The Massachusetts House released its FY2022 budget proposal last Wednesday – a $47.6 billion spending bill that is 3.9% higher than Governor Baker’s H1 proposal and is dependent on a $1.87 billion withdrawal from state reserves, compared to the governor’s $1.6 billion withdrawal from the Rainy Day fund.
  
The House Ways and Means budget, as well as Governor Baker’s proposal, does not include any of the $4.5 billion coming to Massachusetts through President Biden’s American Rescue Plan Act. State leaders have said the decision not to include the federal funding is based largely on the lack of federal clarification on how funding programs will be overseen and the need to further develop a clear strategy in a separate spending bill. 
  
Of interest to the healthcare sector, the House budget does not include Governor Baker’s proposed changes to the acute hospital assessment, which MHA strongly opposed. MHA is committed to working with the administration and legislature on an assessment program for FY2023. 
  
The House budget differs from the governor’s proposal in terms of MassHealth funding, with the House assuming more federal matching funding coming to the state, which was uncertain at the time the governor’s proposal was being drafted. With that assumption, a higher MassHealth caseload is also assumed.
  
The House Ways and Means budget makes several investments in behavioral healthcare. It includes $84 million to support the Executive Office of Health and Human Services (EOHHS) behavioral health redesign, which will support the expansion of community-based and urgent behavioral healthcare across the state. (See related story below on EOHHS's upcoming roadmap webinar.)
  
The budget includes $160 million for the Bureau of Substance Addiction Services (BSAS), including $3.5 million for five additional recovery centers in the state with geographic precedence for Gateway Cities. The budget requires the Department of Public Health (DPH) to investigate the effects of the outbreak of COVID-19 on frontline healthcare workers. In addition, it requires the DPH commissioner to establish a public information campaign to promote awareness to pharmacies and the public about the availability of 12-month prescriptions for contraceptives. (See related DOI/MHA/MMS webinar story below.) 
  
House lawmakers are expected to start debate on the budget next Monday, April 26.
  

The Health Policy Commission voted on Wednesday, April 14 to maintain the state’s healthcare cost growth benchmark at 3.1%, following a year in which COVID-19 destabilized the healthcare system.
  
The HPC’s interim report entitled Impact of COVID-19 on the Massachusetts Healthcare System found that hospital inpatient volume dropped 32% from January to April 2020. While the system bounced back a bit after the pandemic’s peak, overall admissions were 9% lower in 2020 than in 2019. Yet the severity of cases was higher; overall, the number of ICU/CCU days increased 10% from 2019 to 2020, even as the number of admissions was lower. 
  
Federal relief helped hospitals and health systems, but the HPC reported that some hospitals, particularly community hospitals and community high public payer hospitals, had negative margins in FY 2020 even with relief funding preventing greater losses. Health insurance companies did better. The HPC reported that Massachusetts-based commercial insurers retained a greater amount of their premium income in 2020 than in the previous two years. Across Massachusetts-based insurers, fully insured premium revenue increased by 2.3% ($10.7 to $10.9 billion) from 2019 to 2020, while medical claims expenditures decreased by 1.9% ($9.5 to $9.3 billion).
  
On the behavioral health (BH) front, the HPC report states that BH-related ED visits were 16% lower in January to September 2020. “However, the percentage of these visits resulting in ED boarding (waiting over 12 hours in the ED) increased, from 27% of BH-related visits over those months in 2019 to 29% in 2020,” the HPC wrote. “The percentage of BH-related ED visits resulting in ED boarding increased throughout the pandemic, reaching 31% in September. The rate of ED boarding was highest among pediatric patients.” The report also tracked the remarkable rise in telehealth throughout the pandemic and its importance in treating behavioral health patients.
  
MHA agreed with the HPC’s decision not to lower the benchmark. Steve Walsh, MHA president and CEO, said of the HPC’s findings, “The report also confirms what our providers are seeing on the ground: behavioral health has become an epidemic within the pandemic. Even as we look ahead to a new normal in Massachusetts, it is critical that we grasp the profound impact that the pandemic has had on our healthcare system and its patients. The HPC’s interim report underscores a need for urgency as we work to get patients back after many had delayed care, to empower telehealth to reach its full potential, and to ensure the financial stability of our providers – especially community and safety net organizations.”
  

Today marks the third and final phase of vaccine availability in Massachusetts, as the state allows anyone over age 16 to get vaccinated. Until today, vaccines have been limited to an ever-widening circle of individuals, depending on their age, health conditions, essential professions, and other factors. 
  
MHA, with the assistance of clinicians throughout its membership, produced this public service announcement – “We Are Here” – to reassure the public about the vaccine and to encourage individuals to seek the counsel of their hospitals and care providers if they have any questions or concerns.
  
“We can help walk you through how these vaccines were developed, the side effects you might experience, and the many benefits of getting your shot,” clinicians in the PSA state. “Getting vaccinated is what will help us get back to doing the things we have missed. And it will protect you and those you love. We are proud that over a million and a half people in our state are fully vaccinated. Now it’s your turn. From all of us from in the Massachusetts healthcare community: We are here for you.”
  
Last week, Attorney General Maura Healey issued a reminder that people cannot be turned away from getting a vaccine if they do not present ID cards, Social Security numbers, health insurance cards, or other forms of identification. While asking for such information is OK as the federal government attempts to track COVID-19 metrics, people do not need identification or health insurance to get the vaccine. The vaccine is free to everyone.
  
The distribution of the vaccine has encountered problems with scheduling and availability both locally, nationally, and globally as the private and public sectors grappled with essentially technical problems. Yet the fact that one year after the COVID-19 virus was identified as the great global threat it is, vaccines are being produced and distributed quickly could be considered a historic achievement.
  

Cambridge Health Alliance’s (CHA’s) Health Equity Research Lab has found that transgender and gender diverse (TGD) patients are more likely to be victims of violence, attempt suicide, or experience suicidal thoughts.
 
The study, published in World Medical and Health Policy, analyzed CHA’s patient data from 2008-2019 and compared the health outcomes of 916 potentially transgender and gender diverse individuals against those of 511,026 other patients in the system. The identified TGD patients had more suicide attempts (5.2% vs. 0.4%), more suicidal ideation (20.5% vs. 1.8%), and more violence victimization (5.4% vs. 1.7%). The study highlights the need for improved health services for transgender and gender diverse patients and offers a method that can be readily deployed in other health systems to understand system-wide disparities and design approaches to reducing them. 
 
“Cambridge Health Alliance has started training staff to ask about sexual orientation and gender identity,” said study co-author Nathaniel M. Tran. “As a health system, we started to ask every patient about potential social needs like access to food, housing conditions and violent relationships. By routinely asking our patients about these potential areas of need, we can reduce stigma, provide additional support during their visit and connect them with community resources.”
 

The Massachusetts Division of Insurance (DOI) is hosting a virtual meeting in collaboration with MHA and the Massachusetts Medical Society on Friday, April 30, from noon to 12:30 to clarify insurance benefits for contraceptive coverage, including required coverage for up to a 12-month contraceptive prescription. The meeting is intended for healthcare providers and their staff, pharmacy staff, and other interested parties.
 
During the meeting, Kevin Beagan, DOI’s deputy commissioner for the Health Care Access Bureau, will discuss covered benefits, required waiver of cost-sharing, and the availability of filling a 12-month prescription after the first contraceptive prescription is provided to a person. There will be time for individuals to ask questions. 
 
Click this Zoom link to attend, or participate by telephone by dialing (646) 558-8656 and requesting meeting number 838 6291 4975 and passcode 596790. For those unable to participate on April 30, the meeting will be recorded.

The state’s Roadmap for Behavioral Health Reform is the most focused effort in recent years to assist people cut through the confusing mental health and substance use disorder landscape to get timely treatment. In addition to creating a centralized “front door” to treatment options, a major component of the roadmap is strengthening the role of community behavioral health centers as an entry point into the system for timely assessment and connection to treatment.
  
On Tuesday, April 27 from 2:30 to 4 p.m., the Executive Office of Health & Human Services is hosting a webinar on the role of the community behavioral health centers. It is open to the public and will provide an opportunity for Q & As. Register in advance here.
  
The state has also posted new FAQs about the roadmap.

A scheduled 2% cut to hospital Medicare payments has been put on hold through the end of 2021 thanks to legislation that President Biden signed last Wednesday.
 
The Medicare sequester cut was halted at the start of the pandemic and that moratorium was extended by Congress several times. The legislation to extend the moratorium on the cut through the end of year received bipartisan support in recognition of the financial destabilization the pandemic has caused the hospital sector. Last week the U.S. House voted 384-38 to pass the legislation and send it to the president.
 
The moratorium officially ended on March 31, but the Centers for Medicare and Medicaid Services (CMS) said it would hold claims payments as Congress worked on the moratorium legislation. The Massachusetts congressional delegation was very supportive of the move to halt the sequester cuts.

The attempt to inoculate everyone against COVID-19 faced a drawback by the “pause” – not “suspension” – of the Johnson & Johnson vaccine until federal regulators investigate further the rare brain blood clot that occurred in six women out of the 6.85 million people who received the J & J vaccine. One of the women, who were between the ages of 18 and 48, died.
  
These cases of cerebral venous sinus thrombosis have all been associated with thrombocytopenia. This syndrome has been labeled, “vaccine-induced immune thrombotic thrombocytopenia (VITT).” The administration of the anticoagulant heparin should be avoided in patients with potential VITT.
  
The federal FDA and CDC are investigating whether the affected women had some underlying condition other than the vaccine. They will also investigate any similarities between the Johnson & Johnson vaccine and the AstraZeneca vaccine that is not yet approved in the U.S. but that has caused similar “thrombotic events” in individuals who received the vaccine in Europe.
  
The Massachusetts Department of Public Health issued a health alert last Wednesday, recommending the pause on administering the Johnson & Johnson vaccine, outlining the symptoms clinicians should look for in patients, and telling the public that if they are scheduled to receive the J & J vaccine they should “contact your healthcare provider, vaccination location, or clinic to learn about additional vaccine availability.”
  
Since the pause was announced, hospitals and healthcare providers have worked to communicate clearly with patients about why the measure was taken, the nature of the rare medical reaction, and how recipients of the J & J vaccine can appropriately monitor their health in the weeks after receiving their dose. 

MHA’s Executive Insights Series
BMC’s Kate Walsh: Leading with Purpose

Wednesday, April 28; 8-8:30 a.m.

Join MHA's Executive Insights Series, which throughout 2021 will feature candid interviews of hospital leaders. 
  
We welcome you to pour a cup of coffee and start your day with us as we hear directly from the CEOs who help power our world-class healthcare community.
  
Kate Walsh, president and CEO of Boston Medical Center, will join us on Wednesday, April 28 to share her unique perspective from leading an academic health system dedicated to underserved populations.
 
Register today.