Last November’s statewide ballot saw Massachusetts voters roundly reject government-mandated nurse staffing ratios by a 70% to 30% vote. Of the commonwealth’s 351 cities and towns, 346 of them voted against mandated ratios. Since then, nursing groups, hospital officials and others have worked on recouping from the tough political battle by, among other actions, addressing violence prevention measures in the healthcare workplace, engaging in initiatives to recognize and reward nurses and other caregivers for the demanding work they do, and promoting the ability of Massachusetts R.N.s to practice across state lines. (See nurse licensure story below.)
  
But the Massachusetts Nurses Association – representing less than one quarter of the R.N.s in the state – remains fixated on ratios. The MNA tried to insert into the House budget an amendment that would re-open the door on the scientifically unsound ratio scheme and ultimately impose ratios on hospitals. The House did not adopt that amendment and so the nursing union is attempting the same in the Senate budget. The MNA also has stand-alone legislation this session to once again promote its repeatedly rejected ratio scheme.
  
“Numerous studies and real-life experiences have already shown that mandated ratios don’t work – and policymakers, researchers, and the voters of Massachusetts understand this,” said Patricia Noga, R.N., MHA’s V.P. of Clinical Affairs. “It’s time to shift our collective focus to meaningful improvements that will benefit patients and healthcare professionals alike, across every element of our care delivery system. To this end, cross-sector collaborative approaches are now moving forward on patient-centered scientific models of care, workplace safety and quality of life improvements, and increasing the supply of patient care professionals across all care settings.”

As debate on the Massachusetts Senate’s proposed FY 2020 state budget begins next Tuesday (May 21), hospitals are urging senators to provide some needed relief to hospitals serving large populations of Medicaid patients as well as shoring up support for the state’s Health Safety Net, among other budget requests.
  
The Senate budget proposal, released last week by its Ways & Means Committee, contains $42.7 billion in spending and, in the case of many MassHealth components, it hews very closely to the governor’s FY20 budget proposal he released in January. For example, the Senate and governor’s budget proposal (and the final budget the House released last month) all call for $13 million for disproportionate share hospitals (DSH). The DSH received $51 million in FY2015, $24 million the next year, zero in FY17, and then $13 million the next two years. The steadily decreasing funding has occurred even though the number of Medicaid patients has grown, as has the cost of caring for them, and the number of hospitals now designated as DSH. MHA asks through budget amendment #550 that the Senate increase DSH funding to $20 million with an additional supplemental payment of $10 million dedicated for behavioral health services provided at DSH.
  
Another amendment concerns the hundreds of thousands of Massachusetts residents who don’t have any comprehensive insurance. Their care is reimbursed through the Health Safety Net program, which is primarily funded by hospitals and insurance companies; each group is assessed $165 million annually. Recent state budgets, including this year’s Senate Ways & Means document, always include language requiring a state contribution to the safety net, but also always provides permissive language allowing the state to never make the payment – which Massachusetts hasn’t for the past four years. As occurred this year in the House, Senate Ways & Means, and Gov. Baker budgets, the state is directed to include “not more than” $15 million or “up to” $15 million to the Health Safety net. That language ultimately allows for a transfer of zero. MHA’s amendment (#612) includes more directive “shall transfer $15 million” language. MHA’s amendment also includes a prohibition against a proposed transfer of funds out of the Health Safety Net to fund other programs.
  
Other MHA priorities include: providing greater MassHealth “outlier payments” to hospitals treating very complex, very ill MassHealth patients; a directive that MassHealth offer coverage for tele-behavioral health services to fee-for-service patients; a requirement that health insurers provide payment for nasal naloxone rescue kits in hospital emergency departments and other settings; a directive that the state fund (by $500,000) the Massachusetts Consultation Service for Treatment of Addiction and Pain, which is an integral part of the opioid use disorder fight. Another MHA priority is Amendment #521, filed by Sen Harriette Chandler (D-Worcester), to ensure that MassHealth does not prevent safety net hospitals from getting the discounts to which they are entitled from pharmaceutical manufacturers under the federal 340B program.

The Joint Committee on Consumer Protection and Professional Licensure is holding a hearing today on SB.103 filed by Senator Joe Boncore (D-Winthrop) that would authorize Massachusetts to join 31 other states that have adopted the national Nurse Licensure Compact (NLC).
 
The NLC allows a nurse to have one license in his or her state of residency and to practice in other states, subject to the nurse practice laws and regulations of each state. There are 14,000 nurses currently residing in Massachusetts who hold a license in another state; joining the Nurse Licensure Compact would relieve them of the maintenance of multiple, costly licenses in each state in which they practice.
 
Allowing for cross-state care is important since Massachusetts’ renowned hospitals attract patients from across the country. When a patient has completed the necessary care at the bedside, they enter into a complex system of follow-up and remote care that is staffed largely by nurses. To continue this care as patients return home to other states, nurses must hold multiple licenses.
 
Also, telehealth allows nurses to assist patients after they leave the hospital; these follow-up virtual visits contribute to the prevention of unnecessary readmissions. As telehealth adoption increases, the number of nurses who will be required to hold multiple licenses will also increase because nurses must hold licenses in the state where their patient resides.

Senator Elizabeth Warren (D-Mass.) last week reintroduced her Comprehensive Addiction Resources Emergency (CARE) Act, which would provide $100 billion over 10 years to state and local governments to assist in the fight against opioid use disorder.
 
The CARE bill in the House is sponsored by Representative Elijah Cummings (D-Md.). Nine members of the Massachusetts delegation have signed on to it: Senator Edward Markey, and Representatives Katherine Clark, Bill Keating, Joseph Kennedy III, Stephen Lynch, Jim McGovern, Seth Moulton, Ayanna Pressley, and Lori Trahan.
 
The bill would, among other things, provide: 
• $4 billion per year to states, territories, and tribal governments;
• $1.6 billion through competitive grants, and $400 million for tribal grants;
• $2.7 billion per year to the hardest hit counties and cities;
• $1.7 billion per year for public health surveillance, biomedical research, and improved training for health professionals, including $500 million to train and provide technical assistance to professionals treating substance use disorders;
• $1.1 billion per year to support expanded and innovative service delivery, including $500 million for public and nonprofit entities; and 
• $500 million per year to expand access to overdose reversal drugs (Naloxone) and provide it to states to distribute to first responders, public health departments, and the public. 

Warren’s office estimates Massachusetts would receive about $120 million annually from the bill, which was first introduced last year. She has said previously that the CARE Act could be funded by her proposed tax on very wealthy individuals (2% tax increase on those with more than $50 million and higher rate for billionaires).
  
MHA, which in coordination with its membership, other health entities, and the state has undertaken a series of substance use disorder initiatives, applauds Warren for the CARE bill.

The Massachusetts Department of Public Health (DPH) is updating its requirements for hospitals reporting healthcare-associated infection (HAI) data.
 
Beginning July 1, 2019, hospitals will be required to provide DPH with access to measures related to central line-associated blood stream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) in adult and pediatric medical, surgical and medical/surgical wards. 
 
DPH currently requires acute care hospitals to report specific HAIs to the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN), and to make that data available to DPH. All licensed Massachusetts acute care hospitals are successfully reporting HAI data to DPH using NHSN, so the newest CLABSI/CAUTI change required will be for hospitals to provide DPH access to these additional measures already reported within NHSN.

U.S. Health & Human Services has released a final rule requiring drug manufacturers to list the expected monthly costs to consumers of the prescription drugs they advertise on TV.
 
The rule goes into effect in July and applies to all drugs that would cost more than $35 per month for a 30-day supply or typical course of treatment. The actual text that must be displayed is: “The list price for a [30-day supply of] [typical course of treatment with] [name of prescription drug or biological product] is [insert list price]. If you have health insurance that covers drugs, your cost may be different.” The final rule also describes the way the text must be displayed in the ad to avoid the typical small-font, bad-contrast, hard-to-read disclaimers on many advertisements.
 
In releasing the rule, HHS wrote, “Up until now, drug companies were required to disclose the major side effects a drug can have—but not the effect that buying the drug could have on your wallet.”

Sen. Lamar Alexander (R-Tenn.), chairman of the Health, Education, Labor and Pensions Committee, said he expects to have a bill addressing “surprise medical billing” by July. He commented on the bipartisan efforts to address the issue after President Trump on Thursday called for an end to the billing practice.
 
A surprise medical bill is when an insured patient is billed for care from an out-of-network provider usually when they seek immediate, necessary care in an emergency room. The White House issued what it feels are guiding principles for billing legislation, including:

• In emergency situations, balance billing for amounts above the in-network allowed amount should be prohibited; and 
• Before scheduling their care, patients should be given information about whether the care providers are out of their network and what related costs that may bring. 

The AHA issued a statement after the Trump announcement saying, “"The AHA has urged Congress to enact legislation that would protect patients from surprise bills. We can achieve this by simply banning balance billing. This would protect patients from any bills above their in-network cost-sharing obligations.”

How will new population-centered care models affect pediatric care? Under the new systems, opportunities exist to work more holistically with patients and their families, paying more attention to their economic realities to help ensure better outcomes. The social determinants of health concept is finally gaining traction and funding. At this conference we’ll explore emerging best practices along these lines. We’ll also look at other areas of care innovation in pediatrics taught by leaders from children’s hospitals around the country. We’ll feature sessions aimed at caregiver burnout and resilience. the conference takes place Monday, August 5 & Tuesday, August 6; 9 a.m. to 3:45 p.m. at Sea Crest Beach Hotel, Falmouth, Mass. Come to Cape Cod at a very affordably priced beachfront hotel for a few days of high-quality learning and rejuvenation in a relaxed setting. You’ll leave refreshed and energized to get back to the important work you do with pediatric populations. Learn more here.