Mental Health Parity, Surprise Billing, N95 Masks, and more....

Senate Passes Mental Health Parity Bill

The Massachusetts Senate unanimously passed a sweeping mental health reform bill last Thursday that takes a large step forward in ensuring that insurance coverage for mental health benefits are equal to and no more restrictive than coverage for physical health benefits, and, perhaps most importantly, helps eliminate the stigma of seeking treatment for behavioral health services.
A major component of the legislation for which the hospital community has long advocated is the removal of insurance company prior authorization for adults and children who are experiencing a mental health crisis. Timely treatment decisions for those patients are now in the hands of clinicians and the patients rather than the insurer. The legislation – The Mental Health ABC Act – also addresses the long-standing issue of mental health and primary care providers being reimbursed at different rates. The bill sets a rate floor mechanism to ensure that insurers reimburse mental healthcare at the same rate as primary care.
It also establishes a pilot program at the Department of Public Health to increase student access to tele-behavioral health services. The program would be modeled off of the successful initiative currently in use by Heywood Healthcare and public schools in its service area. 
The Mental Health ABC Act also contains a number of mechanisms to increase the pipeline of mental health workers by creating a Psychiatric Mental Health Nurse Practitioner Fellowship Pilot Program for community health centers; another pilot program through the Department of Higher Education to support individuals from diverse backgrounds seeking careers in mental health; and a sweeping workforce commission to study a variety of issues ranging from identifying shortages in inpatient and community-based settings, how commercial insurance and MassHealth reimbursement rates and administrative processes affect the workforce, and barriers to providers’ acceptance of commercial insurance and MassHealth.
MHA and its membership were able to secure through an amendment filed by Sen. Jim Welch (D-West Springfield) an enhancement to the bill’s provision requiring hospital emergency departments (EDs) to have the ability to evaluate, stabilize, and refer behavioral health patients; the amendment allows the use of telemedicine and e-consultation to meet the new requirement.
Hospitals applauded a component of the legislation that prohibits insurers from denying coverage for mental health services and primary care services solely because they were delivered on the same day in the same facility. Providers had consistently argued that the insurer practice disrupted the integration of mental health and primary care.
MHA’s President & CEO Steve Walsh praised the chief authors of the bill: Senators Julian Cyr (D-Truro), co-chair of the Joint Committee on Mental Health, Substance Use and Recovery; Senate President Karen Spilka (D-Ashland); Cindy Friedman (D-Arlington), co-chair of the Joint Committee on Health Care Financing; and Michael Rodrigues (D-Westport), chair of the Senate Committee on Ways and Means. Walsh said, “Massachusetts hospitals have long sought parity in coverage between behavioral health and medical/surgical care. I applaud the Senate for their leadership on an issue so critical and personal to our patients and their families. This legislation is an important step forward in ensuring that every Massachusetts resident has access to the mental health services they need and deserve.”

Ways & Means Approves Surprise Billing Legislation

Last Week, the U.S. House Ways and Means Committee, chaired by Richard Neal (D-Mass.), passed the Consumer Protections Against Surprise Medical Bills Act (H.R. 5826) by unanimous voice vote.
MHA has strongly endorsed the bill as it avoids setting fixed benchmark rates, opting instead to allow health insurance companies and providers to negotiate out-of-network reimbursement. If those negotiations fail, under the Ways & Means bill there would be mediated dispute resolution.
At the outset of the committee meeting, Neal said, “The need to protect the patient is something I think we all agree on. But throughout this process we have asked, ‘What is the best approach?’ The doctors and insurance companies blame each other while the patient is caught in the middle. I think the legislation we have before us today is the right approach – it protects the patient, but also recognizes the private market dynamics between insurance plans and providers.”
Neal crafted the no-benchmark surprise billing legislation with the Committee’s Ranking Member Kevin Brady (R-Texas). Neal said he wanted to avoid benchmarks because “we already know insurers are looking for any way they can to pay the least amount possible. They will work to push those rates down, regardless of what it means for community providers like physicians, hospitals, and our constituents who they employ.”
Neal also mentioned MHA, the Mass. Medical Society, along with national healthcare groups that have endorsed the House Ways & Means proposal.

It’s Now Covid-19, and the Risk in Mass. Remains “Low”

DPH reports that the risk of the novel coronavirus – newly named Covid-19 last week by the World Health Organization – is still low in Massachusetts. 
The greatest concern in the state is the potential shortage of N95 respirators that healthcare workers use as part of their infection control efforts. DPH notes there have been isolated reports of N95 shortages and urged facilities to assess their supplies and follow the CDC’s strategies for optimizing the supply of them. If supply concerns remain after internal reviews and undertaking the CDC strategies, then DPH has developed a process whereby facilities first work with regional Health and Medical Coordinating Coalitions, which will, if necessary, forward the concern to DPH.
The most up-to-date Covid-19 information, including the latest guidance on healthcare personnel exposure to the virus, is available at CDC’s website and at DPH’s.

Focus on Community Benefits: Baystate Franklin Medical Center

The Franklin County Perinatal Support Coalition is a multi-sector and provider initiative that convenes monthly more than 30 community agencies, and is facilitated by nurse leaders from the Birthplace at the Baystate Franklin Medical Center. The goal of the Coalition is to improve maternal mental healthcare at the community level. Efforts include universal postpartum depression protocols for screening from first prenatal visit through second year postpartum, a weekly support group, and a community resource and referral guide. The Coalition serves as a referral network “so that no mom suffers without immediate and knowledgeable help and support in Franklin County.”
The Coalition is also leading the way in integrating perinatal mental healthcare with trauma-informed and recovery programs to better support moms with substance use disorders.
In 2015, the Franklin County Perinatal Support Coalition in collaboration with the Birthplace at Baystate Franklin Medical Center and Baystate Pioneer Women’s Health developed EMPOWER (Engaging Mothers for Positive Outcomes With Early Referrals) to address the needs of this vulnerable population that requires comprehensive, multifaceted, coordinated care by all providers and agencies involved.
Key accomplishments of the EMPOWER program include: training all providers in Perinatal Substance Use Disorder and Screening, Brief Intervention and Referral (SBIRT); implementing a comprehensive screening and referral program; providing care coordination from first visit through the postpartum period; developing a Recovery Coach Program; and creating a pregnancy plan of safe care to help women build a team of support during their pregnancy.
Baystate Franklin Medical Center is an entity of Baystate Health.

According to the Attorney General’s Office, Massachusetts hospitals provided $641 million in community benefits for residents of Massachusetts in Fiscal Year 2018. These hospital community benefits programs – provided at no cost to those being served – are not reimbursed by state or federal governments, by any health insurance company, or through any public subsidy.

President’s Budget Attacks Medicare & Medicaid

President Trump released his proposed FY21 budget last year and it is remarkable for the ferocity with which it attacks Medicare and Medicaid. Presidential budgets are essentially vision statements with no real statutory authority; the real budget power lies with Congress. But provisions in the presidential budget that can be accomplished by rulemaking at federal agencies, often eventually show up in such rulemaking.
The administration proposes the following reductions over 10 years: cutting Medicare and Medicaid graduate medical education funding by $52.2 billion; cutting hospital uncompensated care by $87.9 billion; reducing Medicare coverage of bad debt by $33.6 billion; reforming the post-acute care payment system that would result in a $101.5 billion cut; paying hospital-owned physician offices located off-campus at the physician office rate, resulting in a $47.2 billion cut; paying on-campus hospital outpatient departments at the physician office rate for certain services, resulting in a $117.2 billion cut; and continuing the Medicaid Disproportionate Share Hospital allotment reductions by $32.4 billion.
In a statement, AHA President and CEO Rick Pollack said, "Hospitals and health systems remain steadfast in our commitment to stand up for patients and families. Every year, we adapt to a constantly changing environment, but every year, the administration aims to gut our nation's healthcare infrastructure.”

AG Accuses JUUL of Targeting Youths

Attorney General Maura Healy last week filed suit against JUUL Labs, the e-cigarette manufacturer, claiming that it willfully advertised and sold nicotine products to children under the minimum legal sales age, and that it “bears responsibility for the fact that millions of young people nationwide are now addicted to e-cigarettes, reversing decades of progress in combatting underage tobacco and nicotine use and addiction.”
Healey said JUUL not only created suggestive advertising geared towards nicotine use, it bought ad space on websites frequented by teens such as teen.com and seventeen.com. The suit filed in Suffolk Superior Court says that JUUL “also directly sold its e-cigarettes to underage persons through its own ecommerce website … JUUL made more than ten thousand shipments of e-cigarettes to recipients and addresses in Massachusetts for which it conducted no age verification whatsoever. As a result, JUUL shipped its e-cigarettes directly to adolescents, including to individuals as young as sixteen years old.”
The suit asks for restitution to consumers “injured by JUUL’s unfair or deceptive acts or practices,” $5,000 for each of the numerous violations the company is alleged to have made against the state’s Consumer Protection Act; and “reimbursement to the Commonwealth for expenses incurred abating the nuisance of youth nicotine addiction.” Healey said that because JUUL “created a public health emergency of e-cigarette addiction among underage Massachusetts consumers … the Commonwealth seeks to hold JUUL accountable for the costs the Commonwealth has and will incur in combating the public health crisis JUUL created.”

George Washington: Healthcare Hero?

Today is “Presidents’ Day,” but the official federal holiday is still legally known as “Washington’s Birthday.” In 1968, Congress passed the Monday Holiday Law, which shifted most federal holidays to Monday to provide uniformity and three-day weekends for federal employees. People began to refer to the third Monday in February as the Washington-Lincoln Holiday (Abe was also born in February), and then President’s Day, recognizing all presidents (even the not-so-good ones). But it’s officially Washington’s Birthday.
What’s the healthcare angle of all this? That is, what did Washington do about healthcare during his term? 
In 1790, President Washington signed a law from the first Congress that required every American ship over a certain tonnage that was engaged in international commerce to “be provided with a chest of medicines, put up by some apothecary of known reputation, and accompanied by directions for administering the same.” The medications had to be regularly inspected and freshly supplied and – this is key – if the medicine chest wasn’t kept properly, “the master or commander of such ship or vessel shall provide and pay for all such advice, medicine, or attendance of physicians, as any of the crew shall stand in need of in case of sickness, at every port or place where the ship or vessel may touch or trade at during the voyage, without any deduction from the wages of such sick seaman or mariner.” That’s health insurance for sailors (without prior authorizations) if their boss doesn’t keep a good supply of medicine on board. Happy birthday, George.

Lean in Healthcare Certificate Program at Tufts Medical Center

Starting: Friday, May 8 (8 sessions total); 8:30 a.m. - 4:30 p.m.
Tufts Medical Center, Boston

Hospitals are challenged continually to improve quality and reduce costs as they deliver care to patients. At the same time, complex processes and equipment and supply issues can frustrate the efficient delivery of care. This course teaches leaders, managers, and staff how to apply real process-improvement and problem-solving techniques in an actual hospital setting.
This intense eight-day course provides participants with hands-on experience learning and applying both the technical science and social science of Lean. The technical science of Lean focuses on learning and applying Lean tools and techniques, while the social science aspect of it focuses on people and organizational development. Both are necessary for an effective Lean implementation.
Learn about each aspect of the eight courses, who the program is geared towards, and the registration costs by visiting here.


John LoDico, Editor