INSIDE THE ISSUE

> The FY2023 Budget
> Reproductive Protections
> Food Insecurity
> Insurance Reform Needed
> Telehealth Bill Advances
> Nursing Academy Fellows
> Transition

MONDAY REPORT

FY23 State Budget: Historic Hospital Medicaid Plan Included

Last Thursday, Governor Charlie Baker signed the state’s Fiscal Year 2023 budget that the legislature had sent him on July 18. The governor vetoed budget items totaling just $475,000 from the $52.7 billion annual budget.

Of greatest significance to the hospital community, the budget marked the state’s final seal of approval of the hospital assessment and related Medicaid spending plan that the Executive Office of Health and Human Services (EOHHS) and MHA have spent the last year-plus developing. Major portions of the plan are tied to the 1115 waiver that EOHHS is currently negotiating with the Centers for Medicare and Medicaid Services (CMS). The waiver is the five-year agreement between Massachusetts and the federal government that defines innovations and coverage expansions in the MassHealth program. (The 2017 iteration, for instance, facilitated the establishment of MassHealth Accountable Care Organizations in the state.)

The pending waiver proposal takes unprecedented steps to support and hold hospitals accountable for their health equity efforts. It also includes critical funding for safety net hospitals. Other components of the hospital-assessment-financed plan dedicate funding to incentivize improved clinical quality outcomes and support increased reimbursement for hospital services provided to MassHealth patients.

Governor Baker was in Washington D.C. last week to advocate for the waiver with CMS decisionmakers. Here in Massachusetts, EOHHS is heavily engaged with MHA and hospitals on numerous implementation activities related to the hospital Medicaid spending plan.

“MHA recognizes the extensive effort that EOHHS has put into making this historic plan a reality and we are grateful for the Baker Administration’s strong collaboration and commitment to Massachusetts hospitals,” said MHA’s President & CEO Steve Walsh.

As of late last night it was unclear how the legislature would respond to the governor’s budget signing, vetoes, and proposed amendments.

Governor Signs Reproductive Protections Bill

Last Friday, Governor Baker signed into law the reproduction protections bill that the legislature had sent to his desk. The bill secures under the state’s constitution protection to providers that offer reproduction services, including abortion services, as well as gender-affirming care to patients within the commonwealth.

Advocates, including MHA, and supported by state leaders, stressed the protections are needed to shield Massachusetts clinicians providing care to those travelling to the commonwealth from states that have outlawed abortion following the Supreme Court’s decision overturning Roe v. Wade. Other states are also prohibiting gender-affirming care.

The new Massachusetts law also requires insurers to cover abortion services and requires the Department of Public Health to issue a standing order allowing any pharmacist to dispense emergency contraceptives. It also further protects the ability of those who are pregnant to receive abortions in special circumstances. The new law follows an earlier executive order Baker issued prohibiting executive department agencies from assisting another state’s investigation into a person or entity for receiving or delivering reproductive health services that are legal in Massachusetts, and adds licensure and discipline protections for providers.

“We applaud state leaders for acting swiftly to protect our providers as they prepare for a potential increase in out-of-state patients seeking access to essential reproductive, abortion, and gender-affirming care in the commonwealth,” said MHA’s Vice President, Government Advocacy & Public Policy, Emily Dulong. “MHA and our members have no doubt that Massachusetts will continue to be a beacon for safe, accessible health services for any patient who needs them. These protections, in addition to the legislation’s coverage and access provisions, are essential in ensuring that the Supreme Court’s decision does not impede the commonwealth from providing equitable care for all birthing people and for patients seeking services that support and affirm their gender identity.”

The State and Hospitals Address Food Insecurity

The state announced last week a new program that allows residents to apply for Supplemental Nutrition Assistance Program (SNAP) benefits at the same time they are applying for or renewing their MassHealth benefits online.

The one-stop-shopping process allows MassHealth to send the applicants’ information to the Department of Transitional Assistance, thereby reducing the “SNAP gap” experienced by people who need assistance.

A recent MHA survey of its membership found that after housing security, most hospitals say food insecurity is the social determinant of health to which they are devoting the most time and resources. The focus on food has become even more important during the pandemic, hospitals say.

Berkshire Health Systems (BHS), for example, working with the Berkshire County Sheriff’s Department, Community Health Programs, Fallon Health, and the Partnership for Health in the Berkshires, provides interactive nutritional services to people with chronic illness and/or experiencing food insecurity. The Flexible Services initiative offers medically tailored meals and/or groceries to members of the Berkshire Fallon Health Collaborative, which is a MassHealth Accountable Care Organization (ACO) Partnership Plan. Members must meet health-based needs criteria and be at risk of a nutritional deficiency. Participants from dozens of communities throughout the Berkshires not only receive free access to healthy food, but also engage with community health workers and a registered dietitian to learn about how to manage their health conditions, how to identify and cook with nutritious food items, and how to connect with other community resources and healthcare programs that can support their varying needs. Berkshire County House of Correction inmates prepare the meals under the supervision and guidance of kitchen corrections officers, and Berkshire Fallon staff package the groceries and prep the meals for at-home delivery across the county.

BHS estimates that the grocery delivery program has helped participants to reduce food insecurity by 53%, and the medically tailored meals program by 48%, based on survey data gathered from participants.

AHA White Paper: Insurer Reform Needed; Plus Medicare Advantage RFI

As the healthcare system keeps close track of COVID-19 cases, it is also watching the trend line of influenza activity in Massachusetts. The overall influenza rate in Massachusetts (based on weekly reporting by sentinel provider sites and posted by DPH) is “moderate.” While the most recent week’s data showed more flu cases than the previous three seasons in the same week, the percentage of influenza-associated hospitalizations is comparable to previous seasons.

The American Hospital Association (AHA) released a report last Thursday that detailed how the policies of some private commercial health insurance companies are adding unnecessary administrative costs to the system and are “compromising patient care.”

The key takeaways of the AHA’s 15-page report are as follows:

• “Many health plans apply prior authorization requirements in ways that create dangerous delays in care, contribute to clinician burnout and significantly drive up administrative costs for the healthcare system.
• Insurers often force patients to suffer through periods of ineffective treatment before permitting access to the most appropriate therapy. Use of step therapy or fail-first policies is increasing, and its inappropriate application often results in short-term savings for insurers while increasing provider administrative burden and adding downstream costs due to patient delays and complications.
• Insurers frequently establish flawed or overly stringent medical necessity policies that prevent patients from obtaining the necessary care recommended by their physician.
• Many commercial insurers leverage their market power and position to steer providers to purchase their auxiliary products that drive up administrative costs and line insurers’ pockets.
• White bagging is an insurer practice that effectively bans a provider from using their own medication inventory to supply drugs used to treat patients in their facility and prohibits providers from having oversight of the procurement, storage and handling processes, which has important implications for safety and efficacy.
• Many insurers use electronic payment methods that require providers to pay money to receive their contractual reimbursements from commercial insurers. The insurers often receive incentives from credit card companies or payment vendors for issuing these payments. Providers should not have to pay to get paid.”

On the local level, MHA and its hospital membership have long been involved in issues relating to insurers around prior authorization, white bagging policies, medical necessity guidelines, and transitions of care. As a founding member of the MassCollaborative (along with the Massachusetts Medical Society, Massachusetts Association of Health Plans, and Blue Cross Blue Shield of Massachusetts), MHA is working with providers, health plans, and government agencies such as the Division of Insurance and Health Policy Commission to streamline and address the administrative burdens inherent in many of these commercial plan policies.

“Insurers’ use of policies that deny or delay medically necessary care — often applauded by insurers as ways to control cost — have become extraordinarily burdensome on hospitals, providers and patients,” the AHA wrote in its report.

In a related development, CMS has issued a Request for Information seeking feedback on the Medicare Advantage Program, also known as Medicare Part C. Medicare contracts with private insurers to offer traditional Medicare services to people, along with supplemental benefits, such as vision or dental benefits, and prescription drug coverage (Part D).

MHA has been critical of many Medicare Advantage plans, noting that they have been inflexible throughout the pandemic, insisting on prior authorizations for routine transfers between hospitals and post-acute facilities, which has in turn caused “direct patient harm” due to the capacity crisis hospitals are facing, according to this letter MHA sent to the regional U.S. Department of Health and Human Services administrator in July. In Massachusetts, the state’s Medicaid program, MassHealth, waived prior authorization requirements throughout the pandemic and the Division of Insurance issued numerous directives mandating that commercial insurers do the same. But CMS oversees Medicare Advantage plans; the state has no jurisdiction over their actions.

Federal Telehealth Bill Gains Wide House Support, Advances to Senate

It is almost universally acknowledged that the pandemic revealed the many benefits of telemedicine, as patients and caregivers fearful of transmitting the virus in traditional care settings were able to access care nonetheless through virtual means. The challenge now is how to maintain telehealth’s benefits as the world slowly emerges from the pandemic.

Last Wednesday, the U.S. House of Representatives, by a rare, overwhelming majority of 416-12 passed H.R. 4040, the Advancing Telehealth Beyond COVID–19 Act of 2021. The bill extends for another two years, through the end of 2024, several telehealth flexibilities under Medicare that were initially authorized during the COVID-19 public health emergency.

Specifically, the bill allows beneficiaries to receive telehealth services from any site they are located in at the time of service, including from the home. It expands the types of providers eligible to offer telehealth services, to include physician assistants, nurse practitioners, nurse-midwives, registered dieticians, social workers, and psychologists. The bill allows for “audio-only” telehealth for certain services, which is beneficial for people who do not have good internet access, and it extends the pandemic-era rule that allows federally qualified health centers and rural health clinics to provide telehealth services.

The bill now advances to the Senate, where the outlook is not yet clear.

Nursing Academy Names 2022 Fellows

The American Academy of Nursing has selected 250 nurse leaders to be inducted into the 2022 Class of Fellows. Among the inductees are R.N.s Ashley Waddell – Organization of Nurse Leaders – MA, RI, CT, NH, VT; Marsha Maurer – Beth Israel Deaconess Medical Center; and Rita Olans and Katherine Simmonds, from the MGH Institute of Health Professions.

Transition

Sam Skura has been named president of Baystate Medical Center and senior vice president of Hospital Operations for Baystate Health, effective September 12. He will join the President’s Cabinet of Baystate Health, which is led by Dr. Mark Keroack. Skura most recently served as COO of Beth Israel Deaconess Medical Center (BIDMC), and previously served as VP of Ambulatory and Clinical Services and chief administrative officer at BIDMC. In his 25-year career, he has also worked at Lahey Hospital and Medical Center and Cambridge Health Alliance, among other postings. Skura earned an MBA from the Isenberg School of Management at UMass Amherst, a master’s degree in public health from Boston University, and a BA and economics degree from Brandeis University.

John LoDico, Editor