INSIDE THE ISSUE
How Public Payers are Addressing Behavioral Health
In recently releasing amendments to the 2022 “RFA” or Request for Applications – which is the main contract between hospitals and the state’s Medicaid program – the Executive Office of Health and Human Services (EOHHS) took significant steps forward in the effort to resolve the boarding crisis affecting the Massachusetts healthcare system.
Amendments 4 and 5 establish supplemental reimbursement that provides payment for the enhanced emergency department (ED) services hospitals deliver to boarding patients, over and above the baseline services they provide, such as screening and treatment for substance use disorder, and close observation of those at risk of suicide and homicide. The enhanced services include, among other interventions, medication evaluation and management, and specific services for children that may include applied behavior analysis or family therapy and group therapy.
Data that MHA has collected from hospitals since last year (see story below) show that between 600 and 750 patients, including hundreds of children, board at any given time in Massachusetts hospitals as they await an inpatient bed or transfer to another community provider. EOHHS has been receptive to MHA and hospital-community concerns that it has become increasingly difficult for acute care hospitals to have the resources to care for boarding patients under the current payment mechanism for ED visits.
An earlier RFA revision, Amendment 3 in March 2022, provided hospitals with supplemental payments to expand capacity in treating behavioral health patients during the pandemic. Specifically, Amendment 3’s payments were geared to increased funding for hospitals accepting COVID-positive MassHealth members needing inpatient behavioral health services, and temporary payments for hospitals that created dedicated COVID units to accept COVID-positive MassHealth members.
The EOHHS amendments only apply to patients covered under the MassHealth program. Commercial health insurance company payments to hospitals are covered in private contracts that in many cases were written before COVID-19; it’s unclear if they have been amended like the RFA to address the system-wide behavioral health issues.
“These are the exact type of actions and reforms that make a difference to behavioral health patients and their providers during what are often extremely stressful healthcare experiences,” said Leigh Simons Youmans, MHA’s senior director of healthcare policy. “We are grateful to EOHHS for their swift decisions in these areas, and we hope they will set a standard for others to follow.”
Over the course of the pandemic, MassHealth also has made capital investments – public money – that will result in more than 300 new inpatient behavioral health beds by the end of 2022. To help staff those beds the Baker Administration has allocated $31 million in preliminary American Rescue Plan Act (ARPA) funding – public funding from the federal government – for inpatient psychiatric workforce development. ARPA legislation dedicated an additional $400 million in non-commercial public funding toward behavioral health, including $122 million in behavioral health professional loan forgiveness and $198 million to create a Behavioral Health Trust Fund.
Sturdy & Berkshire Help Ukraine
In March, MHA assisted the Institute for Clinical and Economic Review (ICER) in Boston in the group’s effort to get much-needed medical supplies to Ukraine to help victims of war. ICER had received a desperate plea for help from the Ministry of Health in Ukraine, which asked specifically for Combat Application Tourniquets (CAT), so-called “Israeli” bandages that staunch blood flow from traumatic hemorrhage, and analgesics. MHA passed on that ask to its membership.
ICER ended up working with Sturdy Memorial Hospital in Attleboro and Berkshire Medical Center in Pittsfield and successfully sent more than 750 pounds of supplies to Ukraine’s Ternopil National Medical University. Yusen Logistics coordinated the shipping and Nixon Peabody LLP also contributed to the effort.
Funding for Family Navigator Pilot Program
The U.S. Department of Health and Human Services (HHS) has announced a rolling funding opportunity to create a pilot program to test the efficacy of a mental health family navigator model. Such models promote early access, engagement, coordination, and optimization of mental health treatment and services for children and adolescents who are experiencing early symptoms of mental health problems. HHS is looking for family navigator models that rapidly engage youth and families in needed treatment and services, and that use technology to monitor the trajectory of mental health symptoms and outcomes over time. More details are here.
MHA and its tMED Coalition have advocated for increased funding for patient navigators within the state. Specifically, MHA and tMED say community health workers and social workers, who are demographically reflective of their communities, can serve a critical role in promoting digital access and literacy across disenfranchised patient populations. Such programs exist but are usually funded on limited timelines.
Recommendations for Patients Returning to Assisted Living Residences
MHA, as part of its Post-Acute Transitions of Care & Emergency Preparedness Workgroup, has assisted in finalizing Mass. Assisted Living Association (MASS-ALA)/LeadingAge Massachusetts Recommendations for Assisted Living Residences & Hospitals Relative to Return from Hospitals. The updated guidance is intended to assist hospital and assisted living staff in determining when to discharge patients to assisted living. Hospital case managers provided significant input to further refine the guidance so that hospitals do not become the default setting for assisted living residents who cannot return to their homes with cognitive impairments, complex skilled nursing needs, or other functional losses. The document outlines a process for hospitals to work in partnership with the patient’s assisted living residence (ALR), their families, their healthcare proxy, and/or designated caregiver to identify alternative care settings for patients whose impairments, nursing needs, or functional losses preclude them from returning to an ALR.