INSIDE THE ISSUE

> Standing Orders
> Tariffs and Healthcare
> AG on ICE Enforcement
> Stuck Patients
> Avian Flu, Ebola, Pediatric Flu
> Transitions

MONDAY REPORT

New MassHealth Standing Orders

MassHealth has issued new standing orders for the administration of prenatal vitamins and oral contraceptives for MassHealth members and Health Safety Net (HSN) patients. And the Board of Registry for Pharmacy has issued a new directive for carrying out the existing standing order for naloxone – the drug used to counter opioid overdoses.

A standing order allows qualified pharmacists to dispense over-the-counter medications or supplements to qualified patients without a physician’s order.

The recent directive from MassHealth authorizes licensed pharmacists to dispense over-the-counter oral hormonal contraceptives to any MassHealth member or HSN patient who states that they are of reproductive potential and age. Specifically, the standing order is for Norgestrel 0.075 mg tablets.

Another directive authorizes licensed pharmacists to dispense over-the-counter prenatal vitamins or multivitamins containing more than 400 mcg of folic acid to any MassHealth member or HSN patient “of reproductive age who states that they are capable of becoming pregnant, considering pregnancy, attempting to become pregnant, are pregnant, or are nursing.”

While a standing order for naloxone has been in effect for some time in Massachusetts, a new statutory requirement mandates that pharmacists offer to dispense naloxone whenever a Schedule II opioid is dispensed. The Board of Pharmacy’s recent policy directive explains the dispensing and reporting requirements of the naloxone standing order.

Seeking a Carve Out from Tariffs

Concerned that the president’s tariffs against China, Mexico, and Canada could hike prices for pharmaceuticals and medical devices imported from those countries, the American Hospital Association last week wrote to the White House asking for a healthcare carve out from the tariffs.

“It is especially critical to have these exceptions for products already in shortage and for which production in the countries subject to increased tariffs supply a significant part of the U.S. market,” AHA President & CEO Rick Pollack wrote. “Despite ongoing efforts to build the domestic supply chain, the U.S. healthcare system relies significantly on international sources for many drugs and devices needed to both care for patients and protect our healthcare workers. Tariffs, as well as any reaction of the countries on whom such tariffs are imposed, could reduce the availability of these life-saving medications and supplies in the U.S.”

AG Gives Guidance Regarding Immigrant Care

In response to the numerous questions arising from the new immigration directives emanating from Washington, D.C., the Massachusetts Attorney General’s office recently released “Information for Massachusetts Healthcare Providers Regarding Immigration Enforcement and Access to Care and Assistance Programs.”

While AG Andrea Joy Campbell stressed that the guidance is “not legal advice or a formal legal opinion of the Attorney General,” it nevertheless provides basics answers to questions about ICE enforcement activities.

“It is important to note that no executive action has prohibited (or could prohibit) healthcare providers from continuing to provide services to all residents, regardless of immigration status, and from protecting the privacy of their patients as required by law,” the guidance notes, adding that providers have expressed concerns that “individuals may be deferring necessary healthcare out of fear that they may be ineligible to receive healthcare services, and that accessing care might lead to enforcement or otherwise adversely impact their immigration status.”

The AG also notes: “Healthcare providers in Massachusetts are not required to ask about immigration or citizenship status and may treat anyone regardless of immigration or citizenship status. An individual may be required to disclose his or her immigration status to apply for certain government benefits, including government-funded health insurance; however, application to such programs is voluntary.”

Another Month of Far Too Many Stuck Patients

Hospitals were experiencing heightened capacity constraints last week, particularly in eastern and central Massachusetts where medical surgical bed occupancy reached some of the highest levels seen this winter.

Last week’s stresses are an amplification of the capacity and patient flow pressures that have afflicted hospitals for years. MHA’s latest monthly survey shows that at a point in time in December 2024, 1,995 patients were stuck in Massachusetts acute care hospitals, unable to be transferred to either a skilled nursing facility, long-term acute care hospital, inpatient rehabilitation facility, or home healthcare. That’s 115 more patients than were stuck during the previous month.

Patients unable to transition to the next level of care cannot receive the rehabilitative or custodial care they require. Plus hospitals must absorb the cost – estimated at $400 million annually – of keeping patients in an inpatient bed. (Hospitals generally do not get paid over and above the cost for a particular procedure or services.) Also, when beds are occupied beds on medical/surgical floors with patients who are waiting discharge, hospitals cannot use those beds to admit new patients and help ease overcrowding in the emergency department.

Many of the flexibilities that had been in place during the pandemic are no longer available to hospitals to assist them in moving patients efficiently to post-acute care services. However, with passage of the state’s new long-term care law, the establishment of a taskforce to look into capacity constraints, and new directives reducing the need for prior authorizations for post-acute care discharges, among other actions, the hope is that the number of stuck patients will trend downward in 2025.

Local and Global Areas of Concern

Incidences of the avian flu (H5N1) have been rare in the U.S. and there have been no human cases of it in Massachusetts.

However, H5N1 is “widespread” in wild waterfowl in Massachusetts, according to the Department of Public Health (DPH), which wants to prioritize certain specimens for testing.

Last week, DPH issued a notice that states: “In order to facilitate early detection of H5N1 human cases, patients with a respiratory infection compatible with influenza, and a recent (within 10 days) history of direct contact with sick or dead wild birds (primarily ducks and geese, gulls, hawks or owls), sick or dead poultry (chickens, turkeys, ducks or geese) or sick dairy cattle should be tested for influenza immediately. Any positive influenza A specimen(s) should be subtyped within 24 hours either through the hospital laboratory, if available, or through” the state laboratory.

Also last week, the Centers for Disease Control, and Prevention (CDC) issued a Health Alert Network Health Advisory about a recently confirmed outbreak of Ebola disease in Uganda.

“Currently, no suspected, probable, or confirmed Ebola cases related to this outbreak have been reported in the United States, or outside of Uganda,” the CDC wrote. “However, as a precaution and because there are other viral hemorrhagic fever (VHF) outbreaks in East Africa, CDC is sharing best practices for public health departments, public health and clinical laboratories, and healthcare workers in the United States to raise awareness about this outbreak.”

Finally, DPH included in the avian flu advisory above a note about increased reporting in Massachusetts of neurological complications of influenza infection in pediatric patients, including encephalitis and acute necrotizing encephalitis. DPH asks that providers notify it immediately of any such cases.

Transitions

Carolyn Jackson, CEO of Saint Vincent Hospital and Tenet Healthcare’s Massachusetts Market, is stepping down from her post, effective February 14. Jackson has led the Tenet Healthcare hospital since 2019. Tenet has not announced who will replace Jackson who, Tenet said, “is choosing to focus on the next chapter of her career.”

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Julie Pinkham, who has led the Massachusetts Nurses Association since 2000, recently announced that she is retiring this year. The search for her replacement is underway with no firm date set for the transition.

John LoDico, Editor