Mandatory Vaccines, Provider Relief Funding, and more

Wholehearted Support for Mandatory Hospital Vaccines

When President Joe Biden announced last Thursday that the federal government will mandate that entities receiving Medicare or Medicaid must ensure that all of their employees are vaccinated against COVID-19, hospitals in Massachusetts expressed relief.
The MHA Board of Trustees voted unanimously on July 29 to endorse mandatory COVID-19 vaccinations for all Massachusetts hospital and health system employees. Most hospitals have now instituted mandates and set deadlines for their employees to comply, while others are preparing to do so.
Just last week, MHA was being urged by its membership to press the Baker Administration for a statewide, hospital vaccine mandate to ensure across-the-state unity. Biden’s announcement on Thursday, therefore, came as a welcome development.
“We are battling a relentless virus, and it will require nothing short of bold and decisive action to defeat it,” MHA’s President & CEO Steve Walsh said as he offered his “wholehearted” support of Biden’s action. “By now, there is no debating the data: vaccines are safe and effective. And a highly vaccinated nation will make for a healthier nation. “Moving forward, our healthcare organizations and clinical leaders will continue to reach out to every corner of their communities to encourage vaccination and get us back on the path to recovery.”

Some States Are Facing the Worst 

If you were to survey a Massachusetts hospital CEO today and asked her or him about their greatest concerns, COVID-19 most likely would not be at the top of the list. The commonwealth’s good vaccination rate has helped minimize the threat of the virus – for now.
The list of concerns may read: workforce shortages and stresses, behavioral health boarding and stresses, continued reimbursement uncertainty, enormous volumes of people seeking non-pandemic care flooding emergency departments, and then COVID-19.
In other states, COVID-19 leads the list, a fact made shockingly evident last week as Idaho was forced to institute its crisis standards of care (CSC) strategy. During a disaster, when healthcare resources are overwhelmed, CSCs are adopted to maximize the number of lives saved. That can lead to care – including life-saving care – not being available to all who need it. Early in the pandemic, many states, including Massachusetts, drafted crisis of care standards. “This is a decision I was fervently hoping to avoid,” said Idaho’s director of its Department of Health and Welfare last week in issuing the CSC directive.
President Biden angrily denounced the fact that some states, due to the unwillingness of the unvaccinated, have led to tragedies like those in Idaho.
“There are elected officials actively working to undermine the fight against COVID-19,” Biden said. “Instead of encouraging people to get vaccinated and mask up, they’re ordering mobile morgues for the unvaccinated dying from COVID in their communities. This is totally unacceptable.”

State’s Surprise Billing Recommendation Comes as a Surprise

The state has issued a legislatively mandated report on the provider reimbursement aspect of “surprise billing,” which surprisingly offers a solution that is in opposition to the federal bill on the issue that was the result of a hard-fought bipartisan compromise.
Surprise billing is a contracting issue that can catch patients in the middle of a payment dispute between a payer and an out-of-network provider, often leaving the patient with an unexpected bill for services. New federal and state laws will prohibit such billing beginning January 1, 2022, and all sides agree with holding the patient harmless. The issue is how to reach agreement between the provider and health insurance company on what to pay the provider.
The federal No Surprises Act, which U.S. Representative Richard Neal (D-Mass.) was instrumental in forging, fully protects patients from such billing. It contains an independent dispute resolution (IDR) provision, which allows both providers and insurers to come to the table with their best offer in a baseball-style arbitration process if negotiations are unsuccessful. Such an IDR process has worked in states such as New York and New Jersey. 
But unfortunately, in the state report issued last Wednesday, the state’s Executive Office of Health and Human Services instead recommends establishing a default rate for non-contracted out-of-network emergency and non-emergency services that would be based on the insurer’s median in-network rate. 
MHA, as well as the state's physician community, has consistently opposed setting default rates because it interferes with the private negotiation process and can have significant unintended consequences, including the ability for health insurance companies to reimburse at a low out-of-network rate, diminishing any incentive for them to contract with providers.
“The fair and balanced IDR approach protects patients, avoids government-mandated rate setting, and doesn’t tip the scales in favor of large national insurers,” said MHA’s Senior Vice President of Government Advocacy and General Counsel Mike Sroczynski. “State-mandated rates could limit access to needed healthcare expertise, especially in underserved communities. We look forward to working with the Baker Administration and legislature to ensure that moving forward, our surprise billing policies in Massachusetts minimize unnecessary conflict and confusion by aligning with federal law and treating all patients equally -- regardless of their insurance type.”

Provider Relief Funding Finally Released

The federal government has announced the release of $25.5 billion in funding for providers battling COVID-19. After the initial surge of funding from the COVID relief bills, the distribution of more than $40 billion in remaining funds stopped. After repeated inquiries about when the money would begin to flow, U.S. Health & Human Services opened the tap on Friday.
The funding includes $8.5 billion in American Rescue Plan (ARP) resources for providers who serve rural Medicaid, Children's Health Insurance Program, or Medicare patients; and an additional $17 billion for Provider Relief Fund (PRF) Phase 4 for a broad range of providers that can document revenue loss and expenses associated with the pandemic.
PRF Phase 4 payments will be based on providers' lost revenues and changes in operating expenses between July 1, 2020, and March 31, 2021. Providers can apply for both programs in a single application beginning on September 29.
Also, providers who believe their PRF Phase 3 payment was not calculated correctly will now have an opportunity to request a reconsideration. Further details on the reconsideration process are forthcoming. Additionally, HHS has announced a 60-day grace period to help providers come into compliance with their PRF Reporting requirements if they fail to meet the deadline on September 30, 2021, for the first PRF reporting time period. While the deadlines to use funds and the reporting time period will not change, HHS will not initiate collection activities or similar enforcement actions for non-compliant providers during this grace period. For more information, visit here.
In Massachusetts, hospitals are advocating for additional support from the nearly $5 billion available to the state from the American Rescue Plan Act.

A Visit to the Soldiers’ Home

As part of the community activities associated with the 2021 Medal of Honor Convention in Boston last week, Medal of Honor recipients visited Massachusetts Soldiers’ Homes in Holyoke and Chelsea. Medal of Honor Recipient Michael J. Fitzmaurice met residents in Holyoke. According to the citation for the Medal of Honor, Fitzmaurice in March 1971 while serving in Vietnam hurled two of three enemy explosive charges out of his bunker and then threw his flak vest and himself on the remining charge, saving his comrades. While seriously injured he continued to fight and inflicted additional casualties on the attacking enemy.

Work Begins on $3.5 Trillion Reconciliation Bill

Key Congressional Committees began holding hearings last week on the Build Back Better Act, which is the multi-part, multi-trillion-dollar package from the Biden Administration to rebuild the nation’s infrastructure and invest in a wide variety of areas such as Medicare, childcare, renewable energy, and more.
From a healthcare standpoint, the legislation would address prescription drug pricing by, among other things, requiring drug manufacturers that increase their prices faster than inflation to pay back that excess amount to the federal government. It would expand Medicaid eligibility by expanding the Affordable Care Act’s premium tax credits to below 100% of the federal poverty line in 2022 to 2024 and providing enhanced cost-sharing assistance. And the legislation would invest in dental, vision, and hearing coverage for seniors under Medicare.
During the markup of the bill before the House Ways & Means Committee, which he chairs, Rep. Richard Neal (D-Mass.) said, “The pandemic has been first and foremost a public health crisis, underscoring the need to get more Americans enrolled in health insurance, improve access to care, and enhance protections for vulnerable communities. We will devote funds to help more people get covered, lower the cost of prescription medications, and expand Medicare coverage to include hearing, vision, and dental care. The virus took an especially terrible toll on our nation’s seniors, and we propose an array of improvements related to long-term care facilities to keep the elderly safe at all times, especially during public health emergencies.”

MCSTAP’s Wednesday Call-In Hour

The next call-in hour of the Massachusetts Consultation Service for the Treatment of Addiction and Pain (MCSTAP) is scheduled for Wednesday, September 15, from noon to 1 p.m., when MCSTAP Medical Director Dr. Christopher Shanahan will discuss managing opioid use disorder in a patient with chronic pain, who is in palliative care. The case discussion call-in hours are an opportunity for participants to hear about real, anonymized cases concerning management of chronic pain and SUD. Click here more information and to register. CMEs will be available.
MCSTAP is available to support providers treating chronic pain and/or SUD. Please contact MCSTAP at 1-833-PAIN-SUD (1-833-724-6783), Monday – Friday, 9 a.m. to 5 p.m. with questions or to request a consultation.

Mark Your Calendars: Telehealth Forum September 29

On Wednesday, September 29 from 10 a.m. to noon, the Massachusetts eHealth Institute (MeHI) will host a workshop in partnership with MHA on telehealth coverage, reimbursement, and equitable patient access. The event will feature a panel discussion on equitable patient access to telehealth that will include Dr. Assaad Sayah, CEO at Cambridge Health Alliance; Susan Adams, VP of health informatics at the Massachusetts League of Community Health Centers; Dr. Claire-Cecile Pierre, CMO at Harbor Health; and Curt Swanson-Lewis, manager of patient access at Planned Parenthood League of MA. Attendees will have an opportunity to ask questions, offer their insights, and share their experiences. To register, click here.

Addiction Nursing Competencies: A Comprehensive Toolkit 

The Office-Based Addiction Treatment Training and Technical Assistance team at Boston Medical Center has just had published in JONA, the Journal of Nursing Administration, a comprehensive guide to support the addiction nursing workforce, with formal instruments and skilled based checklists to determine nursing proficiency. Addiction Nursing Competencies: A Comprehensive Toolkit for the Addictions Nurse was developed by addiction nurse experts with knowledge and skills of evidence-based practice, in the different settings. The team included external addiction specialist colleagues from Boston Univ. School of Medicine, and East Boston Neighborhood Health Center, who assisted in the development and validation of the competencies to support practicing addiction nurses and their nurse leaders..

MHA's Fall Healthcare Leadership Summit

Thursday, September 23; 9 - 11:30 a.m.
Virtual Conference

The healthcare landscape is evolving rapidly, as are the leadership skills needed to navigate through these transformational times. Join us at MHA's Fall Frontier Forum to learn from expert faculty on the latest in leading through crisis, managing remote teams, and inclusive practices. Register today to be a part of this can’t-miss summit.

John LoDico, Editor