The State Budget, Urging Pharma Transparency, and more ...

House Releases $42.7 Billion Budget

The House Ways & Means Committee last Wednesday released its FY2020 $42.7 billion proposed state budget. The House proposal is just $1.8 million less than the budget total Governor Baker offered in January.
Following Governor Baker’s blueprint for MassHealth spending, hospital reimbursement will remain essentially flat relative to FY2019 rates, which therefore continues a significant rate reduction that was introduced in the 2019 MassHealth contract with hospitals, or “RFA.” The House requires supplemental funding for disproportionate share hospitals at $13 million, which is the amount assumed in the administration’s FY2020 budget proposal. Like the governor’s proposal but with further limitations, the House budget plan contains language giving the state more authority to negotiate with pharmaceutical manufacturers for MassHealth-reimbursed drugs – a proposal the hospital community supports.
The Health Policy Commission – a state regulatory agency that is funded by hospitals, insurers and ambulatory surgical centers, but not by the state itself – would have its budget increase 8.7% to $9.5 million under the House Ways & Means budget.

Safety Net Funding for Uninsured in Doubt

Each year, hospitals in Massachusetts contribute $165 million to fund the Health Safety Net Trust Fund – a pool of money that helps pay for the care received by the hundreds of thousands of low-income Massachusetts residents who are uninsured or underinsured. Health insurers also contribute $165 million annually to the Health Safety Net, and the state itself, by law, is required to contribute $30 million. Hospitals are then additionally required to make up any shortfall in the program when costs exceed the required funding assessments. This year, the shortfall is estimated to be $65 million.
Yet, the state has regularly declined to make its statutory transfer to the Health Safety Net despite recent directives from the legislature to do so. In FY2019, the legislature directed the state to commit “up to” a reduced $15 million in funding. Despite clear legislative intent, no transfer has been made since FY2015, as the administration has viewed the “up to” language as permissive in nature. As a result, MHA will be working with legislative champions in the House to strengthen the FY2020 budget directive in a manner that will ensure the administration fulfills the $15 million transfer to the Health Safety Net that the House sought in its budget proposal.
The House Ways & Means budget also contains language that the governor included in his proposal that would allow an annual transfer of money from the Health Safety Net into a Medicare savings program to help certain elderly residents pay for care. In a communication to legislators, MHA said it “supports the coverage expansion for seniors; however, funding transfers from the Health Safety Net are not an appropriate or sustainable funding source and will create instability in the Health Safety Net program.”

Government & Hospitals to Pharma: Be Transparent

State and federal governments are looking into rising prescription drug prices, which Massachusetts regulators have identified as the fastest-growing element of the commonwealth’s healthcare annual cost growth.
In Washington, the House Ways & Means Committee, chaired by Massachusetts Representative Richard Neal (D), unanimously passed the bipartisan Prescription Drug STAR Act (H.R. 2113) on Tuesday. That act would:

Require drug manufacturers to publicly justify large price increases for existing drugs and high launch prices for new drugs.
Require applicable manufacturers to report to the Health & Human Services Secretary the total aggregate monetary value and quantity of samples provided to covered entities.
Require the Secretary to conduct a study on inpatient (Medicare Part A) drug costs, including trends in the use of inpatient drugs by hospital type.
Require the Secretary to publicly disclose the aggregate rebates, discounts, and other price concessions achieved by pharmaceutical benefits managers (PBMs) on a public website, so consumers, employers, and other payers can understand and compare the discounts PBMs receive.
Require all drug manufacturers to submit information to the Secretary on the average sales price for physician-administered drugs covered under Medicare Part B.

Neal was a featured speaker at the American Hospital Association annual meeting in Washington, D.C. last week. On Tuesday shortly before the Ways & Means vote on the STAR Act, he addressed the gathering, as did House Speaker Nancy Pelosi (D-Calif) and Senate Majority Leader Mitch McConnell (R-Ken.).
In addition to his comments on the STAR Act, Neal issued a strong defense of the Affordable Care Act, saying, “I think that this constant threat and sabotage effort as it relates to the Affordable Care Act is unwarranted and indeed unwise. We should be working to repair the ACA. We should all be working together to buy into the idea of universal access to healthcare. That ought to be the standard we should try to embrace, that everyone has the chance to access healthcare.”
On the state level, last Thursday the Joint Committee on Health Care Financing reviewed two dozen bills dealing with prescription drug access, cost, and transparency. 
In testimony submitted to the committee, MHA’s Senior Vice President of Government Advocacy Michael Sroczynski, said, “Hospitals, physicians, and health insurers are held accountable for healthcare costs, must meet healthcare cost growth benchmarks, and are required to report cost and utilization data to various state agencies. This data, in turn, is readily available to the public. Hospital financial information, in particular, is an open book. By contrast, there is currently little to no transparency around pharmaceutical costs.”

DMH Proposes New Regulations on its Oversight of Facilities

The Department of Mental Health (DMH) released proposed revisions to its regulations governing DMH’s oversight of mental health facilities. The majority of the proposed changes are to implement relevant sections of last year’s opioid law (Chapter 208 of the Acts of 2018).
Among other things, the proposed amendments require all licensed DMH facilities to provide services to commonwealth residents with public health insurance on a non-discriminatory basis, and require the reporting of a facility’s payer mix to DMH on a quarterly basis. The proposed regulations also require designation of a comfort or sensory space in the facility, allow an on-duty clinician acting on behalf of the treating physician to restrict or authorize a patient’s access to the outdoors depending on a change in circumstances that affects the patient’s ability to safely access the outdoors, and allow the use of telemedicine in specific circumstances.
DMH will hold a public hearing on these regulations on Wednesday May 1, from 2 to 4 p.m. in the Boston Room at DMH’s Central Office at 25 Staniford Street, Boston.


The American Organization of Nurse Executives (AONE) has changed its name to the American Organization for Nursing Leadership (AONL). The organization’s new tagline is: Education. Advocacy. Community. The Massachusetts Organization of Nurse Executives (MONE) changed its name to Organization of Nurse Leaders (ONL) in 2011.

Tuesday, April 16: National Healthcare Decisions Day

Tomorrow (April 16) is National Healthcare Decisions Day, when people are encouraged to finally get around to putting into writing what they desire when it comes to their healthcare if they become seriously ill.
MHA has been a longtime partner of Honoring Choices Massachusetts, a leading advocate for advanced care planning. Honoring Choices has highlighted three key steps in making a plan (see graphic). 
“Advance care planning” is necessary so you have a plan in place when you might not be able to articulate it for yourself. With a plan in place, your wishes are carried out, bickering between family members who believe they are acting in your best interests is avoided, and caregivers are not drawn into those conflicts.
How do you go about taking the first steps? This brochure from the Institute for Healthcare Improvement (IHI) and the Conversation Project lays out the basics. This brochure explains how to pick a healthcare proxy – the person who acts on your behalf when you can’t. And this brochure explains how to talk to your doctor, nurse, or other provider about end-of-life care.
For additional information, you can visit the Honoring Choices Massachusetts website, or PatientCareLink.

MHA’s Annual HR/Labor Forum
Caring for Caregivers: Making the Case for Clinician Wellbeing & Resilience

Healthcare’s disruptive forces are putting unprecedented stress on caregivers and the broader healthcare workforce. From onerous regulatory requirements to difficult workplace and societal issues, challenges arise every day, adding to burnout and lowered morale. Using emerging research and creative ideas, some healthcare organizations are tackling clinician wellbeing as a top-level priority. Development of resilience training and the creation of new executive-level Chief Wellness Officers are examples. Some healthcare organizations are even promoting the concept of "joy at work." Join us at this year’s forum, where we’ll look at the importance of clinician wellbeing, and how healthcare organizations can be proactive and innovative to create a better environment for both workers and their patients. The forum takes place Friday, May 3, from 9 a.m. to 3 p.m. at MHA's Conference Center, Burlington, Mass. Click here to see the impressive lineup of speakers, as well as registration info.

John LoDico, Editor