Last week, Governor Charlie Baker released his FY2022 state budget proposal totaling $45.6 billion, which is $300 million less than FY21 spending. The plan does not include any tax increases to residents but does impose an excise tax on opioid manufacturers and transfers $1.6 billion from the Rainy Day fund to help balance the state’s books.
  
The governor proposes changing the current hospital assessment that is a critical factor in financing the state’s Medicaid and Health Safety Net programs. Prior to FY2017, the acute hospital assessment had been $160 million annually to help fund the Health Safety Net. Beginning in FY2017 through September 2022, hospitals are assessed an additional $257.5 million annually (for a total of $417.5 million) which is used to support new payment programs created through the federal Medicaid waiver, including funding investments for Accountable Care Organizations as well as supplemental payments to hospitals. Now, the Baker Administration is seeking to increase the $417.5 million assessment by $100 million in FY22 to support the Medicaid program and additional payments to hospitals – bringing the acute hospital assessment to $517.5 million. The administration’s proposal also addresses the assessment in FY2023, which under current law sunsets to the original $160 million in alignment with the Medicaid 1115 waiver renewal and therefore needs to be revisited given its importance to the program and hospitals.
  
The governor’s FY2022 MassHealth budget proposal is funded at $17.569 billion – or 3.4% less relative to FY2021 – but that FY22 budget figure could change. After the document was drafted, the Biden Administration announced that it would likely extend the COVID-19 public health emergency (PHE) throughout all of 2021. As the PHE is extended, so is the temporary 6.2% increase in the Medicaid Federal Medical Assistance Percentage (FMAP) that states can use in their budgeting; Baker’s FY22 budget had not assumed the extension of the FMAP increase.
  
The budget proposal also invests an additional $357.3 million to address substance use disorder – a 7% increase from the FY2021 general appropriation. It would also impose an excise tax on opioids distributed in the commonwealth and penalize drug manufacturers for excessive price increases.
 
"MHA and our members are grateful for the funding that the Baker Administration through its proposed FY22 budget has committed to the healthcare system and its continued COVID-19 response," said MHA's V.P. of Government Advocacy Emily Dulong. "We are particularly pleased to see the investments devoted to behavioral health and substance use disorder, as these health needs in communities have only intensified during the pandemic. Support from Massachusetts political leaders will continue to be vital for providers as we strive together toward a new normal in the coming year." 
  
The governor’s proposal is the opening step in the state budget process; the budget proposal from the House is expected in April, and from the Senate in May.
  

It’s all about supply.
  
There are more people in Massachusetts and the U.S. that want the vaccine than there are doses of the vaccine available. Last week, when the commonwealth opened up the availability of vaccines to a new group of people – initially, those over age 75 – the supply-and-demand issue resulted in dismay from people who had trouble finding an open appointment slot.
  
Another concern that arose is that the only way to book an appointment last week was by going online. However, many residents over age 75 are not computer savvy, meaning they had even more trouble scheduling a vaccination. Governor Charlie Baker announced last week that the state intends to set up a vaccine call center this week to alleviate that appointment access problem.
  
The state estimates that as of this week there are nearly 1 million people in the state eligible to receive the vaccine under the current phased-in list. As the state expects to receive 100,000 doses a week, up from 80,000 due to the Biden Administration’s increases to state allotments, there’s a big discrepancy between the number of people who need doses – two doses – and the amount of vaccine the state is receiving. Baker said last Thursday, the state hopes to receive 305,000 doses per week by February 15.
  
Each Thursday going forward, after the state receives from the federal government its expected allocation for the following week, the state’s four mass vaccination sites will post their vaccine appointment book. That book contains tens of thousands of available slots. (The state hopes to eventually have seven mass vaccination sites.) Throughout the week, smaller vaccine sites such as CVS and Walgreen stores, will post their open slots for eligible populations. Hospitals, which have been taking the lead in vaccinating their staff and other healthcare workers, have begun communicating with their patients about how they will be notified of vaccine availability and how to schedule an appointment when the vaccine supply grows. Many upcoming slots at all locations, however, must be reserved for individuals who are receiving their second vaccine dose. It’s all a matter of having patience and repeatedly refreshing various websites to find an open slot. The state says in a notice about the vaccine to those 75 and over “it may take several weeks to get an appointment at a location near you.”
  
Governor Baker said last week that “we’re talking about huge numbers” of vaccines. But he said even if President Biden fulfills his goal of providing 100 million vaccines in 100 days, that would mean that by May 1, 50 million people (100 million divided by two doses) would be vaccinated out of a U.S. population of 350 million.
  
Last week, concern about the supply chain was eased a bit by the announcement from Johnson & Johnson that its Phase 3 clinical trials of its vaccine showed a 66% effectiveness rate globally and a prevention rate of 85% for severe cases worldwide. The company said it would apply for FDA authorization for the vaccine this month. Dr. Dan Barouch, director of the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center, was a leading partner with Johnson & Johnson on development of its vaccine, which uses technology developed by his team a decade ago.
  

People getting a vaccine don’t have to pay for it, but they are encouraged to bring their insurance card to wherever they are getting the shot so the provider can bill the appropriate insurer. But what about the uninsured? Massachusetts has one of the best insurance rates in the U.S. – a full 97% of individuals have some form of public or commercial coverage – but for the remainder, some providers have expressed uncertainty about who to bill. Last week, the state reminded providers that if they give the vaccine to an uninsured individual, they can visit the federal Health Resources and Services Administration (HRSA) to fill out a reimbursement form.

DPH posted this great tweet last week featuring Dr. Mark Johnson, a neurosurgeon with UMass Memorial Health Care, encouraging people to get vaccinated. Johnson said while many people may have concerns, he noted that it went through rigorous testing and is safe. 
 
Johnson himself received the vaccine and told those on the fence about it: “Trust the facts and get the vax.” Expect similar messages from other trusted authorities in the coming weeks

A week before the end of the Trump Administration, the U.S. Department of Health & Human Services (HHS) announced it would end the so-called “X-waiver” requirement that physicians undergo 8-hours of training before being allowed to prescribe buprenorphine in the treatment of opioid use disorder. Physicians and behavioral health advocates generally hailed the decision as a way of getting more physicians authorized to treat more patients with opioid use disorder more quickly.
  
But last week, the new Biden Administration halted elimination of the x-waiver. A statement posted on the Substance Abuse and Mental Health Services Administration website noted that announcement of the x-waiver elimination “was made prematurely.” The statement said that HHS and the Office of National Drug Control Policy “are committed to working with interagency partners to examine ways to increase access to buprenorphine, reduce overdose rates and save lives.”

President Biden signed an executive order on January 28 directing any federal government department with purview over Medicaid and the Affordable Care Act to review any regulations that could be a barrier to enrollment in healthcare coverage. The order also directs U.S. Health & Human Services to consider establishing a new enrollment period for uninsured and under-insured Americans to seek health coverage. 
  
The regulatory review does not in itself rescind orders that previous administrations may have imposed; rather, it identifies specific policies and practices that could be rescinded or altered in the future by regulatory action. As such, the agency review will present a good indication of the new administration’s healthcare priorities. The order specifically encourages reviews of “demonstrations and waivers” that may reduce coverage or undermine the ACA and the Medicaid program.

Cooley Dickinson President and CEO Joanne Marqusee will leave her post at the end of February to become executive vice president and chief integration officer for Wellforce, the healthcare system consisting of, among other entities, Circle Health (including Lowell General Hospital), Tufts Medical Center, MelroseWakefield Healthcare, and the physicians of New England Quality Care Alliance, Lowell General Physician Hospital Organization, and Hallmark Physician Hospital Organization.
  
Steve Roach has been named president of UMass Memorial HealthAlliance-Clinton Hospital, after serving as the facility’s interim president since the fall of 2019 when he succeeded Deborah Weymouth. Roach will also continue as president of UMass Memorial's Marlborough Hospital, a role that he has held since 2013. 
  
Tom Croswell, the CEO of Tufts Health Plan since 2016, announced last Thursday that he will retire in the summer of 2021. Following the merger of Tufts Health Plan and Harvard Pilgrim Health Care in January 2021, Croswell became CEO of the combined organization and Harvard Pilgrim’s President & CEO Michael Carson became president of the merged companies.