Mandatory Vaxs, PRF Funding

AHA, MHA Weigh in on Intricacies of Relief Fund Distributions

During the height of the pandemic in the first half of 2020, Provider Relief Funds (PRF) the federal government began distributing helped ease the large financial hit hospitals experienced. The funding was staggered, and in some cases depended on metrics such as the rate of hospital admissions over a certain time period. Hospitals whose case counts didn’t fall within the specific dates set by U.S. Health & Human Services (HHS) sometimes saw their funding relief delayed until the next tranche of funding.
Now a new deadline related to the Provider Relief Fund is causing concern. HHS recently extended the deadline for use of PRF funds, but only those received after June 30, 2020. The deadline remains June 30, 2021, for any PRF funds received from April 10, 2020, through June 30, 2020. Last week, the American Hospital Association wrote a letter to HHS Secretary Xavier Becerra asking that all providers be allowed to keep and expend PRF distributions through the end of the COVID-19 public health emergency or June 30, 2022 – whichever comes later.
AHA said setting a deadline for expending funds based only on when the money was first received harms some facilities. As an example, AHA wrote, “HHS made a $10 billion distribution to hospitals serving high numbers of Medicaid and uninsured patients in early June 2020; these providers must spend these funds by June 30, 2021. It made a $3 billion distribution to additional hospitals serving high numbers of Medicaid and uninsured patients in mid-July 2020; these providers have until December 31, 2021, to spend these funds. These payments were made to similar providers only about one month apart, yet one group has six months less to spend the funding.”
The extended deadline is important, AHA wrote, because hospitals are still battling COVID-19, are still assisting states in vaccination efforts, and are still facing worker burnout questions, facility reconfigurations and more – all of which fall under the guidelines for use of PRF funding.
“Hospitals and health systems must be able to apply their PRF money toward these costs, which they will undoubtedly continue to incur beyond June 30 and through the end of the PHE, without regard to when the funds were originally received,” AHA wrote.
In a related development, MHA recently sent a letter to the Health Resources and Services Administration (HRSA) outlining concerns about how HRSA is determining expenses and revenues as they relate to distributions from the Provider Relief Fund (PRF). MHA also called on HRSA to show flexibility when making its calculations to account for the fact that various hospitals use different end dates for their fiscal years, which affects the “lost-revenue” calculations HRSA employs. MHA said HRSA’s actions were especially detrimental to disproportionate share hospitals.

Massachusetts Hospitals Announce Mandatory Vaccinations

Some Massachusetts hospitals and systems announced last week that they will require all staff to be vaccinated against COVID-19 once the vaccines are fully authorized by the Food and Drug Administration (FDA). The three vaccines now available in the U.S. are being offered under an FDA emergency use authorization; full authorization is expected for the Moderna, Johnson & Johnson and Pfizer vaccines by year end.
Beth Israel Lahey Health (BILH) , Dana-Farber Cancer Institute, Mass General Brigham, and Wellforce all made the mandatory vaccination announcement last Thursday. Other hospitals contacted by media outlets said they would most likely require all staff to get vaccinated.
One healthcare leader, Dr. Kevin Tabb, the CEO of BILH, said in a video message to employees that a reason for mandatory vaccines is that “we are an organization grounded in the art and science of healthcare – and in data. And the data show that vaccination is highly effective, and it’s safe. We need to take the lead, for ourselves and for those around us, in setting an example to the broader community about why this is important.”
MHA, which has consistently advocated for mandatory flu vaccines for healthcare workers, fully supports mandatory COVID-19 vaccines for hospital workers. 
"MHA stands with our members who are making COVID-19 vaccinations mandatory for all employees and fully supports the workforce vaccination policies put in place by each of our members," said MHA President & CEO Steve Walsh. "We feel strongly that, given their mission to deliver the saftest possible care, our healthcare professionals hold a distinct responsibility to get vaccinated. We already have seen the unmistakable difference that vaccines have made within our care settings. As patients are welcomed back into these settings, it is critical that they feel as protected as possible. This starts with a widely vaccinated workforce. Every healthcare organization is continuing to listen to the questions and concerns of their workers regarding vaccination, and are offering educational opportunities so that every employee can feel comfortable getting their shot."

Joint Commission on Workplace Violence

The Joint Commission, which accredits hospitals, will implement new and revised workplace violence prevention requirements beginning on January 1, 2022.
Last week, the commission released a series of resources to assist hospital comply with the new requirements. These include an overview document of the new standards; a compendium of resources to help facilities comply with the new requirements; a document showing the changes from the old standards to the new; and the Joint Commission’s website portal on the issue. 
MHA has long been involved in addressing and helping to resolve the issue of workplace violence in healthcare settings. Working with its Healthcare Safety & Violence Prevention Workgroup, composed of professionals from MHA member hospitals, the association has published best practices, incorporated violence prevention in its sweeping Caring for the Caregiver initiative, conducted surveys to get the baseline data necessary for improvement, held education programs on the topic, and advocated for violence prevention legislation at the State House.

Cambridge Health Alliance Opens Adolescent Inpatient Psych Unit 

Cambridge Health Alliance (CHA) opened a new, 21-bed adolescent psychiatry unit at its Somerville campus last Wednesday. CHA said the opening was the first step in its plan to expand its inpatient mental health capacity and services.
“The mental health crisis in Massachusetts is seriously exacerbated by a lack of resources for treating individuals with behavioral health needs, particularly for adolescents and children,” said Assaad Sayah, M.D., CEO of Cambridge Health Alliance. “It is a tragedy that there are so few options – and that so many patients are forced to resort to emergency departments for needed care at critical moments. The opening of our adolescent inpatient psychiatry unit marks a milestone for CHA as we partner with the commonwealth to address the shortage of inpatient beds for youth and adults and provide needed behavioral health services for our communities.”
The 17,500-square-foot adolescent unit is the first phase of CHA’s new Child and Adolescent Inpatient Mental Health Center in Somerville. Upon its completion in 2021, the center will include inpatient psychiatry services for children aged 3-12 and specialized autism spectrum/neurodevelopmental inpatient psychiatry services for youth. It will also provide unique opportunities for training and research.
CHA will also convert two units at its Cambridge Hospital campus to adult psychiatry units. Scheduled for completion in the spring of 2022, this will result in 22 new adult beds, with eight beds designed for high-acuity adult patients who face challenges getting beds at facilities across the region. In total, CHA will add 64 inpatient beds to its current 89-bed inpatient behavioral health continuum of care for patients of all ages.

Federal Funding to Hospitals: Either by Legislature or the Administration

As has been reported, Governor Charlie Baker recently outlined his plan to immediately spend $2,815 billion of $5.3 billion in federal funding coming to the state through the federal American Rescue Plan Act. The House, however, on Tuesday rejected that plan and voted to keep most of the $5.3 billion in the trust fund it had created. The Senate followed suit on Thursday. The legislature wants to hold hearings and seek input on how to distribute the funding as opposed to allowing the administration to determine how the majority of the funds are used.
The House and Senate votes puts most of the $5.3 billion into the COVID-19 relief fund, less about $300 million that has already been spent or could be spent on COVID-related emergencies. 
While the vehicle for delivering the federal funding is still unresolved, the need for funding to assist the hospitals and healthcare systems that took extraordinary measures to stay open and protect the public during the pandemic still remains. Funding to date has not yet bridged the funding losses that hospitals have experienced. MHA has stated that funding is needed especially to assist hospitals in addressing the growing behavioral health challenges that have grown during the pandemic, as well as workforce challenges and rate challenges.

Flexibilities Associated with MassHealth Managed Care Plans

The state’s Executive Office of Health & Human Services (EOHHS) last week issued this list of program flexibilities that MassHealth promulgated during the COVID-19 state of emergency. Now that the emergency declaration has been lifted in the state, and as the federal public health emergency continues, some of the flexibilities have also been lifted while others have been extended.
“This document is not meant to be an exhaustive list of programmatic changes but is instead focused on changes that pertain to managed care plans,” EOHHS wrote.

Top of Mind Conference: The Challenges and Promise
for Mental Health in Massachusetts

Tuesday, July 13, 2021, 9 - 11 a.m. ET

MHA’s Top of Mind Conference: The Challenges and Promise for Mental Health in Massachusetts will spotlight the most pressing topics in the world of mental healthcare. Leading experts will address innovations in behavioral health technologies, how hospitals are supporting pediatric patients, and the state of mental health reform. The conference will focus on shattering the stigma around mental health and identifying opportunities for capacity building in the behavioral healthcare space. Click here for registration information.

John LoDico, Editor