State and National Emergency

COVID-19 Updates

Developments around COVID-19 are occurring by the hour. The following items were key developments among those emerging last week.


National and Massachusetts States of Emergency

President Trump declared a national state of emergency on Friday afternoon. The move frees up $50 billion to states and territories to fight COVID-19. U.S. Health & Human Services is granted more authority under the declaration, allowing it to waive the three-day hospital stay requirement for skilled nursing facility coverage, and limits on the numbers of beds and length of stay in critical access hospitals, among other potential actions. Massachusetts Governor Charlie Baker had declared a state of emergency in Massachusetts on Tuesday afternoon.


Baker Bans Elective Surgeries, Endorses Telehealth

Governor Charlie Baker announced at yesterday’s 6 p.m. press conference that all non-urgent elective surgeries must be cancelled, effective Wednesday. Some Massachusetts hospitals had already begun to phase out such surgeries, undertaking various facility-specific strategies. The state directive creates a uniform policy that will free up beds and resources to counter any COVID-19-generated surge.


Details are expected to emerge today but it appears that there will be regular reviews of the policy as the impact of COVID-19 is better understood.


The state is also barring visitors to any post acute or nursing facility. In addition, hospitals now must screen all visitors to the facility and can deny visitation to anyone. This applies across all facilities, even those licensed by the Department of Mental Health.


Governor Baker also announced an important strategy for which MHA had been advocating. Effective immediately, all telehealth services in the state -- not just those related to COVID-19 -- must be covered by private and public insurers. These are important moves by the state and MHA endorses the governor's actions.


Laboratory Testing Authorization Expanded

A key concern in Massachusetts and around the U.S. is the inability of hospitals and other caregivers to quickly provide COVID-19 testing. Patients are flooding emergency rooms demanding tests and hospitals want to test their workforce to ensure they can maintain an adequate supply of caregivers. On Thursday, CMS and the FDA finally announced that hospital labs can begin testing immediately as long as they are CLIA certified (that is, approved through the Clinical Laboratory Improvement Amendments of 1988). Two large commercial labs also received FDA clearance to begin processing COVID-19 tests.


DPH also altered its testing oversight, allowing clinicians to send tests directly to FDA-approved labs without first receiving DPH approval. A new, single-swab testing directive, as opposed to two swabs, will speed up processing of samples.


Legislature Passes $15 Million Funding

The Massachusetts House and Senate quickly passed a $15 million bill to fund “monitoring, treatment, containment, public awareness, and prevention efforts” against the 2019 novel coronavirus by DPH, regional and local boards of health, and other public groups. Governor Baker signed the bill Thursday.


Courts Issue Standing Order

On Saturday, the Trial Court issued standing orders to take effect on Wednesday, March 18 in order to reduce the need for people to go to courthouses. MHA had raised with the courts concern from hospital systems about how commitment hearings would proceed in the event that access to courts was limited. The standing order for the District Courts and the Boston Municipal Court allows commitment hearings to occur via videoconferencing.


Travel and Meeting Policies Changed

MHA joined many other government entities and private businesses in curtailing employees business travel, urging workers to forego national and international travel, and shifting all face-to-face meetings that involve more than 10 people to conference calls or webinars. MHA employees that travel to one of the “Level 3” countries must self-furlough for 14 days before returning to work. Beginning today, MHA employees are encouraged to work from home.


School Closures Raise More Questions

“Social distancing” may be the best way to curtail the spread of the novel coronavirus. But as school districts yesterday were ordered closed for three weeks, the parents of children – many of them employed by the commonwealth’s important healthcare sector – may need to stay at home to care for their youngsters. Can daycare rules be waived to allow medical facilities to set up child care centers? What are the other options? MHA is investigating the issue with the state and its membership.

MassHealth Issues Two Important Bulletins to Assist Virus Fight

MassHealth released two bulletins (All Provider & Managed Care) regarding changes to MassHealth coverage and services in light of the state of emergency declared in the commonwealth due to COVID-19. The bulletins are in effect for the duration of the state of emergency.
The first all-provider bulletin applies to MassHealth members enrolled in MassHealth Fee-for-Service, Primary Care Clinician plan or Primary Care ACOs. Among directive included in the bulletin, MassHealth is: expanding presumptive eligibility for patients testing positive for COVID-19 and covering their medically necessary lab tests; expanding coverage for all telemedicine services, not just those relating to COVID-19; expanding the services it will cover in the home health setting; establishing new billing practices when hospitals need to quarantine patients testing positive for COVID-19; and allowing a 90-day supply of certain medications to be dispensed.
The managed care MassHealth bulletin directs managed care plans to: establish dedicated call centers to respond to inquiries about COVID-19; align with the Division of Insurance’s recent guidance regarding relaxing referral, prior approval, and out-of-network requirements to ensure timely access to testing and treatment; cover testing, treatment and prevention of COVID-19 to the same degree as the MassHealth fee-for-service program; and refrain from imposing any referral requirements for testing or treatment related to COVID-19.
“By removing barriers and easing the worries of enrollees, these administrative moves from the state will ensure that people will seek needed treatment, said Steve Walsh, the president & CEO of MHA. “The expansion of telemedicine coverage for all services is an especially important move that will greatly help healthcare providers and protect patients. MassHealth and the Executive Office of Health and Human Services deserve our thanks for these important bulletins.”

Telemedicine Seen as Way to Help in COVID-19 Fight

If you need medical care but want to reduce potential viral exposure through a crowded doctor’s office waiting room or a hospital ED, what do you do? To many on the public health front, the answer is telemedicine – that is, contacting your provider online and getting a “virtual” examination.
Telehealth already exists, is being deployed vibrantly, but has always been constrained by insurance companies’ barriers to reimbursement.
In addition to Governor Baker's Sunday directive to commercial health insurance companies and the Group Insurance Commission to cover all medically necessary telehealth services at the same rate as in-person care, the federal government has acted. Last week's $8.3 billion supplemental budget for COVID-19 that the president signed allows the Secretary of Health and Human Services to remove telehealth restrictions for Medicare beneficiaries. The new ruling is limited in that it requires that the provider must have “a previous relationship” with the patient for Medicare to cover the consultation. The new rule also appears to not extend the acceptable “originating sites” to a patient’s home; that means the care can be provided to Medicare patients but providers will not get paid for it. Such “free” services raise other regulatory concerns.
MassHealth last week issued a more favorable bulletin relating to coverage under the state’s Medicaid program (see related MassHealth story). And the Division of Insurance recently issued a bulletin directing commercial health insurance companies to “promote tele-health options” including removal of applicable cost-sharing for such services related to screening, evaluation, diagnosis and/or treatment for COVID-19. Keeping as many people at home to get care frees up needed space in hospitals for those afflicted by COVID-19. MHA has been a strong advocate for the expansion of telemedicine.

Out of State Nurses to Be Licensed in a Single Day in Mass.

An important version of an MHA priority – the Nurse Licensure Compact – is now in place in Massachusetts under Governor Charlie Baker’s state of emergency order.
Out-of-state nurses and other medical professionals will now be licensed in just one day by the state’s medical registration boards as long as they have the necessary paperwork in order, Baker announced last Thursday. 
A similar concept – the Nurse Licensure Compact (NLC) – allows R.N.s to have one multistate license from the state in which they reside, with the privilege to practice in their home state and all others that are members of the Compact.
Hospitals praised Baker’s quick-license move, saying it would help alleviate what could be large disruptions in the healthcare workforce if COVID-19 spreads as rapidly as expected.

Community Benefits: Beth Israel Deaconess Hospital-Plymouth

As Massachusetts hospitals lead the fight against COVID-19, it’s important to remember that each day they are involved in strengthening their communities through their community benefit program outreach.
Knowing that the onset of substance use disorders can occur during adolescence, Beth Israel Deaconess Hospital-Plymouth (BID-Plymouth) and Plymouth Public Schools are collaborating by taking a proactive approach to address the risk with a targeted program called Preventure.
Preventure is an evidence-based prevention and education program that uses personality testing to identify, understand, and prevent youth from engaging in destructive behaviors, and to strengthen mental well-being and skill development. The program has been shown to be effective in delaying the onset of adolescent substance use as well as reducing the frequency of drug misuse, binge drinking, and other alcohol-related problems.
In addition to funding the program at Plymouth Public Schools, BID-Plymouth provides a part-time hospital social worker, trained in Preventure program, to educate school counselors and staff about the program.
In FY18, 486 eighth-grade students were screened, with 250 identified as potential program participants, and of those, 40 students enrolled. In FY19 the participation rate doubled, with 80 students going through the program.
According to the Attorney General’s Office, Massachusetts hospitals provided $641 million in community benefits for residents of Massachusetts in Fiscal Year 2018. These hospital community benefits programs – provided at no cost to those being served – are not reimbursed by state or federal governments, by any health insurance company, or through any public subsidy. View community benefit stories from across Massachusetts in this MHA Commitment to Community publication.

CMS' New Price Transparency Rule: What Hospitals Need to Know

Tuesday, April 21; 1 to 2 p.m.


After reviewing public comments, CMS has released the price transparency final rule and it is effective January 1, 2021. 2020 is now a critical year for hospitals and health systems to prepare to publish pricing for items and services – and to understand how this will affect your organization going forward. This webinar will review hospitals' obligations for posting standard charges in a machine-readable format and for posting 300 "shoppable services" in a consumer-friendly format. We will also provide an update on the lawsuits filed against the U.S. Department of Health and Human Services to block the final rule from going into effect in January 2021. Click here for more information, including registration details.

John LoDico, Editor