposal here.

Comments received from organizations in Maryland are available here.  Response to comments is available here.

On October 11, 2013, Governor Martin O’Malley submitted a proposal to modernize Maryland’s all-payer hospital system.  Read the proposal here.  

Public Engagement  

To date, the Department and HSCRC leadership have held more than 50 meetings with stakeholders on the waiver application. The public engagement process will continue and broaden as we move closer to a final submission.  On April 23, 2013, Secretary Sharfstein wrote to leaders of the General Assembly explaining the public engagement approach planned for the finalization of the waiver application. 

In late September 2013, the Department posted a revised model proposal for public comment. Comments from Maryland organizations are available here and a response to comments is available here.