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> Budget Conference Committee
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> Insurance Rate Increases
> Seeking Telehealth Rules
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> Juneteenth

MONDAY REPORT

MHA to Conference Committee: Retain Workforce Commitments in Budget

Strengthen the healthcare workforce and the state’s behavioral health system. That’s the main message of a letter MHA sent last week to the members of the House-Senate Conference Committee now negotiating details of the fiscal year 2024 state budget.

Both chambers passed budget proposals that are, in many areas, similar to one another. The six members of the conference committee, drawn from the House and Senate Ways & Means committees, are now crafting a compromise budget from the two separate proposals. MHA’s letter identified specific line items in the House and Senate proposals that are of critical importance to healthcare interests.

For example, on the workforce front, MHA leant strong support to Senate budget language that appropriates $192 million to address behavioral health workforce shortages, including: $100 million to replenish the existing Massachusetts loan repayment program (which also expands the settings in which behavioral health workers can be employed to be eligible for the funding); and $25 million for a scholarship program for behavioral health providers.

MHA also supports funding for a hospital workforce training and apprenticeship grant program to be administered by the Executive Office of Health and Human Services (EOHHS), as well as Senate budget language that funds a Department of Public Health pipeline program to create partnerships between community colleges and hospitals to recruit mental health workers.

Both the House and Senate budgets invest money in education, which MHA supports, including the House budget section that establishes a scholarship program for students seeking employment in high-demand sectors, such as healthcare; and the Senate’s line item to establish a scholarship program for community college nursing students.

MHA strongly supports Outside Section 73 that would direct the Board of Registration in Nursing, for the FY2023 and FY2024 academic terms, to develop an alternative approval process for allowing faculty whose highest earned degree is a baccalaureate degree in nursing to teach a clinical or skills lab component of a registered nursing program course. A lack of qualified nurse educators is one of the major reasons that nursing programs have small class sizes and many qualified applicants are turned away from education programs that are at capacity.

MHA also supports Outside Section 78 in the Senate budget, which would establish a task force to make recommendations regarding geriatric psychiatric patients who can’t be discharged from acute care to a nursing home due to a shortage of placement beds. Another MHA priority outlined in the letter would require the Department of Children and Families (DCF) to develop a pilot program for DCF congregate care provider programs for youth that are experiencing an intensive behavioral or behavioral and medical crisis, or are being housed in emergency departments or inpatient units, or cannot safely receive treatment in the existing congregate programs.

Revisiting 224: Focusing on More than Just Oversight

The Joint Committee on Health Care Financing holds a hearing tomorrow, June 20, on a slate of bills of great interest to the hospital and healthcare community, including several MHA priority bills.

The hearing, which begins at 10 a.m. in State House’s Hearing Room A-1 as well as virtually, focuses mainly on hospital and health system oversight. As the two main state agencies empowered to provide that oversight – the Health Policy Commission (HPC) and Center for Health Information and Analysis (HPC) – continue to grow, so has their funding. Unfortunately, their only funding source since their inception through Chapter 224 has been hospitals, ambulatory service centers (ASC), and health insurers. Chapter 224, signed into law in 2012, specified that the state’s general fund would also share costs equally with the providers and insurers – but that state contribution has always been withheld.

Bills that will be heard tomorrow, H.1181 and S.725, An Act Regarding Shared Responsibility for Health Care Oversight Agencies, from Rep. Michael Day (D-Stoneham) and Sen. Nick Collins (D-Boston), would require that hospitals, ASCs, insurers, and the general fund share equal responsibility for funding CHIA and the HPC. This shared mechanism is currently more important than ever given the growth in the agencies’ budgets, while hospitals and healthcare providers have experienced historic financial losses since the onset of the March 2020 COVID-19 pandemic.

Another set of bills – H.1209 and S.746, An Act Relative to The Operating Budgets of Health Care Oversight Agencies – would limit the amount that CHIA and HPC can increase their respective operating budgets over the previous year. The limit would be equal to the same year’s cost growth benchmark that the agencies use to control insurer and provider healthcare spending.

“Our concern is not with healthcare oversight per se, but rather ensuring that the financial burden of these government entities is shared fairly by all,” said Emily Dulong, MHA’s V.P. of Government Advocacy & Public Policy, who is expected to testify tomorrow. “And as we focus on oversight, it’s also a good time to revisit the other elements of Chapter 224 that have not yet been fulfilled – including ensuring the viability for community hospitals, updating payment models to cover the healthcare needs of every patient, and even creating a state health plan.”

Insurers’ Merged Market Health Insurance Rates for 2024

Last week, the Division of Insurance (DOI) held a public information session for health insurance plans to present their proposed merged market health insurance rates for 2024. These rates affect approximately 626,705 consumers enrolled in merged (individual/small group) market plans. Insurers were required to submit their proposed 2024 premium rates by May 15, 2023.

DOI will review all rate filings for compliance with statutory standards and are subject to disapproval if the DOI finds that rates are not reasonable in relation to health plan benefits, or if they are excessive or inadequate or use rating factors that are discriminatory or not actuarially sound. The rates the insurers submitted ranged from a decrease of 3.8% by WellSense to a 12.1% increase from United Healthcare. Blue Cross Blue Shield Massachusetts (BCBSMA) is proposing a 4% increase while Harvard Pilgrim Health Care and Tufts Public Plans are requesting a 7.3% and 3.4% increase, respectively. The proposed overall weighted average premium increase for all the insurers is 3.7%.

All the plans cited cost pressures resulting from providers requesting higher reimbursement due to staffing shortages and inflation as well as pharmacy trending higher because of new treatment options, specialty medications, weight loss drugs, and increased utilization of drugs. However, the plans diverged in terms of the effects of utilization and medical trend on premiums, with BCBSMA and WellSense experiencing a more favorable claims experience leading to lower premiums while others found that utilization has rebounded and are expecting it to return to higher levels in 2024. DOI restricts contributions to surplus to 1.9% and medical loss ratio must be at or greater than 88%.

The Health Care Access Bureau within the Massachusetts Division of Insurance is currently reviewing these assumptions. This review process will culminate in a final decision in August 2023. DOI is making summary information about these rate filings available for viewing online here.

tMED to DOI: When Can We Expect Regulations?

The tMED Coalition – a group of 50-plus organizations promoting telehealth, of which MHA is founding member – sent a letter to the Division of Insurance (DOI) last week, expressing concern over DOI’s delays in releasing regulations relating to a law that became effective three years ago.

Chapter 260 of the Acts of 2020 required, among other things, that telehealth services for behavioral health, chronic disease management, and primary care be covered at parity with in-person services for set periods of time. Since January 2023, health insurance companies are no longer required to reimburse providers for telehealth visits at parity for primary care and chronic disease management. But they still are required to pay at parity for behavioral health. But what constitutes “behavioral health”? And can a primary care clinician, as opposed to a behavioral health clinician, provide behavioral health services? These questions, among others, were supposed to be answered by DOI through its regulations.

“As you are aware, the definitions of what constitutes behavioral health services, in addition to primary care services and chronic disease management services, has a significant effect upon the reimbursement for and accessibility of telehealth services,” tMED wrote. “Given that there are no final regulations that clearly define the services delineated in the legislation, the tMED Coalition is concerned that this lack of guidance from the state has compounded confusion in the marketplace for healthcare providers and patients. In addition, as we move forward, it is likely that each carrier may take a different approach to defining these service categories or identifying what provider types may be reimbursed at parity. The disorder resulting from a lack of uniform definitions is significantly affecting patients’ ability to receive certain services via telehealth. The provider and hospital communities are seeking clarity and certainty to best serve our patients, and it is therefore important to know when DOI expects to release final regulations.”

ONL Awards and New Board

The Organization of Nurse Leaders – Massachusetts, Rhode Island, New Hampshire, Connecticut, and Vermont (ONL) recently elected its new board leadership at its annual meeting June 13 and 14.

Orla Brandos, the V.P. patient care services & chief nursing officer at Newport Hospital, is ONL’s new president; Jennifer Thiesen, assistant chief nursing officer professional practice at Cambridge Health Alliance, is president-elect; and Nancy Gaden, senior vice president & chief nursing officer at Boston Medical Center, is past president. Monica Tucker-Schwartz, senior nurse director, procedural services & co-Magnet director at Brigham and Women’s Hospital, is secretary; and Madelyn Pearson, senior vice president/chief nursing officer at Brigham and Women’s, is treasurer. Amanda Oberlies is the CEO of ONL.

At its annual meeting, ONL also presented its prestigious Mary B. Conceison Award for excellence in nursing leadership to Helene Thibodeau, the CNO and COO of Northeast Rehabilitation Hospital Network. For the full list of ONL award and scholarship recipients, please visit here.

Juneteenth: Commemorating with Intention

Juneteenth, a portmanteau of “June” and “nineteenth,” is the federal holiday to acknowledge and commemorate the emancipation of enslaved people in the United States. It is a day to honor the contributions, culture, and experiences of Black people in the country. It was on June 19, 1865, that enslaved people were declared free in Texas – a holdout state that continued slavery even after the Emancipation Proclamation and the Civil War itself. With jubilant yells and cries ringing through the air, and kisses exuberantly doled on tear-streaked cheeks, Black people could finally envision a different life for themselves — a life that, until that moment, seemed unfathomable and out of reach, a life of freedom. The Juneteenth celebration in Galveston, Texas, reverberated throughout the country over the years, until June 19 was recognized as a national holiday in 2021. And although strides have been made to undo the brutal legacy of slavery, its political, economic, and social effects remain pronounced, persistent, and pervasive.

Juneteenth is an opportunity to reckon with these effects and engage in meaningful conversations to better understand and address the entrenched ideologies that uphold structures that propagate and promote racism, and which, by default, perpetuate inequities.

Although Juneteenth is regarded as the second Independence Day of the U.S., many Americans do not know its significance nor what it means to commemorate the day. Similarly, many organizations are still identifying the most meaningful ways to acknowledge this historically significant day.

So what does it mean to “commemorate” Juneteenth? How can organizations meaningfully and willfully show honor for the day in a way which exceeds performative acts and goes beyond the actual day? Although there is no correct answer to this question, one way would be for them to engage in discourse that allow difficult conversations about the genesis for Juneteenth to take place. To this end, organizations, both within and outside of healthcare, can:

1. Create ongoing opportunities and safe spaces for staff to engage in conversations about race, racism, and racial justice.

2. Engage with the community and/or community partners in meaningful dialogues about the effects of systemic racism and the organization’s strategy in approach in addressing disparities.

3. Engage with staff and the community to create an anti-racism statement and/or consider an anti-racism pledge.

In reflecting on Juneteenth this year and beyond, it is vital that we go beyond “passive moments of reflection” and use Juneteenth as a transformative opportunity. Only then will we able to realize an equitable and just care ecosystem and society.

John LoDico, Editor