Increasing Coverage Options

Biden Releases American Families Plan

Last Wednesday, President Biden unveiled his American Families Plan and highlighted the proposal in his remarks before a joint session of Congress. The American Families Plan centers on “human” infrastructure issues such as childcare, paid leave, nutrition assistance, unemployment insurance, and pre-school and college aid. 
The $1.8 trillion dollar proposal would largely be paid for by taxes, through changes to individual tax rates, capital gains rates, carried interest, real estate assessments, and increased IRS audits on high earners. Healthcare interests noted that the plan does not include substantial healthcare proposals aside from a permanent increase in insurance marketplace subsidies. House Democrats had been urging the president to tackle prescription drug prices and lower the Medicare eligibility age – issues that still may generate congressional attention. (While not including it in his proposal, the president in his remarks before Congress did stress the need for action on drug prices.) 
The American Family Plan is the final of the three comprehensive proposals President Biden has announced: The $1.9 trillion American Rescue Plan focused on COVID pandemic aid and was passed on March 11; The $2.7 trillion American Jobs Plan was unveiled by the White House on March 31 and includes the administration’s infrastructure priorities. House and Senate Committees are working on drafting the details behind the proposal and the House has announced it hopes to pass its infrastructure bill by mid-summer; and last week’s $1.8 trillion American Families Plan.
For hospitals, the state and local aid and other COVID proposals included in the American Rescue Plan were appreciated, but none of these comprehensive plans include additional dollars for the Provider Relief Fund, nor possible revisions or loan forgiveness for the Medicare Advance and Accelerated Loan program – both priorities for hospital advocates. 

State on American Rescue Plan: More Help for Coverage

Massachusetts is calling on the healthcare sector to help spread the word that funding the state has received from the recently passed American Rescue Plan (ARP) has resulted in the possibility of lower premiums for people getting their health insurance coverage through the Health Connector. People who’ve already been eligible for premium subsidies through the Connector will get more help as a result of the ARP, and people who never could have qualified for subsidies before because they earned too much money may now newly qualify.
The new savings are time limited (right now, just for 2021 and 2022) and the state is starting a social media campaign to get the word out to eligible people so they don’t leave this new financial help on the table. Connector officials say they want to reach many of Massachusetts’s remaining uninsured residents, and also provide help to people who’ve been buying their own individual market coverage off-exchange.

HHS Allows New Buprenorphine Exemptions

The Department of Health and Human Services (HHS) announced on Tuesday that it had removed some of the prescribing barriers for buprenorphine. The new guidelines allow an expanded group of practitioners to prescribe buprenorphine without having to undergo the hours of training currently necessary to obtain permission through what is known as the “X-waiver.” Buprenorphine is used to treat opioid use disorder, but only 18% of people with opioid use disorder (OUD) reported receiving medication-assisted treatment in the last year according to data released by the HHS Substance Abuse and Mental Health Services Agency.
The new expanded group of practitioners includes physicians, physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, and certified nurse midwives. If these clinicians possess the valid registration from the Drug Enforcement Agency, and are treating no more than 30 patients with OUD, they do not first have to meet the existing “training, counseling, or other ancillary services” requirement before prescribing buprenorphine. MHA and its members have long advocated for easing the prescribing of buprenorphine and welcomed HHS’ action as a first step in reducing barriers to buprenorphine and methadone treatment options.

Providing Coverage for Pediatric Conditions

The Massachusetts Division of Insurance (DOI) has released Bulletin 2021-06 that informs health insurance companies of their responsibility – effective January 1, 2022 – to provide coverage for PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection) and PANS (pediatric acute-onset neuropsychiatric syndrome). 
DOI expects the insurers to notify network providers and their members about PANDAS and PANS coverage and to identify providers within their networks able to provide PANDA and PANS services. If a plan’s network does not include providers able to treat the conditions, then the insurers are to cover services from out-of-network providers.
Insurers are expected to notify DOI – by September 1, 2021 – of the names and locations of providers within their networks who can provide medically necessary treatment for PANDAS and PANS. DOI’s regulation helps implement sections of Chapter 260, An Act Promoting a Resilient Health Care System That Puts Patients First, which became law in 2020.

House Budget Focuses on Populations in Need

The Massachusetts House last week has passed a $47.7 billion FY22 state budget proposal. Attention now turns to the State Senate, which will debate its budget plan this month.
From a healthcare point of view, the budget’s amendment process showed the legislature’s commitment to directing resources towards populations that have been hit hardest by COVID-19. For example, Rep. Christine Barber’s (D-Somerville) Amendment #311 was included, as amended, to require the Commission on Autism to submit a report to the legislature which would assess the effect of the COVID-19 pandemic on Black, Latinx, Asian-American, Pacific Islander, and other persons of color with a diagnosis of autism spectrum disorder.
Several amendments would improve the social determinants of a person’s health. Rep. Marjorie Decker’s (D-Cambridge) Amendment #83, as amended, increased the grant amounts for cash benefits offered for low-income families (TAFDC grants) and for low-income elderly individuals, those who have a disability, and those caretaking a child with a disability. Rep. Kevin Honan’s (D-Boston) Amendment #496 directs the Department of Housing and Community Development to identify and address existing gaps in levels of service within the state’s emergency assistance housing shelter program. This legislation comes at a time when the administration is engaged in interagency efforts to assist housing-insecure patients in accessing shelter upon discharge.
An MHA priority amendment, #352 from Rep. Decker, passed; it requires reporting of the availability of adult and pediatric beds at inpatient continuing care facilities contracted by the Department of Mental Health, as well as the duration of wait time for continuing care patients in acute psychiatric facilities.

Family Caregiver Wellness Webinars Launch This Wednesday

Family caregivers – those who help older adults and individuals with disabilities – face enormous pressures, especially during COVID-19 when the caregivers may have not been able to rely on their pre-pandemic supports.
In response, the Executive Office of Elder Affairs, Mass Home Care, and the Massachusetts Technology Collaborative are offering a monthly webinar series that focuses on ensuring that the people who are caring for others are also cared for themselves.
Each month, expert leaders in Massachusetts will offer accessible and practical tools to educate and support family caregivers. These webinars are intended to support family caregivers who are providing care for someone, including an aging parent, partner with a serious illness, or child with a disability. 
The webinar series launches on Wednesday, May 5, from noon to 1 p.m. Register here.

Clinical Documentation Strategies for 2021

May 4; 1:30 - 2:45 p.m. ET

Improved severity reporting through accurate and appropriate clinical documentation has never been a greater priority for healthcare organizations. The increased demand for healthcare organizations to deliver high-quality, cost efficient care has resulted in the evolutionary quickening of clinical documentation initiatives. Now more than ever, it is crucial to capture the full breadth and depth of patient severity and not limit efforts to appropriate DRG assignments alone. This session will make a case for implementing severity reporting solutions that give you a competitive advantage, is provider focused, and driven by performance and actionable data. Register here.

John LoDico, Editor