Funding Threat Eliminated, Vaccine Distribution , and more ...

MFAR Finally Terminated

Last Thursday, CMS Administrator Seema Verma announced she had officially withdrawn the Medicaid Fiscal Accountability Rule (MFAR) from the Federal Register, meaning that the much-derided proposal that limits the way states can finance their Medicaid programs will not be inflicted on hospitals in the final days of the Trump Administration.
If enacted, MFAR would have placed at risk the supplemental payment methodologies that states like Massachusetts use to maximize the federal Medicaid match. MFAR also would have hampered the state from rightly claiming federal revenue for Medicaid-covered services across state agencies such as the Departments of Public Health and Mental Health. MHA and the Baker Administration vigorously opposed MFAR.
In September 2020, CMS announced it would withdraw the rule, but MFAR was technically still able to be imposed until Verma’s action last week. Given the profound instability of the Trump Administration and its ability to wreak further havoc until 12 p.m. on January 20, CMS’ MFAR action came as welcome relief to healthcare interests.

Massachusetts Takes Telehealth Step; More Federal Work Needed

Now that Massachusetts has taken some very progressive telehealth steps forward through the enactment of Ch. 260 of the Acts of 2020, An Act Promoting a Resilient Health Care System that Puts Patients First, advocates are turning their attention to the federal level to improve Medicare’s telehealth provisions.
The bill that Governor Baker signed in December permanently mandates telehealth coverage parity across all payers – including MassHealth and the Group Insurance Commission. (Parity provisions are in place under the governor’s executive pandemic orders; the new law will codify many of those orders when they expire.)
Notably, the law requires MassHealth and commercial insurers to provide permanent coverage of tele-behavioral health services to be reimbursed on par with in-person services. Additionally, primary care and chronic disease management services (including cancer, stroke, and coronary artery disease) will be reimbursed at the same rate as in-person services for two years from the effective date of the legislation. Telehealth is defined as both synchronous and asynchronous technologies and includes audio-only telephone.
On the federal level, there are more than a dozen telehealth bills pending before Congress that would seek to address telehealth beyond the current flexibilities that are available to providers under the public health emergency. Telehealth advocates also want to remove CMS’ antiquated geographic and originating site restrictions, which limit a provider’s provision of telemedicine outside of rural areas, and which require patients in these areas to travel to a healthcare facility (as opposed to staying at home) to receive telehealth services. The outdated geographic and originating site limits have been waived during the pandemic; proposed legislation in Congress would permanently remove the limits.
Other proposals contain provisions to allow providers to be reimbursed for providing audio-only services similar to the provisions in the Massachusetts law. The concern is that underserved communities do not have access to adequate broadband to support audio-visual telemedicine technology or do not have access to interactive audio-video devices. This “digital divide” requires the federal government to recognize that telephone – or audio-only access – is an appropriate, reimbursable way to provide quality telehealth care to patients. 

Organ Procurement Entities Merge

LifeChoice Donor Services and New England Organ Bank have merged, effective January 1. The two organ procurement organizations will retain the name New England Organ Bank and will be responsible for the recovery of organs and tissues for transplant in a service area encompassing the states of Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island and the eastern counties of Vermont. Nearly 200 hospitals are within the service area.


Among the founders of the New England Organ Bank was Nobel Laureate Dr. Joseph Murray, who in 1954 performed the first successful human transplant – a kidney from one twin to another – at Boston’s Peter Bent Brigham Hospital.

Pandemic Updates

First responder vaccinations begin today across the commonwealth. There are more than 45,000 first responders in Massachusetts, including fire and police personnel and EMTs.
The state’s capacity limits – for most businesses 25% – will remain in effect for an additional two weeks, until January 24, Governor Baker announced last week, citing the increasing COVID-19 burdens on hospitals and health systems. 

MHA President & CEO Steve Walsh endorsed the governor’s action, saying, “We cannot take the availability of our healthcare community for granted, and we have witnessed the negative consequences that arise when healthcare systems become overburdened. At this pivotal crossroad, we urge individuals to follow key safety guidelines to stop the spread of this virus, which protect our caregivers and save lives.” 
According to daily hospital reporting, COVID-19 patients in Massachusetts occupied 189 hospital ICU beds on November 12, and as of January 7 that number was 450. There were 669 patients in hospital medical/surgical beds on November 12; on January 7 there were 2,049 patients in those beds.
The American Hospital Association wrote a letter to U.S. Health & Human Services Secretary Alex Azar last week asking for urgent clarification of HHS’ vaccine distribution policy. AHA wrote, “Throughout the country, we are hearing of issues that need to be addressed, including hearing that some hospitals received far less vaccine than they requested and needed, while others received more than they could use for Priority 1 individuals, but without an explanation for this mismatch.” When HHS is asked to resolve issues, the response has not been encouraging. “It is unclear who is responsible for answering questions or by what mechanism all interested parties will receive the answers to these questions that should shape their actions going forward,” AHA wrote.

Reducing Stigma About Substance Use Disorder & Treatment

During the pandemic there has been an uptick in overdose deaths and numerous reports about increased drug and alcohol usage. As a result, DPH launched a new phase of the #StateWithoutStigMA public information campaign aimed at reducing the stigma of substance addiction that prevents people from seeking treatment. 
The new advertisements feature people from all walks of life, including healthcare providers, talking about how and why they support #StateWithoutStigMA. 
The campaign, which is funded through the Substance Abuse and Mental Health Services Administration’s State Opioid Response federal grant, has a $575,000 media buy that runs through the end of February 2021 and will be featured on TV, billboards, digital media, social media, and on display ads on public hand sanitizer stations across the state. Campaign assets also include community outreach collateral items, such as posters to help spread the word. To see the new TV ads, view this playlist.

Laura’s Law: Helping to End Needless Tragedies

Governor Baker is expected to sign the patient safety legislation known as “Laura’s Law” that requires the development of hospital standards for baseline signage, lighting and wayfinding practices to make it easier for patients to find and access emergency rooms when they are in crisis.
The bill is named for Laura Levis, a young woman who passed away from a severe asthma attack in 2016 after having difficulty accessing an emergency room. A review found that issues with lighting, signage, and a locked ambulance entrance contributed to her inability to access the ED that could have saved her life.
In response to the event, an MHA Emergency Department Access Working Group, with the assistance of Cambridge Health Alliance, in early 2020 developed these recommendations to ensure optimal access to all Massachusetts EDs. 
Laura’s widower, Peter DeMarco, has worked tirelessly since her death in 2016 to get the formal legislation passed. The bill was sponsored by Rep. Christine Barber (D-Somerville) and Sen. Patricia Jehlen (D-Somerville) who worked closely with the hospital community on the final language. 


Brigham Health President Betsy Nabel, M.D., has resigned from her post, effective March 1. Nabel has led the Brigham since January 2010. During that time Brigham and Women’s Hospital has consistently been considered one of the leading hospitals in the United States. Mass General Brigham said it will immediately initiate a succession planning process.

2021 Joint Commission Update

Thursday, January 28; 8:30 – 11 a.m. ET
Virtual Webcast

Hospitals need to stay abreast of the evolving compliance issues and shifting priorities regarding Joint Commission accreditation. At this year’s conference, we will hear from Lisa Diblasi Moorehead, associate nurse executive at The Joint Commission, and an expert on its standards. She’ll provide an update on the challenging standards from 2020 and highlight some of the new ones for 2021. We will also feature a hot-topics session and conclude the program with a panel of your colleagues from recently surveyed hospitals with the goal of sharing tips and updates about current priorities. Register here.

John LoDico, Editor