INSIDE THE ISSUE

> The NLC Gains Steam
> Senate Hospital Relief
> Congress Urges Action
> OD Data & Health Equity
> MCDHH Pilot Extended

MONDAY REPORT

Boston Globe: Pass the NLC in Massachusetts

The Boston Globe has joined the chorus of healthcare experts and public officials calling for passage of the Nurse Licensure Compact (NLC) in Massachusetts. In an editorial published Friday, the Globe argued that the compact is necessary because of the shortage of more than 5,100 nurses in the state’s acute care hospitals, and because of its ability to simplify the licensure process and allow RNs to treat patients across state lines.

The NLC would give Massachusetts RNs the flexibility to possess a single multistate license while permitting them to practice both in their home state and the other 39 states that are members of the Compact.

“The state is still battling the coronavirus, and hospitals remain under stress keeping up with manifold other health care needs that have been shunted aside during the pandemic,” the editorial concludes. “Time is running out in this legislative session. Taking this step, even if it is a limited one, is the least the Legislature can do to help a beleaguered and too-often forgotten profession, even if its union disagrees.”

As cited in the piece, the compact has gained renewed relevance in light of threats to reproductive care in the United States. Should Massachusetts experience an uptick in out-of-state birthing patients seeking abortion services, the NLC would allow local nurses to legally deliver follow-up care to those patients via telehealth if they returned to other states belonging to the Compact.

“Given the worsening nursing shortage and the evolution of a more regional healthcare delivery system, the NLC is a proven solution right at our fingertips,” said Emily Dulong, Vice President of Government Advocacy and Public Policy at MHA. “The NLC has always been a critical tool in helping to address healthcare providers’ workforce needs, but now the overturning of Roe v. Wade has only intensified the need to bring the commonwealth into the fold before the session ends.”

The NLC has received endorsement from a broad coalition of healthcare providers and nursing associations, as well as the Massachusetts Health Policy Commission and the Baker Administration.

Senate Approves “Historic” Hospital Relief

The Massachusetts Senate devoted $400 million to hospital relief as a part of its $4.4 billion economic development package passed last Thursday. This follows the House version of the bill approved on July 14, which put forth $350 million for hospitals. Like the House proposal, the Senate legislation pulls hospital relief from the state’s remaining American Rescue Plan Act (ARPA) funds.

“The Senate, House, and Baker Administration have all shown a tremendous commitment to helping our healthcare organizations stabilize,” said MHA President & CEO Steve Walsh. “This economic development bill will provide a historic investment in those who have helped the commonwealth survive a historically turbulent time. It will be instrumental in allowing providers to remain as accessible as possible to patients across Massachusetts who count on their care.”

Congress Urges Action on Two Key Issues

More than 180 members of congress sent a letter to U.S. Health and Human Services Secretary Xavier Becerra last week asking the federal government to take action against drugmakers who are overcharging hospitals participating in the 340B program. The Office of the Inspector General (OIG) has issued warning letters to the culprit companies and is authorized to impose monetary penalties, but little action has been taken since the issue was flagged by lawmakers last year. “Every day that drug manufacturers violate their obligation to provide these discounted drugs, vulnerable communities, federal grantees, and safety net health care providers are deprived of resources Congress intended to provide,” stated the letter.

The contingent is asking OIG to complete its review of the seven companies already referred to the office and impose monetary fines for those found in violation of federal law. They request that penalties be handed down to eleven additional companies implementing overcharge policies as well. Four members of the Massachusetts congressional delegation have signed onto the letter.

In a separate set of letters, a bi-partisan group of lawmakers is calling upon the Centers for Medicare & Medicaid Services (CMS) to revisit its proposed FY23 inpatient prospective payment (IPPS) system rule. As detailed in Monday Report earlier this month, providers quickly expressed concerns that the proposed payment changes for IPPS hospitals do not account for the economic pressures they are experiencing — particularly inflation. Now, leaders from the House and Senate are echoing concerns on how the resulting shortfall of resources could keep those organizations from being fully operational and requesting that CMS reconsider its approach.

Reps. Brad Schneider (D-IL) and Carol Miller (R-WV) are leading the House letter. Sens. Bob Menendez (D-NJ) and Kevin Cramer (R-ND) are lead signatories on the Senate’s letter.

OD Data Sparks Equity Concerns

A new study from the Center for Disease Control and Prevention (CDC) shows that overdose deaths in the U.S. accelerated fastest among minority populations between 2019 and 2020. Overdose rates increased by 44 percent among Black individuals and by 39 percent among non-Hispanic American Indian or Alaska Native persons, as compared to 22 percent among the White population. In an especially striking data point, overdose death frequency in Black males aged 65 or older was nearly seven times higher than non-Hispanic men of the same age.

“When we talk about addressing health disparities, we are talking about more than just a set of ideals for the future. This is an effort to save lives that are being taken every day due to uneven access to care,” said Akriti Bhambi, MHA’s Director of Health Equity. “MHA and our members are committed to taking these disparities head-on. That means connecting with disenfranchised communities in new and meaningful ways. And as this data shows, we don’t have a single day to waste.”

The opioid-related death rate in Massachusetts rose by 8.8 percent between 2020 and 2021. While rates among minority groups remained mostly stable, there was a notable spike among American Indian/Alaska Native residents. Previous reports from the Massachusetts Department of Public Health also highlighted disparities in overdose deaths. While overall opioid-related overdose fatalities in Massachusetts increased by five percent in 2020, they increased by 69 percent for Black non-Hispanic men. The highest overall rate of overdose deaths during that timeframe was among Hispanic men. This data prompted the creation of MHA’s Equity and Addiction Workgroup.

MCDHH Pilot Program Extended

The Massachusetts Commission for the Deaf and Hard of Hearing is alerting providers that its After-Hours Emergency Referral Service Pilot Program is being extended through next January. The program was launched in April and provides interpreters and Computer Assisted Real-time Transcription (CART) outside of traditional business hours. The program handles all emergency-related requests made to MCDHH, such as rape kits, mental health crises, violent crimes, and more.

Data collected during the pilot program will inform the level of need and the potential creation of a permanent After-Hours Emergency Service Program. More about the pilot service can be found here.

John LoDico, Editor