The Massachusetts Senate has unanimously passed a healthcare reform bill – S.2769, An Act Putting Patients First – that advances telehealth and scope of practice, among other items.

Of particular note, the final bill adopted an MHA-priority amendment – #28 from Sen. Jason Lewis (D-Winchester) – that struck language disallowing providers from charging a facility fee for telehealth care. While the bill did ultimately allow insurers to use prior authorization for telehealth, new language added through the amendment process requires the Health Policy Commission (HPC) to examine, in its telehealth report, the effect of prior authorization or other utilization management tools on access to telehealth care and to issue recommendations for appropriate limitations on those tools to ensure access. The legislation establishes a flexible definition of telehealth, which includes synchronous and asynchronous technology and audio-only telephone, and guarantees reimbursement for telehealth services on par with in-person visits for two years in order to promote social distancing and conserve personal protective equipment. It also allows for proxy credentialing for healthcare providers who use telehealth services in order to reduce the paperwork burden of providing care to patients. These provisions have been long-time priorities of the MHA-led tMed Coalition.

The final legislation also included language to charge the HPC with determining that its recommended rates for out-of-network services do not have a negative effect on the delivery of care by providers serving communities that experience health disparities as a result of race, ethnicity, or socioeconomic status. Additionally, the Senate adopted an amendment to expand advance practice registered nurse (APRN) scope of practice for voluntary mental health commitments and to extend existing commitment liability protections to include qualified APRNs.

MHA issued a statement after the bill’s passage last Thursday, saying it appreciates the Senate’s efforts to build upon the lessons learned during the COVID-19 pandemic. “The expansion of telemedicine has been a fundamental part of our response to this public health crisis, and today’s vote is further confirmation that it must be a permanent part of our healthcare future,” MHA wrote. “We are especially grateful that reimbursement parity was included in the final bill, which will help providers sustain telehealth advances for the long-term. As we continue to grapple with the impacts of COVID-19 and a looming second wave, we thank the legislature for their commitment to the healthcare community and our patients.” MHA will continue to work to secure the gains made during the COVID-19 crisis relative to telehealth and scope of practice expansion.

The restrictions on what services hospitals can offer were loosened last Wednesday as DPH Commissioner Monica Bharel issued an order allowing “non-essential elective invasive procedures,” which includes elective cosmetic procedures. Before beginning such procedures, hospitals must attest to meeting Phase 2 guidelines relating to clinical, capacity, safety, and governance requirements. The order took effect immediately and will remain in place until either the DPH Commissioner rescinds it or the governor lifts the state of emergency.

he Massachusetts eHealth Collaborative (MAeHC), which has led or been involved in many state and national health information technology initiatives over the past 15 years, is ending its operations this year. While it has sold or transferred many of its assets, MAeHC is initiating a request for proposal (RFP) process to help it distribute some of its cash reserves.

“As those of us at MAeHC close our final chapter, we are still looking to the future by ensuring that other organizations can continue to innovate on the unique foundation of HIT assets our organization has built over the years,” said Christopher Matarazzo MAeHC president and CEO.

To be considered for the funding, Massachusetts-based Section 501(c)(3) charitable organizations will need to demonstrate the ability to use information technology innovations to take healthcare to the next level. MAeHC anticipates awarding several grants up to $250,000 each to selected organizations. Qualifying organizations may apply independently or in collaboration. Here is the grant application form.

MAeHC has sold certain assets to Arcadia, a Burlington, Mass-based population health management organization. The majority of the MAeHC workforce transitioned to Arcadia. MAeHC has also assigned the New England Healthcare Exchange Network, Inc. (NEHEN) contract to the Massachusetts Health Data Consortium (MHDC).

The state’s Division of Insurance (DOI) has once again issued guidance to the state’s commercial health insurance companies, reminding them to ease their red tape with providers during the COVID-19 crisis. DOI Bulletin 2020-21 follows similar directives relating to health plan administrative processes, which have become especially burdensome during the pandemic as hospital administrative staff has been cut back and the influx of COVID-19 patients increased rapidly.

Following a joint request from MHA and the Mass. Medical Society, DOI directed the health insurers to forego prior authorization reviews or concurrent reviews for any scheduled surgeries and behavioral health or non-behavioral health admissions at acute care and mental health hospitals for a period lasting through September 30. It requested that health insurer resources be directed to assist hospitals with discharge planning, that insurers allow hospitals more time to respond to claims review information, and that they delay audits of hospital payments. DOI also reiterated its directive from a previous bulletin that insurers “develop processes that expedite health plan credentialing.” All of these provisions had been set to expire on June 30.

MHA was instrumental in bringing to DOI’s attention the health insurers’ continuing practice of conducting retrospective reviews of COVID-19 care. DOI noted that it had already declared that it is “not appropriate” for insurers to require prior authorization of COVID-19 treatment. In the recent bulletin, DOI added that it “would also not find it appropriate for carriers to conduct any retrospective reviews to deny emergency or inpatient hospital services that were provided to treat COVID-19 during the declared state of emergency as being ‘not medically necessary’ when rendered to an insured individual for the purpose of treating COVID-19.”

On the national insurer front, patient advocates last week expressed concern that patients with lingering COVID-19 ailments – respiratory problems, infections, etc. – are getting hit with large insurance bills. While national policy has encouraged coverage for COVID-19 care, coverage for related care of ailments that are caused by the coronavirus may not be offered. Some of the problem depends on how post-virus-related care is coded.

In an important step to reduce the national problem of clinician burnout, the Centers for Medicare & Medicaid Services (CMS) last Tuesday announced the creation of the Office of Burden Reduction and Health Informatics that will be dedicated to reducing healthcare regulatory and administrative burden. CMS said the announcement “permanently embeds a culture of burden reduction across all platforms of CMS agency operations.”

The new office covers CMS’s efforts across Medicare, Medicaid, the Children’s Health Insurance Program and the Health Insurance Marketplace to decrease the hours and costs clinicians and providers incur for CMS-mandated compliance. The office will also increase the number of clinicians, providers, and health plans CMS engages to get a wider range of stakeholder feedback. “Fostering innovation through interoperability will be an important priority,” CMS wrote, “and the office will leverage technology and automation to create new tools that allow patients to own and carry their personal health data with them seamlessly, privately, and securely throughout the healthcare system.”

Efforts in Massachusetts have addressed clinician burnout and have shown how administrative processes can contribute to burnout. For example, the Massachusetts Medical Society – Massachusetts Health & Hospital Association Joint Task Force on Physician Burnout published a paper in 2019 that identified inefficient electronic health records as one of several leading causes of burnout among healthcare providers. The same task force later published a paper entitled Changing the EHR from a Liability to an Asset to Reduce Physician Burnout, which included more than a dozen practical EHR optimization techniques an organization can take to improve the usability of the EHR and its associated workflows to reduce the administrative burden. The MMS-MHA Task Force on Physician Burnout is pivoting in 2020 to also address stress and anxiety related to dealing with the COVID-19 pandemic, as well as the burden systemic racism adds to both clinicians and patients.

A judge in the United States District Court for the District of Columbia has ruled that CMS can compel hospitals to disclose their privately negotiated charges with commercial health insurers. The American Hospital Association (AHA) had brought suit against the government, arguing that U.S. HHS does not have the statutory authority to order the mandate and that revealing the privately negotiated rates is a violation of the First Amendment that will unduly burden hospitals and confuse patients. The rule is slated to go into effect January 1, 2021. AHA said it would appeal and would ask for an expedited hearing. Massachusetts already has a law in place since 2013 that allows consumers to get allowed amounts upon request from payers and providers.

Jim Puente, director of the Nurse Licensure Compact (NLC), will lead a series of brief webinars during which he will provide an overview of the NLC; explain E-Notify and Nursys, the national nurse licensure database; provide an update regarding the status of pending legislation in various states; and explain requirements when changing primary state of residence. Massachusetts lawmakers are considering legislation about joining the nurse licensure compact – a move that MHA strongly endorses. The webinars take place on: July 14, August 25, September 8, October 20, and November 10, 2020. All webinars begin at 3 p.m. ET and will last 30-60 minutes. Register here.

The Massachusetts DPH Division for Children & Youth with Special Health Needs is sponsoring a live online event for caregivers, parents and families of children with special health needs during the pandemic. This free webinar will provide practical, easy to follow strategies to help families be ready if a parent or caregiver should become hospitalized and someone else needs to care for their loved one in this time of COVID-19. The discussion will be led by Carrie Noseworthy and Cheryl Ryan Chan, who are community leaders, skilled in safety and person centered planning, and parents of children with disabilities. The DPH Division for Children & Youth with Special Health Needs works with families, providers, and others to support and promote good health and quality of life for all children and youth with special health needs ages birth to 22. This includes children and youth with chronic medical, physical, developmental, behavioral, or emotional conditions. The event is Tuesday, June 30, from 7:30 to 8:30 p.m. Click here to register.

WEBINAR—COVID-19: Transforming Hospital Operations under a “New Normal”
Monday, June 29, from 3-3:30 p.m. EDT

Hospitals and health systems have risen to the tremendous operational challenges in managing the COVID-19 pandemic and now face the new difficult task of transforming themselves again under a new normal. Join Chief Integration Officer of Beth Israel Lahey Health, Peter Shorett, as he discusses the changes and transformations underway at his system. During the webinar, he will discuss challenges and opportunities relating to developing system-wide guidelines and compliance protocols, improving volume recovery, and communicating and engaging effectively with patients.
 

WEBINAR-- Telemedicine Fireside Chat
Tuesday, June 30, from 12:30 - 1 p.m. EDT

When it comes to the rise of telehealth, the numbers speak for themselves; the latest reports show that telehealth usage in northeast states increased by more than 15,000% from March 2019 to March 2020. Join MHA for an interactive, virtual, fireside chat on the latest updates, trends, and challenges in telemedicine during the COVID-19 pandemic and beyond. Bernard F. Godley, M.D., lead physician executive, AMN Leadership Solutions, will lead a discussion with the current president of the American Telemedicine Association, Joseph Kvedar, M.D., VP of connected health at Mass General Brigham, on various telehealth solutions, health equity and the future of healthcare through the lens of telemedicine.

 Please look here for more upcoming MHA educational events.