A Drastic Medicaid Rule and Block Grants

MHA to CMS: Withdraw Drastic Proposed Medicaid Rule

In November, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that would introduce new restrictions and requirements related to certain Medicaid financing mechanisms, such as healthcare-related taxes, supplemental payments, and intergovernmental transfers. Complex in nature, these federally permitted financing arrangements are critical to how state Medicaid programs fund care provided to low-income patients. Last Friday, MHA submitted detailed comments expressing significant concerns with CMS’s new restrictions and requested that the proposed regulation be withdrawn. 
The proposed changes put billions of dollars in Medicaid spending nationally at risk, affecting healthcare providers directly and state Medicaid programs. Manatt Health, in conjunction with the American Hospital Association (AHA), conducted an analysis based on public and private data sources to determine the financial effect of the proposed rule. Nationally, they estimated the total funding reductions could be between $37 and $49 billion on an annual basis. Given the size and nature of the proposed changes – which introduce a significant level of uncertainty, administrative burden, and loss of federal funding – no state is spared, including Massachusetts. 
In a letter to CMS Administrator Seema Verma, MHA President and CEO Steve Walsh said, “MHA strives to be constructive in all aspects of policy making, here in Massachusetts and at the federal level. While we understand the intent of CMS is to improve transparency and ensure program integrity, this proposed rule is too drastic in nature and unworkable…Because of the overwhelming negative effect on access for low-income citizens, the ability of healthcare providers to serve their patients, innovation within the Medicaid program, and the overall economy, we believe it is imperative that the proposed rule be withdrawn.”
MHA joins numerous organizations across the country, including AHA, in its criticism of of the proposal. In Massachusetts, state leaders have expressed strong objections to the CMS proposal and requested that it be withdrawn. Governor Charlie Baker joined Oregon Governor Kate Brown on behalf of the National Governors Association in filing this letter laying out concerns. , Assistant Secretary for MassHealth and Medicaid Director Dan Tsai in this letter detailed the rule's numerous negative effects on the state’s MassHealth program and its “unprecedented federal overreach.” MHA member hospitals, other healthcare providers, and consumer advocates also requested that the proposed rule be withdrawn.

CMS Unveils Medicaid Block Grant Proposal; Critics Pounce

The Trump Administration unveiled its newest version of Medicaid block grants last Thursday –a proposal it calls “Healthy Adult Opportunity” that will allow states to determine how much it wants to spend for certain adults in its Medicaid population and what benefits to include for the population. The state would then receive a federal share that is either tied to historical expense trends or a per-beneficiary amount that fluctuates in a given year. 
In general, the way Medicaid operates now, a state’s expenditure on Medicaid could increase due to increased enrollment or medical expenses, and the federal share of funding will also rise. In a block grant scenario like the one unveiled last week, the federal funding is capped, but gives states new flexibility that could result in state programs modifying enrollee benefits, increasing enrollee cost-sharing, or limiting the availability of certain prescription drugs through a closed formulary. Depending on the model, states risk exposure if more people enroll due to an economic downturn or if medical expenses increase unexpectedly due to, for example, a health epidemic or the development of an extremely high-cost drug.
A group of Democrats in Congress, including Massachusetts Representative Joseph Kennedy and Ayanna Pressley, argue that aside from reducing federal oversight of state programs that could unfairly reduce benefits and access to enrollees, the CMS block grant proposal is plainly illegal. In a letter to HHS Secretary Alex Azar and CMS Administrator Seema Verma last Wednesday, the Congress Members wrote that CMS is required under statute to match state’s spending and “is powerless in determining alternative state payments, including capping the Medicaid funds it disburses. The power and responsibility to change these payments lie solely with Congress.” Block grant proponents commented last week that the new CMS proposal may have been crafted in such a way to alleviate that concern. But all observers agree that a legal challenge awaits Healthy Adult Opportunity.

Get Counted. The 2020 U.S. Census Matters

Massachusetts hospitals are interested in ensuring a complete count of the state’s residents during the 2020 U.S. Census, and last week MHA sent them a toolkit to help them fulfill that goal.
Census data determines the amount of representative that each state is allotted in Congress and informs the shape of Congressional redistricting. The census also dictates how more than $675 billion in federal funding is distributed among states, counties, and municipalities, including funding for Medicaid, Medicare, the Children’s Health Insurance Program, reproductive health programs, community health centers, substance use disorder prevention and treatment, and the Supplemental Nutrition Assistance Program, among many others services.
As hospitals are important community leaders, they have a role to play in informing patients, staff, and the community as a whole on the importance of being counted. The MHA toolkit – including links to U.S. Census resources, flyers, social media posts, and more – helps hospitals get the word out. MHA has been a participant in the Massachusetts Secretary of State’s Complete Count Committee and convened a healthcare subcommittee to assist in the development of the toolkit.

Free CME-Credit Webinars on Contraceptive Choice

Interested hospital-affiliated clinicians are invited to participate in one or more free, CME-credit-bearing webinars sponsored by Partners in Contraceptive Choice and Knowledge (PICCK). PICCK is the state-funded clinical and public health program designed to promote contraceptive choice and effective contraceptive counseling in Massachusetts. 
Enacted in partnership with the state’s birth hospitals, the PICCK program provides education, training, and technical assistance to expand and sustain the capacity of hospitals statewide to provide contraceptive access. MHA supports this multi-year program, which launched in early 2019 and is housed at Boston Medical Center/Boston University School of Medicine.
PICCK is currently offering medical professionals a series of webinars on a variety of contraception-related topics. All webinars are free and offer CME credits. They run from now through May. The program’s next webinar is entitled, “What’s New in Contraception,” and will take place on Thursday, February 13, from noon to 1 p.m. Click here for a complete listing of all available PICCK webinars, as well as registration information.
In addition to the webinars and an annual meeting open to healthcare providers, Massachusetts hospitals and their affiliated practices and health centers are invited to partner with PICCK to receive a customized program that meets their facility’s needs. PICCK offers medical practices provider education and technical assistance related to workflow, billing, and materials. Visit www.PICCK.org for resources and materials, the program’s bi-annual newsletter, and more information.

National Human Trafficking Training Features Brigham Health Expert

The American Hospital Association (AHA) and the National Human Trafficking Training and Technical Assistance Center are holding an intensive education program in March to assist hospitals and other providers identify and respond to individuals who have experienced trafficking.
Through SOAR Training – Stop, Observe, Ask, Respond – healthcare and social service professionals are better able to recognize those who are at risk or who have experienced human trafficking. National studies have shown that more than two-thirds of survivors are seen by a healthcare provider during their trafficking experience.
To participate in the March 4-5 program in Nashville, Tenn., healthcare teams of 3 to 5 people are being asked to bring a letter of commitment from executive leadership and to complete a two-hour SOAR online module before the training. After the training, teams will receive free follow-up coaching from technical assistance experts to help implement their action plans. One of the trainers is Hanni Stoklosa, M.D., executive director of HEAL Trafficking and an emergency physician at Brigham and Women’s Hospital.
Space for the program is limited. To participate, complete this application of interest and upload a letter of commitment by February 7, 2020.

The Spread of Coronavirus

As of yesterday, the 2019 novel coronavirus (2019-nCoV) had spread to more than 14,000 people around the world (but mostly in China) and has caused more than 300 deaths. An emergency committee of the World Health Organization that met last Thursday in Geneva termed the coronavirus “a global health emergency.” On Friday, U.S. Health & Human Services Secretary Alex Azar declared coronavirus a public health emergency. This past weekend, the state announced the first case reported in Massachusetts: a college student in Boston who had recently returned from the epicenter of the virus -- Wuhan, China. 
In Massachusetts, passengers on flights from countries with confirmed cases of coronavirus were being screened at Logan International Airport in Boston. Individual MHA member hospitals were re-visiting and updating their policies and procedures for dealing with infectious diseases – that is, requiring airborne and contact isolation and eye protection for healthcare workers dealing with patients suspected of carrying the virus. Massachusetts General Hospital created a toolkit that provides a step-by-step process facilities can use to deal with infectious diseases, as well as sample signage for patient areas, instructions on how to remove disposable gowns, and more. MHA helped disseminate that resource to its membership on Friday.
DPH also created this website to keep the public and providers up to date. The CDC website is here.
The basic medical guidance is that if patients present with fever and symptoms of lower respiratory illness, and they’ve recently traveled from Wuhan, China or have been in close contact with someone who is suspected of having coronavirus, then providers should undertake infection control and notify DPH.

UMass-Harrington Plan Merger

Another independent Massachusetts acute care hospital appears about to merge with a larger system. The 89-bed Harrington Hospital in Southbridge announced last week that it has signed a letter of intent to be acquired by UMass Memorial Health Care, which currently operates UMass Memorial HealthAlliance–Clinton Hospital, UMass Memorial Marlborough Hospital, and UMass Memorial Medical Center.
Harrington President and CEO Ed Moore said that the UMass and Harrington systems’ missions and visions “strongly mirror” each other’s, and that the acquisition by the larger system would greatly help Harrington.
“Their geographic location is an obvious match for our current footprint; their advanced technology would be an asset to our infrastructure; and the investments they can offer will provide our community a stable, long-term plan for keeping healthcare local to south central Massachusetts and northeastern Connecticut,” Moore said.
The merger will have to be approved by state regulators and would not occur for at least six months. 

Optimizing Patient Flow & Throughput

Friday, March 20; 8:30 a.m. - 3 p.m.
MHA Conference Center, Burlington, Mass.

Hospital-wide patient flow is essential in achieving value-based health and delivering safe, high-quality care. Hospitals are examining how to provide the right care, in the right place, and at the right time while reducing costs and eliminating waste. Join us at this full-day program where we’ll look at patient flow from all aspects of the hospital’s operations. We’ll feature teams doing great work and showing the various innovations that can make all the difference in throughput from admissions to discharge. This program is geared toward clinicians, process improvement staff, or leaders seeking ideas for improving patient flow. Confirmed sessions include: Leading Through Influence: Managing People & Change; Shaving Minutes, Saving Dollars: Driving Operating Room Efficiencies; Bed Management & Length of Stay: Working Effectively as a Team; Reducing Length of Stay for Patients with Complex Needs; and Leveraging Information & Analytics to Improve Hospital Throughput. View speaker list, full schedule, and registration details here.

John LoDico, Editor