08.03.2020

Easing Administrative Burden; Patients Exempt from Order

Legislature Busy in Final Week of Traditional Formal Session

The Massachusetts House and Senate advanced some major legislative initiatives last week, while also reaching an agreement to extend formal sessions through the end of the calendar year to address budget-related, conference committee, and COVID-19 response matters. Of particular note, the Massachusetts House last Wednesday unanimously passed a healthcare reform bill – H.4888, An Act to promote resilience in our health care system. The House legislation follows the state Senate’s reform bill that cleared the chamber at the end of June. Legislative leaders project that conference committee discussions on the House and Senate healthcare proposals may not conclude until the fall months.

 

The House bill contains a proposal to increase MassHealth supplemental payments to certain acute care hospitals. Like the Senate bill, it also promotes telehealth, but through a more narrow scope, limiting coverage of telehealth services that can be provided when a patient is in their place of residence. MHA with the assistance of legislative sponsors was able to get amendments approved to include “evaluation” in the definition of covered tele-behavioral health services, advance provider-to-provider telehealth, put in place a process to allow for the coverage of other remote telehealth services, and expand telehealth prescribing beyond the bill’s initial limitations. The House bill also focused, as did the Senate bill, on surprise billing and, relying on recent experiences related to COVID-19, attempts to assist providers in securing personal protective equipment (PPE).

 

While competing House-Senate healthcare bills failed to be resolved in conference during the last legislative session, this time around legislative leaders have expressed urgency in reaching a compromise agreement, which will be assisted by the expansion of the session beyond the usual July 31 deadline. MHA will continue to advocate for a bill that provides its members with all necessary tools to best protect patients, preserve PPE, and ensure that the commonwealth is able to safely navigate a potential second COVID-19 surge.

DOI to Insurers: Ease the Administrative Burden

The Division of Insurance (DOI) has once again issued a bulletin reminding health insurance companies that they have a responsibility during the pandemic to ease up on their administrative billing.
 
Bulletin 2020-25 issued on July 29 concerns the recent rapid expansion of polymerase chain reaction (PCR) and antigen testing for COVID-19, and the resultant delays in processing the tests. DOI wrote that it is aware that new laboratories are becoming available to process tests but have not yet developed administrative systems to properly bill insurers for the tests as they are conducted.
 
“In order to meet the public health need, carriers are expected to take steps that will permit covered tests to be done by such laboratories and for the related bills to be processed for the laboratories,” DOI wrote.
 
The division also said that while health insurers may currently have contracts that prohibit “pass-through” billing – that is, when a hospital or health center bills an insurer for a test that is sent out to an independent laboratory – DOI now expects those prohibitions to end.
 
“From the date that Bulletin 2020-25 is issued and for the duration of the public health emergency, the Division expects carriers to relax these provisions for the processing of PCR and antigen tests,” DOI wrote. Insurers are also expected to pay the provider the same rate for the test that they would pay the external laboratory, without adding on an additional charge for processing the claim.
 
Throughout the pandemic, DOI has issued numerous bulletins stressing the need for insurers to stop conducting business as usual.
 

Governor’s Travel Order Doesn’t Restrict Patients Seeking Care

Massachusetts hospitals – especially Boston teaching hospitals – reported recently that Governor Baker’s recent order effective August 1 requiring most travelers to the state to self-quarantine has caused some confusion for out-of-state patients seeking care in Massachusetts.
  
The governor’s order specifically excludes: “Patients who are traveling to Massachusetts to seek or receive specialized medical care from a physician located in the Commonwealth and persons accompanying and providing needed support to the patient.”
  
The medical community endorses the commonwealth’s strong social distancing requirements that have, to date, reduced the spike of COVID-19 cases that other states have experienced. But hospitals are assuring local patients and those from across the U.S. seeking the renowned care that Massachusetts hospitals provide that the facilities here are open and safe, and that travel to them is allowed.
 

State Launches Mask Up MA! Campaign

The state last Friday launched the Mask Up MA! campaign to encourage people to wear a mask or face covering in public to slow the spread of COVID-19 and to help keep the commonwealth headed in the right direction in the fight against the pandemic. Here is the kickoff video from the governor, which in coming weeks will be joined by videos from other notable personalities donning a face mask. MHA will help advance the campaign through its social media channels and has encouraged its members to do the same. Here is the campaign website. 

On-Demand Webinar Helps Caregivers Attest to State Requirement

Massachusetts Chapter 220 of the Acts of 2018 requires all physicians, physician's assistants, registered nurses, and practical nurses, who serve adult populations to complete a one-time course on the diagnosis, treatment, and care of patients with cognitive impairments, including, but not limited to, Alzheimer's disease and dementia. An MHA-produced, on-demand webinar will help caregivers attest to meeting the state requirements. The course is one hour long and may be downloaded and reviewed at the caregiver’s convenience. Expert faculty provide succinct, detailed considerations for caregivers and clinicians who serve aging adult populations. Today more than 5.8 million Americans are living with Alzheimer's disease. This course reviews important topics in Alzheimer's and related dementias, including guidelines for diagnosis and treatment as well as care management best practices. Click here to learn more and register.

HHS Reporting Request Receives Further Criticism

The new COVID-19 reporting system that U.S. Health & Human Services (HHS) recently foisted on hospitals and states is receiving even more criticism from officials in Washington and Massachusetts.
 
Last week, U.S. House Ways & Means Chairman Richard Neal (D-Mass.) sent a letter to HHS outlining his concerns, writing, “Creating an entirely new data platform called HHS Protect and shifting the reporting of such data away from the CDC towards a private contractor, which HHS did not publicize before it was reported in The New York Times raises important questions about the accessibility and accuracy of such data going forward.”
 
Last Tuesday, Massachusetts Attorney General Maura Healey and 21 other attorneys general urged HHS to restore the CDC to its role as the primary authority over, and source of information about, the nation’s public health data. In the letter to HHS Secretary Alex Azar, Healey and the other AGs wrote, “Your abrupt decision to bypass the CDC in this national crisis – made without public input and apparently without planning by public health and hospital experts – harms the nation’s ability to track and respond to the pandemic, hampers state and local public health authorities’ efforts to address the crisis in their communities, risks compromising the health data of millions of Americans, and undermines public confidence in any reports about COVID-19 coming from the federal government.”
 

Last Look at the Plan Finances Before COVID-19 Hit

MHA’s Semi-Annual Health Plan Performance Report was sent to the association’s members last week. The report, which covers the period between January 2015 and December 2019, presents an analysis of the financial position of health plans in Massachusetts by looking at a variety of measures, including: plan membership, premium rates, medical and administrative expense trends, and profitability, liquidity, and solvency statistics. It gives providers information about health plan market share, and it presents trends in premium rates to employer groups. The report includes figures important to evaluate a plan’s financial condition: net worth, net income, total premium revenues collected, and medical expenses. Of the 10 plans operating in Massachusetts that are covered in the report, all but two had positive profit margins in 2019.

CHIA Report Tracks Monthly Enrollment Under COVID-19

The Center for Health Information and Analysis (CHIA) is now producing monthly enrollment data summaries to help keep abreast of the changing marketplace under COVID-19. The latest data shows a decline of 0.9% in commercial insurance coverage between March and May 2020. In April and May, individuals with primary MassHealth coverage grew by more 35,000, or approximately 1.5% each month. The CHIA report notes, “Medicare coverage, which has generally grown steadily over time at 1.5% annually, declined slightly between March and May.”

Webinar Tomorrow Helps You Prepare for Falls Prevention Week in Sept.

The National Council on Aging is holding a webinar tomorrow, Tuesday, August 4, at 2 p.m., to help interested parties prepare for Falls Prevention Awareness Week during September 21-25, 2020. The webinar will discuss the Council’s new interactive assessment tool, and will present ideas, resources, and innovative partnerships to maximize the 2020 observation of Falls Prevention Awareness Week. Click here to register.

Virtual Webcast: The Final 2021 Inpatient Hospital PPS Rule

Tuesday, September 22; 11 a.m. – 2 p.m. EDT
(Please note, this is a new date for the program)

 
Join MHA’s annual program to review the final IPPS inpatient rule. We’ll cover all of the critical changes and updates important to hospitals. Learn from expert speaker Valerie Rinkle during this virtual session as she covers updates surrounding IPPS 2021. The webcast will include engaging virtual components such as breakout sessions and polls. Learn about current and future policy changes including: 
  
• Financial updates to standardized amounts, changes to codes and MS-DRG groupings;
• New technologies approved for add-on payment and how to ensure appropriate payment, given caps;
• Uncompensated care, including codification of bad debt policies that would affect charity care and disproportionate share; and 
• Market-based pricing, including a new requirement to report median negotiated payment rates via the cost report and plans to use the data for 2024 rate setting.

Click here for more information and to register.
 

John LoDico, Editor