INSIDE THE ISSUE

> Nurse Licensure
> CHIA Report on ED Use
> Women Leaders Conference
> Telehealth Reimbursement
> Doula Care Under MassHealth
> SUD Privacy Protections
> Flu Cases Rising
> Transition

MONDAY REPORT

Temporary Nurses: Your Licenses Will Expire December 31!

Throughout the pandemic, DPH issued, and renewed, a public health emergency order that allowed hospitals to hire temporary, out-of-state nurses, as long as the nurses verified to the state’s Board of Registration in Nursing (BORN) that their licenses were in good standing.

Last week, DPH sent a reminder that all temporary nursing licenses will expire on December 31, 2022, and added, “to continue to practice in Massachusetts after December 31, 2022, nurses currently practicing with a temporary license must apply for permanent licensure as soon as possible.”

BORN said it will provide “an expedited pathway for licensure” available to both nurses holding a temporary license as well as nurses licensed in other states.

“Under the policy, applicants for a permanent license will receive conditional approval of their license while their application is reviewed,” DPH wrote. “Conditional approval of licensure will be issued within 3 business days of receipt of the application and fee. Nurses will be able to practice with a conditional license while their permanent license is processed.” See more details from BORN here.

Race, Income, Insurance Determine ED Use

The Center for Health Information and Analysis (CHIA) released a report last week confirming the experiences of Massachusetts hospitals, namely that people of color and lower socioeconomic status are more likely to rely on hospital emergency departments (EDs).

CHIA used data from 2015 to 2019 – or before the pandemic, which only magnified the disparities in care – but did add in data gathered over the past 12 months.

“Compared to White residents, Black and Hispanic residents were 60% to 110% more likely to demonstrate a potential reliance on the ED, respectively, after accounting for individual-level demographic characteristics, health status and activity limitations, health insurance coverage, and healthcare access experiences, as well as family-level socioeconomic status over the past 12 months,” CHIA found. “Additionally, residents who are children, female, or have family income below 139% of the federal poverty level (FPL) or family educational attainment of less than a high school diploma were more likely to have a potential reliance on the ED. Moreover, residents in fair or poor health and/or with an activity limitation, residents using Medicare or other public insurance, as well as residents reporting that they were unable to get an appointment as soon as needed all had greater likelihoods of potential reliance on the ED.”

“This report reinforces what our healthcare leaders are seeing every day: emergency departments are where health inequities reveal themselves clearly,” said MHA President & CEO Steve Walsh. “Our new, historic Medicaid waiver hard-wires health equity into the care delivery system, which is a reflection that preventative services are still out of reach for too many. This data should further embolden our commonwealth to build a healthcare workforce that better reflects its communities, to make digital literacy a top priority, and to empower new models of care that improve cultural competency and bring medical services closer to home.”

Annual Women Leaders in Healthcare Conference

“There are so many talented women I come across every day. I feel an obligation to pay it forward,” said Christine Schuster, the president and CEO of Emerson Health shown here (right) with her mentee Renee Fosberg, vice president and chief information officer at Emerson. Schuster is the incoming chair of the MHA Board of Trustees, of which women make up 45% of its membership.

Insurer Temporarily Delays Telehealth Reimbursement Reduction

Blue Cross Blue Shield of Massachusetts (BCBSMA) has informed providers that it will temporarily delay a telehealth reimbursement reduction for primary care providers and chronic care diagnoses. The reimbursement reduction, originally announced in September, will now become effective in July 2023.

According to BCBSMA, “We have evaluated the current strain on hospitals and clinicians due to surging flu, [respiratory syncytial virus], and Covid treatment demands, and have decided to delay this change for primary care and chronic condition visits until July 1, 2023.”

Reimbursing telehealth at parity — that is, at the same rate as in-person visits — is important to ensuring that patients continue to have needed access to telehealth services. BCBSMA joins other insurers such as Point32Health in continuing to reimburse primary care and chronic disease conditions at parity; however, while Point32Health plans to continue this policy indefinitely, BCBSMA, per the announcement, will still implement a 20% reimbursement reduction next July.

MassHealth Seeks Opinions on Coverage-Eligibility for Doula Care

The MassHealth program is interested in providing coverage of doula services for all eligible pregnant, birthing, and postpartum MassHealth members. To do so, the state wants to create eligibility qualifications for doulas to meet. Last week, MassHealth issued a Request for Information (RFI), seeking input on how the doula program should be structured and what provider eligibility should look like.

MassHealth said that research shows that doula care is associated with improved maternal and infant care. It can reduce cesarean delivery and help initiate breastfeeding. “Additionally, community-based doulas are doulas who are trusted members of the communities they serve, providing care responsive to the specific cultural, linguistic, and other needs of their community,” the agency writes in the RFI. “Evidence suggests that community-based doulas may help mitigate some racial maternal health inequities.”

In a related bid solicitation, MassHealth issued advance notice that it will soon post a Request for Responses (RFR) for a Doula Services Program Administrator.

HHS Proposes New SUD Privacy Rules to Protect Caregivers & Patients

Providers attempting to coordinate care for people with substance use disorder (SUD) often face difficulties in providing that care because privacy protections prevent the sharing of patient information between different parties. At the same time, patients are often reluctant to seek care because their privacy protections may not restrict their information being disseminated in criminal, civil, and administrative proceedings.

Last week, the U.S. Health and Human Services Department, through the Office for Civil Rights (OCR) and the Substance Abuse and Mental Health Services Administration (SAMHSA), proposed changing the regulations guarding SUD patient records.

The changes would align privacy protections for SUD records with the protections afforded by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), and would also update HIPAA. The changes are mandated by the CARES Act passed during the pandemic, when SUD cases across the U.S. were magnified.

“Varying requirements of privacy laws can slow treatment, inhibit care, and perpetuate negative stereotypes about people facing substance use challenges,” said HHS Secretary Xavier Becerra. “This proposed rule would improve coordination of care for patients receiving treatment while strengthening critical privacy protections to help ensure individuals do not forego life-saving care due to concerns about records disclosure.”

The changes, among other actions, streamline patient consent and expand the prohibitions against using patient records outside of the care environment. The full draft rulemaking is here; comments are due 60 days after the proposal is formally published.

Flu Cases Rising in Massachusetts

According to the Department of Public Health’s weekly influenza update, cases of the flu in the commonwealth during the last reported week (Nov. 20-26) were significantly higher than the past three years at the same time. DPH considers the current severity of the flu to be “High” through most parts of the state. Illness visits, hospitalizations, and lab confirmed cases were all more than double from the previous week’s totals. Hospitals are tracking the flu especially closely this season given the ongoing capacity crisis brought on by a combination of ongoing pediatric respiratory illnesses, persistent COVID-19 cases, and unprecedented workforce shortages.

Transition

Lauren Peters, the current undersecretary for health policy in the Executive Office of Health and Human Services, will become the executive director of the Center for Health Information and Analysis (CHIA), effective January 3, 2023. The executive director position is a joint appointment of Governor Charlie Baker, Attorney General Maura Healey, and Auditor Suzanne Bump. Peters has been the EOHHS undersecretary since 2017. She replaces CHIA Executive Director Ray Campbell, who has led the agency since August 2016.

John LoDico, Editor