The Executive Office of Health and Human Services (EOHHS) has issued proposed changes to the two regulations governing Health Safety Net (HSN) eligibility and payments. The HSN fund pays hospitals and community health centers for the care they provide to uninsured and underinsured Massachusetts residents. Hospitals contribute $422.5 million annually to the HSN trust fund (Of that amount, $257.5 million is further transferred from the HSN to a MassHealth trust fund that supports other hospital payments and Accountable Care Organization investments.) If there is a shortfall between the money in the HSN fund and the cost of care to uninsured and underinsured patients, hospitals alone are responsible for covering that shortfall – that is, they must absorb the bad debt. The shortfall for FY2020 is estimated at this point to be between $80 and $100 million.
 
Last week’s proposed changes to the rules governing the HSN are relatively minor. But two issues remain unresolved. First, each year the state budget permits a $15 million state-funded transfer into the HSN. In FY2019, the Baker Administration fulfilled the state transfer late in the fiscal year after continued advocacy efforts by MHA and hospitals. The administration did not fulfill the transfer in FY2016, FY2017, and FY2018. MHA has requested that the FY2020 transfer occur early in FY2020 to help alleviate the expected shortfall and help hospitals with their budgeting.
 
Also of concern is that the FY2020 budget permits EOHHS to transfer up to $7.5 million from the HSN fund and the Prescription Advantage program to support the state share of financing the Medicare Savings/Buy-in program, which provides state and federal premium and cost-sharing assistance for low-income seniors.  MHA supports the senior assistance, but has argued that the Medicare Savings Program expansion deserves a more appropriate and sustainable state funding source.

The federal Substance Abuse and Mental Health Services Administration (SAMHSA) has released a proposed rule to revise the regulations (42 CFR Part 2) which serve to protect patient records for the treatment of substance use disorder (SUD) patients. The proposed revisions modify the regulations regarding disclosure of patient information for individuals seeking treatment for substance use disorders, specifically allowing primary care providers to make note of SUD treatment willingly disclosed to them in medical records protected under Health Insurance Portability and Accountability Act (HIPAA); the SUD information would not have to be separated out.
 
The proposal did not align the regulation with HIPAA, as had been proposed by several members of Congress and healthcare organizations, including the American Hospital Association (AHA). Clinicians want access to an individual’s complete medical record without patient consent, arguing that the stricter confidentiality requirements have a negative effect on medical treatment of individuals undergoing treatment for addiction. Individuals would still enjoy confidentiality under HIPAA and 42 CFR Part 2, but clinicians would have access to a greater amount of information about the patient.
 
The AHA stated, “We commend the administration for taking steps to improve safety for patients seeking substance use disorder treatment … We urge Congress to further this progress by enacting legislation to align requirements for information sharing for the treatment of substance use disorder with HIPAA.”

DPH’s Office of Preparedness and Emergency Management (OPEM) has announced details of its “Know, Plan, Prepare” campaign to alert individuals and organizations about disaster preparedness materials. September is designated as emergency preparedness month, in which people are asked to think about how they’ll prepare for public health and medical emergencies, threats, and disasters. The initiative is especially timely this year as the first hurricane of the season, Dorian, approaches the Caribbean and Florida.
 
Various brochures and materials, in multiple languages, are available through the Massachusetts Health Promotion Clearinghouse. And OPEM’s website has the complete list of resources and guidance.

Last Wednesday, the Joint Committee on Public Safety and Homeland Security held a well-attended hearing on 68 gun-related bills. Massachusetts has some of the strictest gun laws in the U.S., but the numerous bills submitted for review cover such items as expanded training for gun purchasers, establishing a firearm violence institute within DPH, and making firearm owners civilly liable for damage caused by lost or stolen firearms.

While much attention is correctly focused on direct victims of gun violence and their families, the healthcare community is concerned about how firearm violence affects caregivers who treat victims in hospital EDs. That is, even steely-nerved physicians and nurses are often traumatized by the senseless, gun-related tragedies they encounter. MHA and its Board of Trustees continue to view the epidemic of gun violence in the United States as a public health issue. MHA commended the legislature and governor for addressing firearm issues, and supports increased research into the causes of, and possible ways to stem, gun violence.

Always one of MHA’s best attended gatherings, this year’s Annual Women Leaders in Healthcare Conference hits on an array of interesting topics, featuring some dynamic speakers. On Thursday, September 26 from 8:30 a.m. to 2:15 p.m. at the Sheraton Framingham Hotel, we’ll feature Stephen W Trzeciak, M.D., co-Author of Compassionomics and CMO at Cooper University Healthcare, and a spotlight session focused on Driving Diversity & Inclusion in Healthcare. A healthcare panel entitled Disruption, Innovation & Uncertainty: What’s Keeping Healthcare Leaders up at Night? will feature Elizabeth G. Nabel, M.D., president of Brigham Health, and Lois Cornell, executive director of the Massachusetts Medical Society. The second spotlight session is entitled Transforming the Well-Being of Mothers and Their Families, featuring Elizabeth Kester, R.N., director of labor and delivery at Beth Israel Deaconess Medical Center, part of Beth Israel Lahey Health. After lunch, we’ll finish with a talk from Debra Fine, motivational speaker and bestselling author of The Fine Art of Big Talk: How to Win Clients, Deliver Great Presentations, and Solve Conflicts at Work. Learn more about this don’t-miss conference and register by visiting here.