INSIDE THE ISSUE

> MHA’s New HQHESP
> Non-Citizen Residents
> CMS Withdrawals Mandated Vax Rule
> “Brown Bagging” and “White Bagging”
> Debt Limit Agreement
> Opioid Use in the Military

MONDAY REPORT

MHA Program to Support First-in-Nation Hospital Equity Measures

As providers engage in one of the most consequential changes to the MassHealth program – tracking beneficiaries’ demographic and health-related social needs data, and being held accountable for addressing health disparities – MHA is stepping in to help in the transition.

MHA has launched the Hospital Quality and Health Equity Support Program (HQHESP) to aid members in meeting technical requirements regarding health equity over the duration of the Health Equity and Quality Incentive Program (HEQIP) that is a core part of the Medicaid 1115 demonstration waiver.

The first-in-the-nation focus on tying provider reimbursement to improving health equity and addressing disparities provides incentives to Massachusetts acute care hospitals for collecting beneficiary-reported demographic and health-related social needs data; identifying disparities, analyzing root causes, and intervening on identified disparities; and collaborating with health systems and community partners. The HQEIP will consist of three domains with measures that hospitals will be expected to meet to receive incentive funding.

As part of the HQHESP, MHA has created an online waiver repository to share resources and ideas, and will hold a series of calls throughout the year focused on subdomain-specific areas of support. The first call on June 15 focuses on disability competency.

MHA members interested in learning more about the Hospital Quality and Health Equity Support Program can contact MHA’s V.P. of Health Equity Izzy Lopes at ilopes@mhalink.org.

CHIA Report Focuses on Coverage of Non-Citizen Residents

A new report from the state’s Center for Health Information & Analysis (CHIA) shows that non-citizen residents of Massachusetts – including those with a lawful presence in the United States – are disproportionately likely to experience periods of uninsurance than their U.S.-born counterparts.

Massachusetts has one of the highest rates of health insurance coverage in the U.S. with 97% of residents covered at any given point, and more than 90% of residents covered continuously throughout the year, according to CHIA.

“Nevertheless, this coverage rate is not universal,” CHIA writes. “Racial/ethnic minority residents and residents with lower family income continue to bear the burden of gaps in the health care system, with higher rates of uninsurance than other population subgroups. Additionally, access to health insurance coverage may be particularly complex for foreign-born populations, who may experience barriers to access to social programs, education, and housing, among other factors.”

CHIA reports that 95.2% of U.S.-born citizens, 91.3% of naturalized citizens, and 74.1% of non-citizens indicated they had continuous health insurance coverage in the 12 months preceding the survey before adjustment for other factors. The gaps were especially significant among children (98.1% coverage for U.S. born citizen children vs. 82.1% for non-citizen children) and the non-elderly adults (92.2% vs. 79.3%).

CHIA said the non-citizen coverage gap could be due to the population being more likely to have limited access to employer-sponsored insurance even though they are equally likely to be employed as their U.S. born counterparts. “Additionally, despite meeting eligibility requirements, non-citizen residents with lawful presence in the U.S. may be reluctant to seek health insurance due to fear of deportation and/or fears that applying for public health insurance may adversely affect their citizenship and/or employment visa applications,” CHIA wrote. The agency suggested that increased outreach to foreign-born residents and non-citizens in particular could help to extend insurance coverage.

CMS Withdraws COVID-19 Vax Requirements for Healthcare Workers

On May 31, CMS issued a final rule withdrawing its previous interim final rule (IFR) that mandated healthcare workers be fully vaccinated for COVID-19 as a Condition of Participation for facilities to participate in Medicare and Medicaid.

In lieu of mandating COVID-19 vaccinations for staff, CMS intends to use a variety of reporting requirements and quality measures across its programs to encourage providers to stay up to date on vaccines. In justifying its decision to withdraw COVID-19 vaccination requirements, CMS cited increased vaccine uptake, declining infection rates, decreased severity of COVID-19, and increased instances of infection-induced immunity.

CMS noted that while the withdrawal will not be in place until 60 days after the rule is published, the agency will not be enforcing it in the meantime. While the elimination of the vaccination requirement was the main aspect of the final rule, CMS also made permanent policies from the IFR that require long-term care providers to educate and provide COVID-19 vaccines to staff and residents, while also removing expired COVID-19 testing requirements for both populations.

Is This the Year to End Brown Bagging?

MHA’s priority legislation, H.1144/S.665, An Act relative to specialty medications and patient safety, would address pharmaceutical distribution practices that, if left without legislative action, could have adverse effects on quality patient care.

At issue are insurer-directed practices known as “brown bagging” and “white bagging.” Brown bagging is when a third-party specialty pharmacy dispenses a drug directly to a patient, who then transports the medication to a healthcare provider for administration. White bagging is when a third-party specialty pharmacy dispenses a drug and sends the drug directly to the hospital pharmacy or physician’s office. The provider stores the drug, and a clinician administers the drug to a patient.

Brown bagging requirements are particularly troublesome and have raised protests from patients and clinicians. There is strong clinical consensus that requiring patients to properly store and then transport a drug to their clinician for administration jeopardizes patient safety.

Hospital pharmacies bear the responsibility of making sure that any medications administered to their patients are obtained from reliable sources, are stored in the appropriate manner, and delivered timely in unspoiled conditions with correct dosages for each individual. Such knowledge and control are essential to ensuring that the pharmaceutical supply chain is never compromised.

H.1144/S.665, sponsored by Rep. Jon Santiago (D-Boston) and Sen. Jason Lewis (D-Winchester), would prohibit insurers, including the Group Insurance Commission (GIC), MassHealth and commercial carriers, from using brown bagging practices. The bill also promotes reasonable guardrails for white bagging; it creates patient-specific exceptions for the use of this practice by insurers, requires a 60-day notification requirement to providers and patients when an insurer intends implement white bagging of medications, establishes clear safety guidelines to ensure that the integrity of the supply chain is not compromised, and prohibits insurer-mandated white bagging for drugs that require sterile compounding or patient specific dosages depending on same day test results. Insurers would also be required to offer site neutral payment for white bagged medications to the healthcare provider administering the medication, and payment must include the cost for providers to intake, store, and dispose of the medication. The bill essentially mirrors recommendations contained in a 2019 report from the Health Policy Commission, which said, among other things, that health insurers should not require brown-bagging for any drug.

“This legislation is necessary to ensure that clinicians – not insurance companies – determine the appropriate setting and method of delivery for their patients who need these medications,” said MHA’s V.P. of Government Advocacy & Public Policy Emily Dulong. “Cost-saving efforts should never threaten the delivery of safe and efficacious treatment for complex patients.”

Debt Limit Impasse Resolved

After weeks of limited action around the debt limit negotiations, an agreement between President Joe Biden, Speaker Kevin McCarthy, and other congressional leaders brought quick action last week. The House of Representatives voted to enact the 99-page bill on Wednesday by a vote of 314 to 117, and on Thursday the U.S. Senate followed suit passing the package by 63 to 36.

From the Massachusetts delegation, Senators Elizabeth Warren and Ed Markey voted no and in the House Representatives Jake Auchincloss, Katherine Clark, Bill Keating, Stephen Lynch, Seth Moulton, Richard Neal, and Lori Trahan voted yes, while Representatives Jim McGovern and Ayanna Pressley voted no. The bill awaits the president’s signature and will be signed into law with time to spare, avoiding the expected June 5 default.

Of note, the agreement contains no changes to Medicare or Medicaid spending. For healthcare providers, the biggest short-term effect will be the downward pressure on discretionary spending due to the spending caps contained in the package, and the rescission of nearly $10 billion from the federal public health emergency fund and $1.7 billion from the Centers for Disease Control and Prevention’s (CDC’s) COVID-19 fund. Also, some hospitals will have employees affected by the return of obligatory student loan payments.

The text of the bill is here, along with a section-by-section summary.

Federal Bill Targets Overdoses Among Military Personnel

MHA has endorsed the Department of Defense Overdose Data (DOD) Act that would address the effects of the opioid epidemic among members of the U.S. military and their families.

Senator Ed Markey (D-Mass.), one of the key sponsors of the legislation along with Sen. Elizabeth Warren (D-Mass.) and Rep. Seth Moulton (D.-Mass.), released information from the Department of Defense indicating that there have been 15,000 active-duty overdose deaths or near-deaths between 2017 and 2021.

“One service member whose life is lost because they couldn’t get the help they need is unacceptable, yet in recent years, hundreds of service members have suffered a fatal overdose, and thousands more nearly did,” Markey said. “The information we received from the Department of Defense is a call to action to address this epidemic’s impact on service members and their families and to institute systemic reform to prevent overdose, improve access to treatment, and reduce the stigma of asking for help.”

The bill would, among other things, require the Department of Defense to report annually on service member and military family overdoses and related data; assess barriers to treatment and prevention by increasing access to care and non-opioid pain management; and develop a new standard for the distribution of naloxone or other medication for overdose reversal, opioid disposal materials, fentanyl test strips, and other resources.

John LoDico, Editor