INSIDE THE ISSUE

> COVID Vaccine Updates
> Addressing Substance Use Disorder
> Promoting Diversity in Nursing
> U.S. House & Senate Bills
> Measure Task Force
> Transitions at HSL & Southcoast

MONDAY REPORT

COVID-19 Vaccines: What to Expect Going Forward

While flu season is still months away – as is an expected seasonal uptick of COVID-19 – the public healthcare system as well as the general public are wondering what to expect in terms of vaccines.

Currently, COVID vaccine manufacturers are following the guidance of the Food and Drug Administration’s Vaccines and Related Biological Products Advisory Committee, which met in June to discuss what vaccines will be needed. The committee found that the XBB sublineages of the COVID-19 virus account for more than 95% of the world’s circulating COVID-19 variants, and that new vaccines should be tailored to fight XBB.

The new strains of vaccines this fall and winter will be directly available through commercial manufacturers, and not through the U.S. government as has been the case throughout the pandemic. Last week, U.S. Health & Human Services (HHS) Secretary Xavier Becerra wrote the COVID-19 vaccine manufacturers saying that when the transition from government to commercial vaccine distribution begins “we expect that vaccines will remain available in the types of locations where the public currently receives them – including pharmacies, clinics, healthcare provider offices, health departments, and other points of care – to maximize access.”

He also noted that since the federal government invested billions of dollars in assisting the manufacturers in their research, development, and procurement of the vaccines, HHS expects that COVID-19 vaccines entering the market this fall “should be priced at a reasonable rate, reflective of the value that you have obtained through U.S. government investment.”

Earlier this month, Centers of Medicare & Medicaid Services Administrator Chiquita Brooks-LaSure wrote to public and commercial insurers and state Medicaid plans outlining expectations about vaccine coverage. She noted that COVID-19 vaccines are covered under Medicare Part B without any cost sharing. States are required to cover COVID-19 vaccinations without cost sharing for all Children’s Health Insurance Program beneficiaries and nearly all Medicaid beneficiaries, through September 30, 2024 – and the federal government will match those expenditures 100%, Brooks-LaSure noted. “After September 30, 2024, state expenditures on COVID-19 vaccine doses and vaccine administration services would be matched at the applicable state federal medical assistance percentage,” but state-funded vaccines for children would still be fully federally funded, she added.

“Finally, most private health insurance, like employer-sponsored plans, Marketplace plans, and other individual market coverage that is subject to the Affordable Care Act (ACA) market reforms are required to cover vaccines for COVID-19 authorized for emergency use or approved by the FDA and recommended by the [Advisory Committee on Immunization Practices] and their administration, without patient cost-sharing,” the CMS Administrator wrote.

DPH issued a bulletin last week that further elaborated on the transitional phase of vaccine distribution, stressing that the federal COVID-19 Vaccination Provider Agreement still stands, meaning that no patient should be charged for getting a COVID-19 shot.

Another question that many vaccinated people have as the new flu/COVID season approaches is: Do I need another COVID-19 vaccination and when should I get it? The basic answer for those ages six and over, who are not moderately or severely immunocompromised, and who already have had one dose of a bivalent vaccine, is you do not need another dose currently. However, people ages 65 years and older who received one dose of a bivalent vaccine have the option to receive one additional dose at least four months after the first dose. In the fall, when the new doses are available, the recommendations will change. For all other non-immunocompromised age groups, view this table for vaccine recommendations. For those who are immunocompromised, view this table.

As of last week, 5,956,528 people in Massachusetts have completed a primary series of COVID-19 vaccinations, but only 2,093,636 Massachusetts residents have received the recommended bivalent booster dose.

Berkshire, Baystate Receive Federal Funding from SAMHSA

Last week, the federal Substance Abuse and Mental Health Services Administration (SAMHSA) announced $48 million in grant funding to address the opioid epidemic, with some of that funding coming to Massachusetts.

Berkshire Medical Center in Pittsfield and Baystate Medical Center in Springfield each received funding through SAMHSA’s “Emergency Department Alternatives to Opioids Program” that aims to develop and implement alternatives to opioids for pain management in hospitals and emergency department settings to reduce the likelihood of future opioid misuse.

MHA and its membership have provided nationally recognized leadership in this area. MHA’s Substance Use Disorder Prevention and Treatment Task Force and other MHA working groups developed “Guidelines for Emergency Department Opioid Management” (2015), “Inpatient Opioid Misuse Prevention” (2018), and “Guidelines for Medication for Addiction Treatment for Opioid Use Disorder within the Emergency Department” (2019), among other resources available at PatientCareLink.

SAMSHA also made grants to Community Against Substance Abuse (Winthrop), Medway Public Schools, and Old Colony YMCA (Brockton) through its Sober Truth on Preventing Underage Drinking Act (STOP Act) program.

MGB and UMass Boston Further Diversity in Nursing Partnership

The Manning College of Nursing and Health Sciences at UMass Boston has received $20 million to expand its Clinical Leadership Collaborative for Diversity in Nursing program. Mass General Brigham (MGB) donated $10 million as did UMass Boston.

The nursing diversity program has been in existence since 2008 and has partnered with MGB since that time. The new injection of funding allows the program – which already has provided hospital experience and career opportunities to 135 graduate and undergraduate nursing students – to expand even further.

Specifically, Manning said it would use the additional funding to provide support for students recruited from the traditional and accelerated nursing programs to participate in the Clinical Leadership Collaborative for Diversity in Nursing program. The students will then be eligible for employment in Mass General Brigham hospitals. “The additional funding will also support the creation of a behavioral health equity certificate for interested program participants,” Manning wrote. “Over five years, 400 students will be recruited to complete the program.”

In 2021, Robert J. and Donna Manning donated $15 million to the college and earlier this year U.S. Representative Stephen Lynch (D-Mass.) announced a $3 million federal grant to create a Home Care Digital and Simulation Lab at the school.

Markey & Neal to Consider Major Bills Containing Good & Bad Points

Next week, the U.S. House’s Ways & Means Committee is expected to act on several bills, including the PATIENT Act that the House Energy and Commerce Committee passed recently. Also, the U.S. Senate’s Health, Education, Labor and Pensions Committee (HELP) is expected to review Chair Bernie Sanders’ (I-Vt.) Primary Care and Health Workforce Expansion Act.

Last week, MHA wrote the Ranking Democrat on Ways & Means, Richard Neal (D-Mass.), to outline the healthcare community’s views on the PATIENT Act, and drafted this letter to HELP Committee Member Sen. Ed Markey (D-Mass.).

MHA signaled strong support for the PATIENT Act’s proposed elimination of scheduled Medicaid disproportionate share hospital (DSH) cuts for fiscal years 2024 and 2025. The cuts were originally enacted in the Affordable Care Act and have been delayed several times. The current delay expires on October 1, 2023, and, if implemented, would result in $8 billion Medicaid DSH reductions annually from FY24-27, with the cuts hitting Massachusetts especially hard since the state has a very high healthcare coverage rate. “Massachusetts’ early leadership in coverage expansion pre-dates the ACA and Medicaid DSH payments are embedded in the financial foundation of our healthcare system, so significant harm will occur if the scheduled Medicaid DSH cuts are not stopped,” MHA’s President & CEO Steve Walsh wrote in the letter to Neal.

While MHA supports the PATIENT Act’s stance on DSH payments it is adamantly opposed to the bill’s “site-neutrality” provisions. The PATIENT Act advanced by the House Energy and Commerce Committee would expand site neutral payments to hospital outpatient departments (HOPD) that are currently grandfathered. In its letter, MHA highlights many of the innate differences between HOPDs and independent offices, and the impediments to access that will result from the proposed cuts.

“Hospital-based outpatient department payments for certain patient services differ from those of independent physician practices and ambulatory surgical centers because the patients and the treatments are different even though some of the services provided may seem the same,” MHA’s Walsh wrote. Patients who are sicker with more complex ailments are often referred to HOPDs; some non-hospital providers can decline care to patients in public payer programs, but HOPDs can’t and won’t; and the licensing and regulatory burdens for HOPDs are often more cumbersome than those for other care locations, MHA noted.

MHA also objected to the PATIENT Act’s new proposed reporting requirements for providers in the 340B drug program, saying the reporting is duplicative.

On the Senate side, MHA’s letter to Markey expressed concern that Sanders’ Primary Care and Health Workforce Expansion Act proposes using site-neutral payments to fund community health centers, workforce, and other initiatives. The proposal would reauthorize critically important programs, including children’s hospital graduate medical education funding, community health centers, and Title VII and VIII health workforce programs. But, MHA stated, undercutting hospital care through the bill’s site-neutral proposals would hurt the healthcare infrastructure these other programs are seeking to bolster.

In its letter, MHA echoed the concerns it had relayed to Neal, noting that non-hospital ambulatory settings can routinely cherry-pick the patients they serve, leaving seriously ill patients, requiring more expensive care, to hospital outpatient departments. The American Hospital Association was also critical of the Sanders bill, saying that while hospital and health systems clearly support workforce efforts, such efforts “should not come at the expense of the same hospitals, health systems and caregivers that need this support in the first place. This bill does exactly that, which is why we oppose it. The hospital field has long been against diverting hospitals savings to other healthcare or non-related programs. … It is incoherent policy to do permanent harm to hospitals’ and health systems’ ability to serve their patients that rely on them every single day in the name of workforce improvements.”

Apply to Serve on Massachusetts Quality Measure Alignment Taskforce

The state is once again looking for individuals to serve on the Massachusetts Quality Measure Alignment Taskforce that builds an aligned measure set for voluntary adoption by private and public payers and by providers in global budget-based risk contracts.

The state created the task force in 2017, and every two years since then it has reopened the taskforce participation process. Providers, payers, employers, consumers, and consumer advocates can apply for membership through noon, Monday, August 7, by applying through this COMMBUYS link. The Quality Measure Alignment Taskforce advises the Executive Office of Health & Human Services (EOHHS) on the definition and maintenance of an aligned measure set and advises EOHHS on the measurement and reporting of health and healthcare inequities and accountability for reducing such inequities, among other tasks. Direct any questions to Quality.Alignment@chiamass.gov.

Transitions

Mary Moscato, the president of Hebrew SeniorLife’s (HSL’s) healthcare services and Hebrew Rehabilitation Center for the past 12 years, is leaving her position, effective September 30. Moscato is also a member of the MHA Board of Trustees, and has been a leading voice within the association’s focus on cross-continuum collaboration. Moscato will work with HSL’s new CEO Dr. Steve Landers and other healthcare leaders on a transition plan.

Moscato’s career as a healthcare executive began in the mid 1980’s as an assistant administrator at Franciscan Children’s. During the past three and a half decades, she led rehab hospitals, skilled nursing facilities, home and community-based organizations, and a senior healthcare network. Moscato said she plans to remain involved with academics and teaching, as well as consulting services.

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David McCready is the new president and CEO of the Southcoast Hospitals Group, effective October 1 and will become the Southcoast Health System president on January 3, 2024. He will succeed Rayford Kruger, M.D. as the system president.

McCready most recently served as president of Brigham and Women’s Faulkner Hospital for the past five years and has been on the Brigham and Women’s Hospital (BWH) executive team since 2005. Before joining BWH, McCready worked at Boston Medical Center and at Highmark Health in Pittsburgh, and as a management consultant with PricewaterhouseCoopers. He earned a master’s degree in business administration and a master’s in healthcare administration from the University of Pittsburgh.

John LoDico, Editor