The Commonwealth of Massachusetts has established the first dedicated skilled nursing facility to care for patients who have been diagnosed with COVID-19, are stable, but still need nursing facility level of care. Moving such patients from acute care hospitals will free up beds for the anticipated surge of patients in the coming weeks.
 
EOHHS Secretary Marylou Sudders on Friday announced the designation of Beaumont Rehabilitation and Skilled Nursing Center in Worcester as the first such dedicated site. Patients without COVID-19 that already are in the dedicated facilities are being moved to other facilities in the area where they can continue to receive nursing care.
 
Sudders wrote, “Implementing these transfers will require significant coordination between the commonwealth, hospitals, nursing facilities and chronic disease rehabilitation facilities as well as resident communities and families.”
 
She added that the commonwealth is actively seeking additional facilities to serve as COVID-19 sites of care. The hospital community in recent calls with Sudders had stressed the potential bottleneck of hospitals having to provide nursing-level care in the midst of a massive influx of patients. MHA praised EOHHS, Beaumont, and all nursing facilities across the state in addressing the challenging post-acute care situation.

CMS on Saturday announced the expansion of its accelerated and advance payment program for Medicare participating healthcare provider, including hospitals and physicians.
 
Accelerated and advance Medicare payments address cash flow issues based on historical payments when there is disruption in claims submission and/or claims processing. These expedited payments are typically offered in natural disasters to accelerate cash flow to affected healthcare providers and suppliers. Medicare will start immediately accepting and processing Accelerated/Advance Payment Requests that are submitted to the appropriate Medicare Administrative Contractor (MAC). CMS anticipates that the payments will be issued within seven days of the provider’s request.
 
Qualified providers/suppliers must request a specific amount to be paid using an “Accelerated or Advance Payment Request” form provided on each MAC’s website. Inpatient acute care hospitals, children’s hospitals, and cancer hospitals can request up to 100%, and Critical Access Hospitals can request up to 125% of their historical Medicare payment amount for a six-month period. Most other providers and suppliers will be able to request up to 100% of their historical Medicare payment amount for a three-month period.
 
Repayment of the accelerated/advance payment begins 120 days after the date of issuance of the payment.
 
An informational fact sheet on the accelerated/advance payment process and how to submit a request is here.

MassHealth issued All Provider Bulletin 291 last Friday, which delves deeply into the complex components of the state’s Medicaid program and how those components are being relaxed or altered to deal with the COVID-19 crisis. Many of the changes in the bulletin respond to the requests MHA made to MassHealth on March 17 on behalf of its membership.
  
The new Bulletin 291 supplements or modifies the recent Bulletin 289. Among the changes are the following:
  
• An eligible distant site provider rendering covered services via telehealth may bill MassHealth a facility fee;
• MassHealth is further expanding its Hospital-Determined Presumptive Eligibility (HPE) process to allow qualified hospitals to render HPE determinations for all individuals – not just potential COVID-19 patients;
• If, due to a variety of circumstances, an Emergency Service Program (ESP) is unable to respond to MassHealth members in the ED, then a qualified behavioral health professional in the hospital itself can provide behavioral health crisis assessment and intervention in lieu of the ESP, and the bulletin provides a mechanism for the hospitals to bill for these services;
• MassHealth members enrolled in the Primary Care Clinician (PCC) Plan or a Primary Care ACO do not need a referral to receive any MassHealth covered service that would otherwise require a referral. (EOHHS is also expecting its MassHealth MCOs and Accountable Care Partnership Plan ACOs to follow suit); and
• MassHealth will not require pre-admission screening of individuals seeking admission to Chronic Disease and Rehabilitation Hospitals (CDRH). Instead, a CDRH may admit a member after submitting a notification of admission packet to MassHealth, with specific additional documentation.
This week many hospitals will begin receiving cash advances from MassHealth to address funding needs caused by significant reductions in revenue due to the elimination of elective surgeries and the decline in hospital visits generally.
 
“We commend Acting EOHHS Secretary Dan Tsai, Acting Medicaid Director Amanda Cassel Kraft, and Secretary Sudders and their team for a very thoughtful, nimble, and impactful response that will assist patients and providers in these very difficult times,” said MHA President & CEO Steve Walsh.
 
MHA is still attempting to receive word from commercial health insurers on how they plan to similarly address these funding needs and administrative burdens.

The state has announced the launch of Buoy Health’s online resource that allows residents to check their symptoms, figure out if they should be tested for coronavirus, and learn about care options available to them. This tool doesn’t replace medical care, but it helps connect people to appropriate care if they begin to feel the symptoms of COVID-19. It takes pressure off hospital EDs and physician offices, which have been imploring people who think they may be sick to contact their healthcare provider before showing up for care and potentially spreading the virus. The 24/7 Buoy Health tool is free for Massachusetts residents. 

Responding to a request from the hospital community, the state last week issued an order allowing more flexible, independent practice by Advanced Practice Registered Nurses (APRNs). The order from DPH Commissioner Monica Bharel, M.D. (who announced on Friday that she had contracted COVID-19) allows APRNs with at least two years of supervised practice experience to be exempt from physician supervision and written guidelines for prescriptive practice. Those APRNs with less than 2 years of supervised practice experience may engage in prescriptive practice with physician oversight as currently required by law. If that APRN during the state of emergency collaborates with a different M.D., the workaround in this order allows the APRN to work under any physician as long as they both have a signed record. The order applies to all types of APRNs except for certified nurse midwives. Regular limitations on scope of practice interfere with the rapid and agile provision of care needed during emergencies.

The commonwealth has unveiled a new website – MA Responds – to register public health, healthcare, and emergency response volunteers. The website requests that licensed or certified healthcare providers, public health professionals, retirees, or individuals with an interest in helping the community complete a secure, online registration process. While the focus is on healthcare workers, MA Responds will process registrations from non-health volunteers as well, noting that “because many health professionals may already be committed to a role during an emergency, many areas are actively recruiting non-health volunteers who will assist when the need arises.” MHA will coordinate with its membership, Mass. Medical Society, the Mass. League of Community Health Centers, and other stakeholders to help determine where best to deploy the volunteers.