90 Additional Days: Ensuring Telehealth's Benefits

An Additional 90 Days Needed to Clarify Telehealth in Massachusetts

When the Massachusetts state of emergency ends next Tuesday, June 15, many of the regulatory flexibilities that were put in place to permit a quick response to the pandemic will also cease. One such set of flexibilities allowed for expanded access to telehealth services, which have been universally credited with providing cost-effective, safe, and convenient care to just about anyone with a phone or computer.
In addition to Governor Baker’s executive orders on telehealth, Chapter 260, which became law on January 1, 2021, advanced telemedicine in Massachusetts more than ever before. The law, An Act Promoting a Resilient Health Care System that Puts Patients First, ordered MassHealth, the Group Insurance Commission, and commercial health insurance companies to reimburse telehealth services at the same rates as in-person services until 90 days after the June 15 end of the state of emergency – which is September 13, 2021. 
Since February, the Division of Insurance (DOI) and MassHealth held listening sessions to inform the regulations that will codify the telehealth provisions of Chapter 260. Those sessions recently ended in April. The administration’s forthcoming regulations will be subject to a subsequent public hearing process prior to the law’s implementation. As a result, there are many uncertainties around how telehealth services will be defined, reviewed, coded, billed, and reimbursed. Both providers and patients are currently left with many unanswered questions. 
At the time Chapter 260 was written, lawmakers did not know when the state of emergency would end. Now, as the law’s September 13 deadline approaches, MHA and its membership are seeking a 90-day extension to keep the state’s current telehealth framework in place through mid-December. MHA argues that because the process of creating the regulations to implement the law is not yet underway, more time is needed to allow providers, insurers, and MassHealth to adjust billing systems and patient scheduling, and to agree on coding, billing, definitions, and other telehealth administrative complexities. Also of great concern are the patients whose existing telehealth-based care has been scheduled beyond September 13, potentially disrupting how those patients access, receive, and pay for care. One of the major unresolved issues DOI is deliberating involves identifying the services that qualify under the law’s definition of primary care and chronic disease management. Additionally, the state’s current telehealth flexibilities have protected access to healthcare for underserved populations, including those from communities of color, immigrants, and low-income communities. MHA has expressed concern about abruptly shifting from the existing telehealth framework without ensuring clarity to secure safe care access for all patients.
With or without the requested extension of current flexibilities, Chapter 260 mandates that behavioral healthcare provided by telehealth will be reimbursed on-par with in-person services in perpetuity. Health insurance companies will be required to reimburse primary care and chronic disease management services provided via telehealth at the same rates as in-person services – but only until January 1, 2023. 
“Given that the state of emergency is now coming to an end, healthcare providers and patients need additional time to understand what the rules of the road will be,” said MHA’s Senior Director of Managed Care Karen Granoff. “Because we do not yet know how the state will define what a telehealth encounter is, or even how certain services will be reimbursed, the conclusion of the state of emergency and the uncertainty of the regulatory framework for telehealth demands that additional time be given to deliberate upon next steps. Providing an additional 90- day glide path will help address hospital, provider, and patient concerns and ensure that current treatment plans are not disrupted, especially as many continue to experience the long-lasting effects of COVID-19. Our state has made incredible strides in the area of telehealth recently, and we look forward to working with the legislature and administration on a solution that works best for patients and providers, who have embraced the benefits of virtual care.”

MHQP Asks Clinicians/Patients About Telehealth

Massachusetts Health Quality Partners (MHQP) is reaching out to clinicians and the public to gauge their feelings about telehealth provided during the pandemic. MHQP says its survey will help “ensure telehealth lives up to its full potential in the future.” Results of the survey, which takes 5 to 10 minutes to complete will be posted at MHQP.org.
The clinician survey is here and the patient survey here. Please submit responses by Friday, June 18.

DMH Seeks Information on Use of Federal Grant

Federal money from the Coronavirus Response and Relief Supplement Appropriations Act, which is distributed through the Federal Substance Abuse and Mental Health Administration, is coming to Massachusetts in a one-time grant, and the state’s Department of Mental Health is asking interested parties how the money should be used.
The COVID-19 relief supplemental funding is intended to be used to prevent, prepare for, and respond to Serious Mental Illness (SMI) and Serious Emotional Disturbance (SED) needs and gaps due to the on-going COVID-19 pandemic. Mandated “set asides” of the funding are dedicated to “first episode psychosis” to address early on the needs of youth experiencing psychosis; and “crisis support services” to address the needs of individuals with serious mental illnesses and children with serious mental and emotional disturbances.
Through the request for information (RFI) on the grant money, DMH wants ideas on how to specifically address, among other topics: behavioral health boarding in emergency departments; the behavioral health needs of children and youth affected by COVID19, including strategies to support parents and schools; and social determinants of health and racial equity in the delivery of behavioral health prevention, intervention, treatment, and recovery support.
Responses to DMH are due no later than Monday, June 14 at 3 p.m. Click here to learn more about the RFI and instructions on how to submit comments.

Holyoke Health Addresses Behavioral Health With Two New Units

Holyoke Medical Center opened two new behavioral health units last week. One 16-bed unit is for adults, and the other 18-bed unit is for geriatric behavioral health. The new Holyoke units are in addition to the 20-bed adult behavioral health unit that has been serving the community since 1989. 
“Holyoke Medical Center has always been committed to providing the care and services that meet the needs of our community. As an independent community hospital, we are also able to adapt quickly as those needs change,” said Spiros Hatiras, president and CEO of Holyoke Medical Center and Valley Health Systems. “The construction for these two units started in January of this year, when the veterans staying with us since April 2020 were able to return to the Soldiers’ Home. In less than five months, our team was able to transform and build two state-of-the-art units, designed specifically to support the needs of the growing number of behavioral health patients throughout our region.”

Infection Control and Prevention Survey

Massachusetts DPH has put a new survey into the field, asking a wide group of healthcare personnel to answer questions relating to their training and needs around the topic of infection control. DPH is working with the federal Centers for Disease Control and Prevention (CDC) on the development of infection control trainings for healthcare personnel. To get a sense of what the training should look like, DPH is seeking information from all workers in healthcare settings, including physicians, nurses, nursing/patient care assistants, healthcare administrators, public health professionals, environmental service workers, and food service staff. This flyer describes the survey and how to access it. Responses are due no later than June 30.

Lucian Leape’s New Free Book on Patient Safety

Lucian Leape, M.D., the well-known patient safety expert who is currently a physician and professor at Harvard School of Public Health, has released a new book – Making Healthcare Safe: The Story of the Patient Safety Movement. The free book available online covers the growth of the patient safety field in the United States from the late 1980s to 2015.
The book is divided into four parts that detail the beginning of the patient safety movement, how major organizations began to apply the new concepts, an analysis of four key issues that demanded special attention, and a look to the future that discusses what it will take to achieve safe care for all. One chapter looks at how the Massachusetts Coalition for the Prevention of Medical Errors came about in the 1990s with the support of a wide-range of Massachusetts interests, including founding member MHA.

Transitions at Wellforce

Wellforce has named Michael Tarnoff, M.D., the president & CEO of Tufts Medical Center and Tufts Children’s Hospital, after he served nine months in the role of the organizations' interim CEO. Tarnoff began his career as a general surgeon at Tufts MC and then took on leadership roles in the medical device industry. He returned to the hospital full time in June 2019, to assume the roles of Surgeon-in-Chief and Chair of the Department of Surgery before being asked to assume the role of interim leader during the middle of the pandemic.
Wellforce also announced that Pam Whelton, previously the president of South Shore Hospital, will be the interim CEO of MelroseWakefield Healthcare beginning June 14. She replaces Sue Sandberg who is moving to Colorado to be with family. Prior to serving as South Shore Hospital’s president, Welton held positions as Chief Operating Officer, Chief Financial and Administrative Officer, and SVP of Physician and Network Expansion with South Shore Health. Wellforce is the health system formed by Tufts Medical Center and Circle Health in 2014. It also includes MelroseWakefield Healthcare (formerly Hallmark Health) and Home Health Foundation. Wellforce’s President & CEO is Michael Dandorph.

Emerging Hospital Technologies and Innovation Conference

Thursday, June 10; 8:15 - 11:30 a.m.

Healthcare innovation is on an accelerating trajectory. Now, hospitals and healthcare systems must be advancing systems and protocols to stay abreast of the rapidly evolving healthcare landscape. Register today for MHA's Emerging Hospital Technologies and Innovation Conference to learn more about the latest in virtual care, tele-behavioral health, the hospital-at-home movement, and more. Hear from local and national thought leaders in the innovation space through this thought-provoking learning opportunity. Register here.

John LoDico, Editor