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MONDAY REPORT

Financial Services Committee to Hear Testimony on Telehealth, MIH Bills

Tomorrow, the Joint Committee on Financial Services chaired by Representative James Murphy (D-Weymouth) and Senator Paul Feeney (D-Foxborough), will conduct a hybrid public hearing focusing largely on health insurance matters. MHA will be commenting on several bills, including two priority bills relating to telehealth and mobile integrated health.

H.986/S.655, An Act Relative to Telehealth and Digital Equity for Patients, sponsored by Rep. Marjorie Decker (D-Cambridge) and Sen. Adam Gomez (D-Springfield), would strengthen some of the telehealth policies now in existence in Massachusetts. While Chapter 260 of the Acts of 2020 required reimbursement parity for behavioral health services offered via telehealth to be on par with in-person visits in perpetuity, H.986/S.655 requires reimbursement parity for all telehealth services by removing the sunset dates for parity that recently took effect. It also requires MassHealth to keep in place its ongoing coverage and reimbursement policies for telehealth which are scheduled to expire on September 30, 2023.

Among other items, the bill establishes two task forces to review the the practice of telehealth across state lines to understand its implications for licensure of providers, It would also require health insurance companies to develop and maintain procedures to identify and offer digital health education to enrollees with low digital health literacy to assist them with accessing telehealth benefits — provisions which the Centers for Medicare and Medicaid Services (CMS) just adopted for Medicare Advantage plans.

“Telemedicine made tremendous gains in Massachusetts during the pandemic, but the policies now in place regarding virtual care are only a start,” said MHA’s Director of Virtual Care & Clinical Affairs Adam Delmolino. “This proposal centers digital health equity for patients and access as it builds off the gains made over the past several years, providing Massachusetts with a long-term infrastructure to sustain and grow virtual care for the millions of patients within its borders.”

For the last several sessions MHA has filed H.1007/S.718, An Act Relative to Insurance Coverage of Mobile Integrated Health, which would prohibit public and private health plans from refusing to cover healthcare services on the basis that they were delivered by a state-approved mobile integrated health (MIH) program. The bill also requires the insurers to cover MIH services to the same extent as they would have had the services been delivered in a healthcare facility.

MIH programs are complimentary to the Hospital-At-Home program that CMS launched during the pandemic as both initiatives address inpatient capacity at hospitals and reduce demand for services in hospital emergency departments, while reducing costs and enhancing patient outcomes. For example, South Shore Health (SSH) has an MIH program based around ED avoidance that proved invaluable during the COVID-19 pandemic by allowing chronic patients to receive care at home, thereby preventing unnecessary hospitalizations and controlling the spread of infectious disease. The SSH MIH program provided mobile COVID tests and vaccinations, treated patients with mild COVID symptoms in the comfort of their homes, and even participated in a Remdesivir clinical trial. However, with no reimbursement from health plans for MIH services — care that would be covered if delivered in a hospital setting — the program is funded by public donations and therefore its future funding is uncertain.

CMS Clarifies Hospital Price Transparency Enforcement

As U.S. hospitals continue their effort to comply with varying state and federal regulations regarding price transparency, CMS last week released new guidelines about its enforcement of the laws.

CMS has been monitoring hospital compliance with the requirements by reviewing consumer complaints and conducting periodic audits, among other methods. While hospitals are committed to the process, the nature of hospital pricing and rate negotiations does not translate easily into a single, fixed rate per service. Hospitals’ contracts with health plans are complex and the actual rate that may apply to a service (or bundle of services) can vary dramatically based on a patient’s specific scenario (e.g., how many services are being delivered during an episode of care or how sick the patient is). In addition, it is very challenging for a patient to use machine readable files to calculate the cost of any episode of care in which more than one item or service is provided. Lastly, there are a variety of ways that patients can seek price information, including through the Transparency in Coverage rule, which mandates that health insurers make cost information available, as well as the No Surprises Act, which requires good faith estimates for patients without insurance coverage. This can lead to different results and much confusion among consumers. For those with insurance, the health plan remains the best source to understand the patient’s actual out of pocket costs.

That being said, CMS has reported that 82% of hospitals met the consumer-friendly display of shoppable services information requirement in 2022 (up from 66% in 2021) and 82% met the machine-readable file requirement (up from 30% in 2021).

To date, hospitals out of compliance have been given warnings and have been allowed flexibility in reaching a corrective action plan (CAP). In the new rules released last week, CMS is setting definitive CAP deadlines and will impose financial penalties for non-compliance earlier and automatically. Since July 2022, CMS has also been enforcing the health plan Transparency in Coverage rule and may take several enforcement actions, including requiring corrective actions and/or imposing a civil monetary penalty up to $100 per day for each violation and for each individual affected by the violation.

To date, according to CMS’ enforcement action web page, four hospitals have received non-transparency fines: Northside Hospital Atlanta ($883,000 in June); Northside Hospital Cherokee, Georgia ($214,000 in June); New Hampshire-based Frisbie Memorial Hospital ($102,000 in April), and Texas-based Kell West Regional Hospital ($117,000 in April).

FOCUS ON WORKFORCE

Hebrew SeniorLife’s Post-Acute Strategies for Retaining Talent

A recent story from MHA’s Workforce Toolkit series, which explores ways that organizations are building programs to attract and retain workers, features Hebrew SeniorLife’s Chief Nursing Officer & Vice President Patient Care Services Tammy Retalic, who shares advice on how to fill post-acute workforce positions.

“Professional development is really critical for people along the whole care continuum and along all generations,” she says. Building the workforce pipeline, she says, meaning building all aspects of it. That means not only trying to attract registered nurses, but also the ancillary teams of CNAs and LPNs which ultimately creates the possibility of workers advancing up the career ladder. Those opportunities for advancement are what allows facilities to retain talent.

Retalic also discusses another critical component of retention – helping workers find joy in their work. “Educational loans are not enough,” she says, adding that rewards and recognition are essential to give people in high-stress jobs the energy to move forward.

Learn more about Hebrew SeniorLife’s program, as well as about other workforce initiatives throughout the state, by visiting MHA’s Workforce Toolkit. Do you have a workforce program that you would like featured in the toolkit? Contact MHA’s Kim Stevenson at kstevenson@mhalink.org.

John LoDico, Editor