Booster Shots

Booster Shots Will Be Made Available Shortly

Following last week’s federal agency votes, and a last-minute decision by Rochelle Walensky, M.D., the director of the Centers for Disease Control and Prevention (CDC), booster shots of the Pfizer vaccine could begin to be dispensed in Massachusetts as early as this week.
Walensky’s surprise decision just past midnight on Friday will allow healthcare workers and others in high-risk jobs to receive the boosters. The CDC’s Advisory Committee on Immunization Practices (ACIP) had voted on Thursday to allow the boosters to a wide range of individuals based on age and medical condition – but did not include healthcare personnel.
The approval of boosters applies only to people who previously received the two-shot Pfizer vaccine at least six months ago. It does not apply to the Moderna and Johnson & Johnson vaccines that the CDC and Food and Drug Administration are still reviewing. 
The ACIP guidance, before Walensky’s intervention, said Pfizer boosters should be given to individuals 65 years of age and older and residents of long-term care settings; people aged 50-64 with underlying medical conditions also should receive boosters. Individuals aged 18 to 49 with underlying medical conditions may receive the vaccine based on their individual benefit and risk, ACIP said (by a close 9-to-6 vote). This CDC list (which may be revised) shows the medical conditions that could trigger the need for a booster. ACIP rejected vaccine boosters for people aged 18-64 years who are at increased risk for COVID-19 exposure and transmission because of occupational or institutional setting. Walensky's late-night decision says this last group may receive a booster shot.
“MHA strongly supports Director Walensky’s decision to include healthcare workers in the first round of eligibility for Pfizer booster doses,” said MHA’s V.P. of Clinical Affairs Patricia Noga, R.N. PhD. “These workers remain on the front lines of this crisis, and they should be among those in front of the line for protection. As our providers and healthcare professionals find themselves strained once again, maintaining a healthy workforce is essential.”
The Baker Administration Friday afternoon said approximately 600,000 residents are eligible for Pfizer COVID-19 booster shots under the federal guidelines. Massachusetts residents can receive the shots from more than 460 locations, including retail pharmacies. Eligible residents can book appointments through vaxfinder.mass.gov.

MHA Weighs in on EOHHS Waiver Proposal

MHA wrote last week to the Executive Office of Health and Human Services (EOHHS) on its long-term proposal for the future of the state’s Medicaid program, MassHealth, that is now underway.
EOHHS is constructing its next Section 1115 waiver proposal that it will submit to the federal government in late October or early November. The waiver outlines many of the MassHealth programs and financing plans over the next five years and will determine, among other items, how the state supports providers, including safety-net providers, as well as how it invests in primary care, behavioral health, health-related housing and nutrition services, and in efforts to reduce health disparities, among many other proposals.
In the letter to EOHHS, MHA thanked the state for the collaborative process to date that has led to some creative ideas on how to maximize benefits to MassHealth enrollees while easing financial burdens to both the state and providers. One such example is EOHHS’ adoption of a plan to pursue new 1115 waiver authority for health equity investments across Massachusetts acute hospitals that is separate and distinct from traditional safety net support.
MHA specifically asked the state “to be ambitious” in seeking support of increased 1115 waiver funding for safety net providers. It also asked, on the topic of quality improvement incentives, to adopt measures and processes that “evaluate hospitals in a fair manner, are realistically able to be incorporated into hospital operations, and do not overly burden hospitals with reporting requirements.” Behavioral health workforce funding is also a priority, MHA said.
A key component of the existing waiver, and whatever new waiver the federal government ultimately approves, is the assessment on acute hospitals. Hospitals are assessed hundreds of millions of dollars over the course of the waiver and that funding is used to support Medicaid payments to hospitals and to fund many of the innovations the state undertakes through the 1115 waiver.

CHIA's Timely Report Shows Hospitals Got Hammered by COVID-19

The state’s Center of Health Information and Analysis (CHIA) last week released its annual hospital and health system financial report for fiscal year 2020, which covers part of the pandemic. The report finds that hospitals suffered immensely due to the pandemic, even with the federal relief they received through the federal Coronavirus Aid, Relief, and Economic Security (CARES) Act.
CHIA determined the statewide median acute hospital operating margin was 1.3%, a 1.2 percentage point decrease from FY 2019. (Rating agencies and lenders say a 3% operating margin is needed for a facility to be considered financially healthy.) The statewide median acute hospital total margin would have been –4.5% without COVID-19 relief funds, CHIA found. Only six of 49 physician organizations reported a profit, which ranged from $62,000 to $16 million. The losses ranged from $511,000 to $108 million. 
An MHA analysis based on CHIA’s data found that hospitals that experienced a decline in their operating margins had an aggregate $1.36 billion decline in those margins in FY2020 through Q2 FY2021 compared with the same periods in FY2019 - even with government COVID-19 financial relief. At the hospital health system level, which includes physician practices that also sustained deep financial losses, that decline grew to $1.71 billion in the aggregate after factoring in financial

DOI Wants to Clarify Contraceptive and Gender Affirming Care Laws

There are two laws on the books on which some insurers and providers still need clarity, and the state's Division of Insurance wants to clear up any confusion.
Patients in Massachusetts can get birth control in Massachusetts without co-pays. And instead of mandating that a patient go to the pharmacy every month to get a birth control prescription refilled, Massachusetts law says insurers must cover a 12-month supply at one time after an initial three-month prescription. That 2017 law and the Division of Insurance (DOI) implementation regulations were pretty much unknown until a series of good journalism reports this year called attention to it.
DOI then held a series of webinars for clinicians and pharmacists to inform them of the law's details. Last week, DOI decided to go even further; it says it wants to produce additional guidance, including a potential question-and-answer document to increase understanding of the benefit.
DOI will hold virtual meetings (details still to be decided but which will be posted on its website) at 1 p.m., on Friday, October 15, Friday, October 29, and Friday, November 12 to discuss the issue. Any provider, consumer, or insurer that has thoughts about what to discuss in the sessions, should contact Kevin Beagan, DOI deputy commissioner of the Health Care Access Bureau, at kevin.beagan@mass.gov.
On September 9, 2021, DOI issued Bulletin 2021-11 regarding prohibited discrimination within health coverage for gender affirming care. Health insurers cannot categorically exclude services used in the treatment of gender dysphoria when those services are medically necessary or when the same services are covered for the treatment of other conditions.
Now, DOI wants to answer questions on the issue and determine if further regulations or explanations are required. As in above, DOI is setting aside three 1 p.m. discussions on Friday October 8, 22, and November 5, with video platform details to come. Send thoughts/inquires to DOI's Beagan at kevin.beagan@mass.gov.

MHA's Noga Elected to National Nursing Position

Patricia Noga, R.N., PhD, MHA’s vice president of clinical affairs, has been elected to the national board of the American Organization of Nursing Leadership (AONL). AONL’s membership encompasses approximately 10,000 nurse leaders working in hospitals, health systems, academia, and other care settings across the care continuum. AONL is a subsidiary of the American Hospital Association.
“I am so honored to be elected by my peers to represent the New England region on the AONL Board of Directors and serve the nursing community at this important time for nursing leadership,” Noga said.

MHA Makes Its Ask for ARPA Funding

MHA President & CEO Steve Walsh testified last week before legislative committees focusing on how to disperse the $4.8 billion in available American Rescue Plan Act (ARPA) funding. Walsh told the Joint Committee on Ways and Means and the House Committee on Federal Stimulus and Census Oversight that hospitals and health systems should receive $500 million of the ARPA funds that would be placed into a fund and distributed to facilities based on need.
“For a year and a half now, Massachusetts healthcare providers have spared no expense to remain safe and accessible for their caregivers and patients,” Walsh said. “At the same time, they have lost billions in revenue, and many may face tough decisions if they cannot fully recover. We are asking our partners at the state to devote a portion of its ARPA funding to where it is needed most: the hospitals and health systems that have risen to every challenge throughout this crisis. When they are not at full strength, their workers and their communities are not at full strength.”
Following Walsh's testimony, Vice Chair of the Joint Ways & Means Committee Cindy Friedman (D-Arlington) noted, "We absolutely have to acknowledge the efforts of the hospital community" during the pandemic. The co-chair of the Joint Committee on Public Health Marjorie Decker (D-Cambridge) told Walsh, "I felt we were a lot safer" seeing the MHA-led collaboration among hospitals to deliver care to individuals and communities.

MHA Executive Insights Webinar: Leading an Alliance
Featuring Assaad Sayah, M.D., CEO, Cambridge Health Alliance

Thursday, September 30, 8 - 8:30 a.m. 

Join MHA's Executive Insights Series, which features candid interviews of Massachusetts’ healthcare leaders. We welcome you to pour a cup of coffee and start your day with us as we hear directly from the CEOs who help power our world-class healthcare community. 
Assaad Sayah, M.D., CEO of Cambridge Health Alliance (CHA), will join us on Thursday, September 30 to discuss his role in advancing community health and CHA’s service to one of the most diverse populations of the state. Register here.

John LoDico, Editor