11.09.2020

A New President, New Exec. Orders, New Budget Proposal

The Joseph Biden-Kamala Harris Administration

The victory of the Joe Biden-Kamala Harris ticket in the presidential election indicates, among other things, a pivotal shift in healthcare policy in the United States, and in the fight against the pandemic.

 

Over the past four years, MHA, national hospital associations, patient advocates, and other health interests have been forced to fight the current administration over its policies that have endangered immigrants’ healthcare, the existence of the Affordable Care Act, state financing of their Medicaid programs, cost-sharing strategies to enable increased enrollment of the uninsured and underinsured, and diversity training in hospitals – among many other issues.

 

Healthcare interests have also been concerned throughout 2020 about the administration’s response to the COVID-19 pandemic, especially about its ongoing indifference to the severity of the threat and the need for basic social distancing.

 

“MHA and our members congratulate President-Elect Joe Biden and Vice President-Elect Kamala Harris on their historic victory,” MHA President & CEO Steve Walsh said on Saturday, after it became apparent Biden would become the forty-sixth President of the United States. “With our nation still in the midst of the most devastating public health crisis in generations, we are confident that their administration will mount a response that is built around science, the expertise of medical professionals, and a close partnership with hospitals and healthcare providers. Our healthcare community is eager to be a resource to the Biden Administration on the ongoing pandemic, as well as the many other issues affecting the lives of our patients.”

The Massachusetts hospital community, and the life-sciences sector of which it is an integral part, has proven time and again its ability to help devise advances in medical care, healthcare financing and access innovations, and broad-based coalitions to improve the health of individuals and communities. From all indications based on previous actions and campaign statements, a Biden Administration will be more collaborative – and not opposed – to pen to well-informed suggestions from the medical-science community.

Delayed FY21 Budget Debate Begins This Week

The Massachusetts House is expected to begin debate tomorrow on a FY21 state budget that emerged from the House Ways & Means Committee last Thursday.

The $46 billion spending bill includes a $1.55 billion withdrawal from the state's rainy day fund – $200 million more than authorized by Governor Baker’s recently revised H.2 budget proposal. It relies on $550 million in federal CARES Act funding, $834 million in enhanced federal Medicaid reimbursements, and includes many of the one-time funding proposals that were included in the governor’s budget.

 In a major portion of the budget relating to MassHealth, the House proposed budget mirrors the governor’s budget in that it provides limited reimbursement rate increases outside of targeted investments and required spending increases; most provider rates are assumed to be held flat in FY21. COVID-19 polices continue into FY21 through the state of emergency, including inpatient rate adjustments for COVID-19-related cases, although the types of cases (the APR-DRGs) eligible for the rate increases are reduced. New supplemental funding is dedicated to inpatient psychiatric services to incentivize hospitals in the hope of alleviating emergency department boarding.

After years of level funding, the House proposed budget adopts the governor’s recommended $31.07 million budget for the Center for Health Information & Analysis (CHIA), which represents a 13.3% increase relative to the FY20 appropriation. For the Health Policy Commission (HPC), the House also follows the governor’s budget recommendation of $10 million – a 1.7% increase compared to FY20. Acute care hospitals, ambulatory surgical centers, and insurers are responsible for funding the expenses of CHIA and the HPC. MHA had recommended that the FY21 hospital assessments to fund CHIA and HPC be suspended in light of the COVID-19 emergency’s effect on hospitals; however, this was not adopted in the HWM budget.

MHA Supports State’s Early Closure/Mask Orders

The state’s stricter mandates regarding COVID-19 social distancing went into effect last Friday and while some sectors of the economy – notably restaurants – pushed back on the 9:30 p.m. early closing aspects of the executive orders, the hospital community embraced the mandates as a necessary move to curb the pandemic.
 
The governor’s latest executive orders require everyone over the age of 5 to wear a mask when in a public location (even when social distancing is possible), limit the size of indoor and outdoor gatherings; and call for many businesses to close and all gatherings to disperse by 9:30 p.m. A separate Department of Public Health advisory recommends all residents of Massachusetts stay home between the hours of 10 p.m. and 5 a.m.
 
“MHA and our members fully support the measures announced by the Baker Administration, which are intended to keep our communities healthy and our healthcare system strong,” MHA President & CEO Steve Walsh said. “The commonwealth has reached yet another critical point with this virus. Now is the time to reinvigorate our focus on stopping the spread. Our healthcare organizations and caregivers are counting on those in their communities to do their part and follow the life-saving guidance put forth by state and public health leaders. They remain safe, ready, and prepared to treat all patients in need of care.”

Coalition Urges Congress Not to Lose Focus on ACA

While numerous challenges – many related to COVID-19 – face the Massachusetts healthcare community, a group of consumer advocates, businesses, insurers, unions, hospitals, doctors, community health centers, and religious groups is attempting to keep the focus on coverage and preserving the Affordable Care Act (ACA).
  
Last week, the Massachusetts Coalition for Coverage and Care, of which MHA is a member, wrote to the state’s entire Congressional delegation asking for their continued support of the ACA. 
  
“At a time when health care access is more important than ever, complete repeal of the ACA would threaten coverage for at least 375,000 low-income Massachusetts consumers enrolled in MassHealth, the state’s Medicaid program, and subsidized insurance through the Health Connector,” the coalition wrote. “The commonwealth stands to lose at least $2.4 billion, a level impossible to fill in usual times. Due to the pandemic, the state faces reduced revenues of nearly $4 billion during the current state fiscal year alone. Put simply, the combination of policy and funding changes that would result from the repeal of the ACA would have a devastating impact on Massachusetts.”
  
The delegation has been a consistent ACA supporter, which the coalition noted, adding, “We need your leadership now more than ever, and we will stand with you in this work.”
 

Proposed Transplant Rule Needs Revisions

MHA last week thanked members of the Congressional delegation who signed on to a letter to U.S. Health & Human Services Secretary Alex Azar, asking him to revise a proposed rule concerning organ donations.
  
MHA joined New England Donor Services in requesting that members of Congress weigh in on the rule that could, if enacted as is, be detrimental to the nation’s donation and transplant system.
  
Specifically, transplant sites are asking for a revision to the metrics used to determine if a site is performing well, as well as revisions to the data used to determining potential organ donors. The proposed rule relies on death certificate databases to determine suitable donors, but the varied ways such certificates are filled out and filed by differing jurisdictions makes them unreliable for determining donors, the transplant sites say.
  
Massachusetts Representatives Lori Trahan, Seth Moulton, Stephen Lynch, and William Keating signed on to the letter to Azar.
 

More Public Charge Rule Developments

The Trump Administration rule that changes the definition of a “public charge” when determining whether to approve certain immigrants seeking to live legally in the United States or obtain legal status through a green card was struck down once again by a federal district court judge in Chicago on Monday. The much-litigated rule, however, was allowed to continue on Tuesday after the 7th U.S. Circuit Court of Appeals said it would review the decision.
  
Among other factors, the rule includes the use of Medicaid as a factor in the evaluation of many individuals. MHA, along with Attorney General Maura Healey, the Baker Administration, healthcare providers, and other advocates across the country, had strongly opposed the rule from the outset, arguing that immigrants would avoid seeking care – even care they are entitled to – due to the fear of having their immigration status revoked. Various aspects of the rule have been argued in the courts – including the U.S. Supreme Court – since the rule was issued in 2019. 
  
Last week’s district court decision seemed to put an end to the issue, as the judge ruled that the entire rule expansion violated the Administrative Procedure Act. However, the appeal followed the next day. Joe Biden has said he is opposed to the Trump Administration’s expansion of the public charge rule.
 

EPIC on Cape Cod

Cape Cod Healthcare (CCH) announced last week that its new $70 million EPIC electronic health record is up and running across the system.
 
Through EPIC, the health system was able to create Cape Cod Healthcare MyChart that allows patients to view test results, schedule appointments, communicate with their caregivers, and more online.
 
Many other health systems use the EPIC system. “For Cape Codders, that means our new system will be able to communicate directly with many providers in Boston, Florida, and across our country, significantly enhancing care coordination for our patients,” said CCH President & CEO Michael Lauf.

Annual Women Leaders in Healthcare Conference

Thursday, November 12; 9 a.m.- 12 p.m.

Join the Massachusetts Health & Hospital Association at our annual conference of women leaders in healthcare. Senior experts from across healthcare will present on communication and negotiation skills, fostering inclusion and equity in the healthcare setting, and building executive leadership. The conference will feature sessions on resilience and self-care, mentoring, and redefining leadership in the “new normal.” Don’t miss out; register today.

John LoDico, Editor