INSIDE THE ISSUE

MONDAY REPORT

State Senate’s Proposed Budget Aims at Workforce Development

The Massachusetts State Senate next week will begin debate on a $55.85 billion Fiscal Year 2024 state budget proposal. The Senate’s Committee on Ways & Means, chaired by Senator Michael Rodrigues (D-Westport), released the budget proposal last Tuesday. It is 6.5% higher than the final FY2023 budget but $400 million lower than the FY2024 version the House released last month. The committee’s budget makes significant investments in several areas, including early education, K-12 education, higher education, housing, regional transportation, workforce development, behavioral health, long-term care, climate, and environment.

The Senate proposal would allow all high school students regardless of immigration status to qualify for in-state tuition at public colleges and universities if they attended a Massachusetts high school for three years and graduated or obtained their GED. Additionally, the proposal broadens the House’s $20 million plan to make community college free for adults aged 25 and older and who don’t already have a degree, by adding an additional $20 million to eliminate community college costs for nursing students starting this fall.

On the workforce front, the senate plan appropriates $192 million from the Behavioral Health Trust Fund to address behavioral health (BH) workforce shortages. Among other workforce expenditures, the senate proposal devotes $100 million to replenish the existing loan repayment program, including expanding the settings in which the BH professionals can work to be eligible for the program; $25 million to provide stipends for unpaid clinical hours required for licensure; $20 million to provide incentives for clinical supervision of behavioral health providers-in-training pursuing licensure; $3 million for one-time training or practice costs for BH professionals; $1.8 million to establish a BH workforce development center; and $1 million for two studies – an analysis of rates for BH services and a study of licensure and certification processes for the behavioral health workforce.

The Senate proposal also designates $1 million to the Executive Office of Health and Human Services toward a new hospital workforce training and apprenticeship grant program. The language stipulates that these monies be used toward not only replacement wages or tuition stipends for those staffers seeking higher education or additional training, but also to retain employees through the provision of housing, childcare, behavioral health, and other similar supports.

Additionally, the Ways & Means proposal directs the Board of Registration in Nursing (BORN), for the FY2023 and FY2024 academic terms, to develop a process to allow faculty whose highest earned degree is a baccalaureate in nursing to teach a clinical or skills lab component of a registered nursing program course. BORN would have the authority to set minimum experience requirements for these facility applicants.

DEA Extends Telehealth Prescribing to November 2023

Following up on what it had hinted at recently, last week the Drug Enforcement Administration (DEA) released a temporary rule last week along with the Substance Abuse and Mental Health Services Administration, allowing buprenorphine and other controlled substances to be prescribed by telehealth through November 11, 2023.

Between now and then, the DEA will review the 38,000-plus comments it received on its previous proposal to end telehealth prescribing of the drugs when the public health emergency ended on May 11.

“We recognize the importance of telemedicine in providing Americans with access to needed medications, and we have decided to extend the current flexibilities for six months while we work to find a way forward to give Americans that access with appropriate safeguards,” said FDA Administrator Anne Milgram. Full text of the temporary rule is here.

MHA had submitted one of those many comment letters to the FDA, arguing that the pandemic-era rules allowing telehealth prescribing saved countless lives and allowed patients to get the critical medicines they needed.

Healthcare Bills a Chief Focus at State House This Week

Tomorrow, several MHA priority bills are being heard before the Joint Committee on Financial Services and the Joint Committee on Health Care Financing. MHA will be providing written and/or oral testimony on the following bills:

Joint Committee on Health Care Financing

H.1184, An Act Relative to Health Equity and Community Health Workers, filed by Rep. Marjorie Decker (D-Cambridge).

This bill would require insurers and MassHealth to reimburse for the covered services provided by community health workers, allowing community health centers and hospital systems to pay them more equitably, while assisting in efforts to diversify care teams to be more reflective of the populations they serve. While community health workers are critical members of the care team, their services are currently paid for by unsustainable funding streams such as grants and donations and are exempt from health insurer reimbursement.

H.1170/S.798, An Act to Promote Primary Care Through Medicaid Graduate Medical Education Funding, filed by Rep. Natalie Blais (D-Sunderland) and Sen. Jake Oliveira (D-Ludlow).

This legislation would require MassHealth to reimburse for expenses related to graduate medical education for physicians training in primary care, behavioral health, and other residency training in fields experiencing shortages. For many years, MassHealth had included such a payment in its MassHealth inpatient acute hospital reimbursement rates, but the funding was eliminated more than a decade ago. Given the workforce challenges and increased emphasis on primary care and behavioral health, MHA believes MassHealth should once again fund its share of these expenses. 

Joint Committee on Financial Services

H.1144/S.665, An Act Relative to Specialty Medications and Patient Safety, filed by former Rep. Jon Santiago (D-Boston) and Sen. Jason Lewis (D-Winchester).

This proposal would prohibit public and commercial insurers from using “brown bagging” practices, while promoting reasonable guardrails for “white bagging.” “Brown bagging” means a drug (often a cancer patient’s chemotherapy drug) is purchased through a specialty pharmacy and shipped directly to the patient, who takes it to the provider’s office for administration. “White bagging” means the drug is purchased through a specialty pharmacy and shipped directly to the provider’s office for administration. Providers are strongly opposed to brown bagging since it takes the preparation of drugs away from the clinicians administering them, which is problematic for several reasons, including the fact that it is fairly common for a patient’s cancer treatment regimen to need adjustments on the planned day of treatment.

H.959/S.704, An Act Prohibiting Discrimination Against 340B Drug Discount Program Participants, filed by Rep. Dan Cahill (D-Lynn) and Sen. Pavel Payano (D-Lawrence).

This bill mitigates the risk for hospitals, patients, and other entities participating in the 340B discount program, which is intended to support safety net providers and the communities they serve. More than 17 states across the country have enacted 340B non-discrimination laws, ensuring protections for covered entities against payment discrimination from pharmacy benefit managers (PBMs) and health insurers. It prevents said organizations from accruing 340B savings that should otherwise accrue to the 340B entity and prevents PBMs and or health insurers from reimbursing for a 340B drug less than it would reimburse non-340B entities or non-340B drugs. The bill also prevents discriminatory requirements for 340B entities and protects patients’ choices to get their 340B medications from their preferred pharmacy. Over the last several years, anti-340B behaviors by insurers have eroded the benefits of the program with significant financial effects to community health centers, hospitals, and other healthcare providers.

A Reminder from the State: 24/7 Behavioral Health Help is Available

John LoDico, Editor