INSIDE THE ISSUE

> House SUD Bill
> The FY2025 Budget
> Steward Outmigration
> Op-Ed: Prior Auth Reform
> Concern Over Adderall Shortage
> HEART-BP Grants Available
> Hospice Care Award
> Happy Juneteenth!

MONDAY REPORT

House Passes Substance Use Disorder Bill

The Massachusetts House on June 13 unanimously passed a comprehensive bill to address substance use disorder (SUD) in the commonwealth.

H.4743, An Act Relative to Treatments and Coverage for Substance Use Disorder and Recovery Coach Licensure, contains many provisions that MHA and its membership have long sought.

The bill requires coverage of naloxone without any patient-cost sharing whether it is prescribed, dispensed directly to a patient, or purchased over the counter; and it requires acute care hospitals and SUD facilities to prescribe or dispense at least two doses of naloxone to patients who have a history of using opioids, have been diagnosed with an opioid use disorder, or who have experienced an opioid-related overdose.

H.4743 also makes significant changes to the 51a process for reporting alleged child abuse or neglect to the Department of Children and Families (DCF). Now mandated reporters treating substance-exposed newborns are no longer required to report to DCF when a mother takes medications to treat an opioid use disorder.

Additional provisions of the bill include:

• more prescriber training about non-opioid pain management options;
• codifying anti-discrimination protections for people in recovery and for those that have obtained naloxone for themselves or others; and
• creating a new licensure, oversight, and coverage structure for recovery coaches, including the directive that recovery coach services are covered irrespective of the setting in which the services are provided without cost-sharing or prior authorization.

Of note, Rep. Ruth Balser (D-Newton) successfully added an amendment requiring the Executive Office of Health and Human Services to ensure there are enough beds in licensed facilities for treating alcohol or substance use disorders in individuals committed under Massachusetts law, Chapter 123 Section 35. These secure facilities must be geographically distributed to provide access to treatment in all regions of the commonwealth. The amendment creates a pathway to remove existing Section 35 beds from correctional facilities by December 31, 2026. Also included was Marjorie Decker’s (D-Cambridge) amendment, which prohibits health insurers from requiring prior authorization for alternative pain management services and requires insurers to annually distribute education materials regarding their pain management access plan.

“As any hospital or healthcare provider can attest, substance use disorder is still very much a public health crisis,” said MHA’s Senior Director of Healthcare Policy Leigh Simons. “We commend the House for taking powerful steps to make lifesaving medication more accessible for patients in need, empower caregivers at the heart of SUD care, and reduce the stigma that too often stands in the way of recovery.”

MHA Weighs in With Budget Conference Committee

The Conference Committee tasked with resolving difference between the House and Senate state budget proposals, and getting a final document to Governor Maura Healey before the July 31 close of the fiscal year, is currently meeting at the State House.

Last week, MHA sent a letter to the conferees laying out budget priorities for the hospital and healthcare communities.

The biggest priority for MHA’s membership is for the two bodies to agree on a newly designed hospital assessment that aligns with the recent MHA and Executive Office of Health and Human Services proposal. That plan increases the tax on hospitals but ultimately results in more federal dollars flowing back to the state in federal Medicaid funding. While both chambers approved the overall plan, the Senate proposal left out language relating to Cambridge Health Alliance’s (CHA’s) special designation as a “public hospital.” MHA respectfully asked that the Senate approve the House language, which would help CHA at no cost to the General Fund.

MHA asked conferees to keep in mind a series of urgent financial considerations as they addressed the budget, each of which could further destabilize the provider community in Massachusetts. Specifically of concern, Governor Healey’s FY2025 MassHealth budget assumed $300 million in payment reductions, an assumption that has been carried forward in the House and Senate budgets. The Executive Office of Health and Human Services (EOHHS) indicated that the hospital portion of those cuts could reach $100 million and the agency plans to soon share its proposal to implement the cuts in the upcoming RY2025 acute hospital RFA. MassHealth Accountable Care Organization and Managed Care Organization rates are also expected to absorb the payment reductions.

MHA also raised alarm with funding deficiencies in the Health Safety Net program that are expected to exceed levels not experienced since prior to the state’s historic 2006 healthcare reform law; the safety net shortfall is anticipated to exceed $210 million in FY2024. The system, as currently designed, would leave hospitals on their own to covering these historic shortfalls.

Among other MHA requests is one asking conferees to adopt a proposal in the Senate budget that would require the Division of Insurance to issue a report on how health insurance companies are implementing mental health parity mandates. Parity ensures that individuals with mental health conditions receive equitable access to diagnosis, treatment, and support services. In the report, DOI is tasked to review consumer complaints alleging health insurer non-compliance.

Outmigration from Steward Hospitals Affects Specific Patient Populations

Many Massachusetts patients, knowledgeable about the ongoing problems afflicting Steward Health Care, are avoiding its hospitals, according to Department of Public Health Commissioner Dr. Robbie Goldstein.

Goldstein made his observation about the migration of patients from Steward and into surrounding hospitals at the Public Health Council meeting last Wednesday.

“And with decreasing volume, it becomes – I think – a question of, where are those patients going? And where are they having those procedures done?,” the State House News Service quoted Goldstein as saying. “This does not seem to be, at this moment, a factor of supplies. It seems really to be a factor of patient choice. Of individuals making the decision to go to a different facility.”

Declining patient volume further affects the finances of the Steward hospitals but also places enormous pressure on surrounding hospitals – many of which were already past their licensed bed capacity before the influx of new patients.

MHA President Steve Walsh stressed the equity implications of the problem, saying, “The reality is that many individuals who have the means to go elsewhere – often those with higher incomes and commercial insurance – are choosing to do so. It is yet another stark reminder of how fragile the commonwealth’s healthcare system is at this moment, particularly for the state’s poorest and most historically marginalized communities.

“This comes at a time when Massachusetts hospitals are already navigating immense capacity pressures,” Walsh continued. “Any uptick in patient volume is cause for serious concern. MHA and our members will continue to work with state officials to monitor these trends, balance out resources and care beds where possible, and ensure that every patient has access to the care they need.”

Health Leaders Weigh in on Prior Authorization Reform

The previous two Monday Reports have featured stories about the burdens associated with excessive prior authorization requirements from insurers. Now, three of the state’s top healthcare voices have come together to draft an op-ed in Commonwealth Beacon, calling on the legislature to pass Sen. Cindy Friedman’s (D-Arlington) S.1249, An Act Relative to Reducing Administrative Burden.

That bill would not eliminate prior authorizations (PAs), which all agree can be a means of reducing healthcare costs, but would require insurers to respond faster to PA requests; prohibit PAs for services, medications, and treatments that have historically low denial rates; and require a PA to be valid for the duration of treatment instead of having to be constantly renewed when the patient’s condition hasn’t changed, among many other practical, time- and cost-saving measures.

The op-ed from Massachusetts Medical Society President Dr. Hugh Taylor, MHA President & CEO Steve Walsh, and Amy Rosenthal, the executive director of Health Care For All noted: “When prior authorization determinations override evidence-based decisions and recommendations of medical professionals, quality of care is reduced, costs go up, and waste is increased, forcing health care teams to spend more time on the phone and the computer than with patients at a time when systems are already stretched beyond capacity. The increased staffing needed to process prior authorizations means increased expenses and overhead unrelated to patient care.”

National Adderall Scheme Disrupted; Supply of Drug at Risk

A federal indictment handed down last Thursday against a telehealth company alleged to have illegally distributed Adderall through the internet could have serious repercussions for attention-deficit/hyperactivity disorder (ADHD) patients throughout the U.S., according to a health alert from the Centers for Disease Control and Prevention (CDC).

“Patients who rely on prescription stimulant medications to treat their ADHD and have been using [the indicted company] or other similar subscription-based telehealth platforms could experience a disruption to their treatment and disrupted access to care,” the CDC wrote. “A disruption involving this large telehealth company could impact as many as 30,000 to 50,000 patients ages 18 years and older across all 50 U.S. states.”

The disruption coincides with an ongoing national shortage of drugs used to treat ADHD. The combined factors exacerbating the shortage could result in people seeking “medication outside the regulated healthcare system,” which in turn could lead to overdoses since counterfeit stimulant pills may contain fentanyl, according to the CDC.

Clinicians were put on the alert to help patients who have lost healthcare access find new licensed pharmacies and to avoid stigmatizing them as they deal with the disruptions in care.

HPC Grants to Monitor Hypertensive Disorders During Pregnancy

The Health Policy Commission (HPC) is making up to $300,000 available to five separate recipients so that they can advance remote patient monitoring of hypertensive disorders during pregnancy. Four grants are available to acute care hospitals, and one is available to a “provider of obstetric services or a licensed birth center.”

The Hypertensive disorders Equitably Addressed with Remote Technology for Birthing People (HEART-BP) program supports monitoring appropriate patients for a minimum of six weeks postpartum.

Awardees must address the presence of, or potential for, inequities in access, outcomes, and experience in their remote monitoring programs. And they must capture data on processes, outcomes, experiences, and avoided costs to help HPC replicate the program across the commonwealth. The HPC hopes the HEART-BP program reduces avoidable readmissions and emergency department visits associated with hypertensive disorders of pregnancy.

The two-year HEART-BP program is funded through the Distressed Hospital Trust Fund ($1.2 million) and the Payment Reform Trust Fund ($300,000).

Full details of the grant availability are available via COMMBUYS. Applications should be submitted no later than September 6, 2024.

Interested organizations are encouraged to attend an information session scheduled for Thursday June 27 at noon. Register here. Direct questions to HPC-HEARTBP@mass.gov.

July 24 Deadline: AHA’s Circle of Life Award

Applications are open through July 24, 2024, for AHA’s 2025 Circle of Life Award, which recognizes hospitals and health systems that advance end-of-life and hospice care that is safe, timely, efficient, effective, and equitable. There will be up to three recipients of the award, and Citations of Honor may also be presented to other noteworthy programs. The awards will be presented at the 2025 AHA Leadership Summit in Nashville, Tenn. Learn more here.

Happy Juneteenth!

MHA offices will be closed this Wednesday, June 19, in recognition of the federal Juneteenth holiday that President Biden signed into law in 2021.

The day commemorates the June 19, 1865, General Order #3 by Major-General Gordon Granger of the Union Army in Texas, who wrote: “The people of Texas are informed that, in accordance with a proclamation from the Executive of the United States, all slaves are free. This involves an absolute equality of personal rights and rights of property between former masters and slaves, and the connection heretofore existing between them becomes that of employer and hired labor.”

Granger’s order followed by two years President Lincoln’s Emancipation Proclamation, which declared all Black people held captive in the states that rebelled against the United States were free. Confederate and some border states unlawfully ignored the proclamation even after Confederate General Robert E. Lee surrendered at Appomattox Courthouse in April 1865, ending the Civil War. Granger’s general order brought Texas in line. Slavery in the U.S., however, did not formally end until passage and ratification of Thirteenth Amendment to the Constitution on December 18, 1865.

The hospital and healthcare community are mindful of the fact that despite the celebration of Juneteenth, systemic and institutional injustices perpetuated against Black communities have resulted in alarming disparities in health access, quality, and outcomes across the healthcare system. MHA, alongside our members, is committed to an ongoing journey toward anchoring equity across public health and healthcare.

John LoDico, Editor