INSIDE THE ISSUE

> CHIA on MIH
> Senate Supplemental Budget
> NIH Cuts
> State Directed Payments
> ONL’s New Name
> Transition

MONDAY REPORT

CHIA Report: Big Benefits from MIH for Just Pennies a Month

Mandating that health insurance companies cover Mobile Integrated Health (MIH) would bolster access to underserved communities, reduce emergency department (ED) overcrowding, and improve health quality outcomes – all at a cost to premiums of just pennies a month, according to a new report from the state’s Center for Health Information and Analysis (CHIA).

CHIA conducted its study at the behest of the Joint Committee on Financial Services that is considering a piece of MHA’s priority legislation this session – H.1154/S.726, An Act Relative To Insurance Coverage of Mobile Integrated Health. The legislation would require public and private health to cover healthcare services on the basis that they were delivered by a state-approved MIH program, and requires reimbursement at the same level as if the services were provided in a healthcare facility.

MIH expands the traditional role of Emergency Medical Services (EMS) by having EMS, often paramedics, coordinate with other healthcare providers and social services to deliver care to people outside of healthcare facility walls. MIH incorporates telemedicine and preventative healthcare to deliver care where patients are, whether it be for physical or behavioral healthcare, post-discharge follow-ups, or referrals to non-emergency facilities.

Such innovative programs, usually coordinated by hospitals, are underway across the state, but they are funded through grants or by hospital reserves, making them unsustainable in the long term.

“No federal laws, including the Affordable Care Act (ACA), require coverage for services provided by MIH programs,” CHIA wrote. “Massachusetts law currently supports the establishment and regulation of MIH programs through the Department of Public Health (DPH). MassHealth has collaborated with healthcare providers to implement MIH services but is not required to cover these services.”

In its study, CHIA finds that requiring coverage for MIH through fully insured health plans “would result in an average annual increase to the typical member’s health insurance premium of between $0.03 and $0.12 per member per month (PMPM) or between 0.004% and 0.014% of premium, over a projection period of five years.”

CHIA said research shows that while the costs are low, the benefits from MIH are high, including reducing hospital readmissions, improving access to underserved communities, diverting patients from higher-cost EDs, and improving patient communication and engagement. “Enhancing these aspects of care can lead to significant cost savings and a stronger return on investment,” CHIA wrote, adding that surveys show the majority of MIH programs “are highly or somewhat successful in reducing per-patient healthcare costs.”

“CHIA’s report is further proof that MIH is a smart and effective resource for the needs of patients and healthcare providers, especially as Massachusetts searches for solutions that can improve community-based care and avoid the use of more expensive emergency settings,” said Leigh Simons, MHA’s senior director of healthcare policy. “We hope this gives legislators the evidence they need to advance these important bills, which have the full support of Massachusetts hospitals and health systems.”

State Senate Releases Details of Supplemental Budget

The Massachusetts State Senate has scheduled a vote this Wednesday on a $533 million supplemental budget proposal.

Among other item, the proposal contains $174 million for “fiscally strained acute care hospitals.”

The greatest fiscal strain on hospitals currently is the enormous shortfall in the Health Safety Net (HSN) fund. Hospitals and insurers each year pay $165 million into the fund, which is used to reimburse for care provided to uninsured and underinsured patients. But hospitals alone are responsible for absorbing any losses that occur after the fund runs out of money. In the current fiscal year, that shortfall will exceed $250 million – straining hospitals beyond the breaking point.

The House in its budget proposal now in conference committee committed $230 million in surplus Commonwealth Care Trust Fund money to supplement the Health Safety Net fund – a provision that MHA strongly supports. The Senate did not provide relief through its proposed budget, but now has taken another route to assisting hospitals through the $174 million proposal. The Senate does not direct the funding to the HSN, but rather to select hospitals based on their percentage of public-payer patients and current operating margins. The Senate proposal also would establish a task force to review and make recommendations regarding administration of the Health Safety Net. MHA expressed its appreciation for the Senate’s willingness to support struggling hospitals, and said it is committed to working with the House, Senate, and Healey administration on a financing plan that maximizes state and federal funding to address Health Safety Net and Medicaid challenges facing hospitals.

NIH Grant Cuts Hit Massachusetts the Hardest

The Commonwealth of Massachusetts’ national preeminence in medical research has suffered a severe blow from the Trump administration’s cuts to the National Institutes of Health (NIH) grant funding, according to a new data brief from the Association of American Medical Colleges (AAMC).

According to AAMC’s analysis, Massachusetts in 2025 has lost $1.285 billion in NIH funding, including $168.1 million in Research Training and Career Development Grants – that is, the grants that support the next generation of the biomedical research workforce. The cuts to the Bay State are more than double the $590 million in cuts to the next most-affected state (New York), and represent 34% of all NIH cuts across the U.S.

“For decades, NIH-funded research has driven groundbreaking medical discoveries and cemented America’s position as the global leader in medical diagnosis, technology, and cutting-edge treatments,” said David Skorton, M.D., AAMC president and CEO. “The impact of funding cuts does not stop at university walls; it reverberates through the lives of millions of Americans facing cancer, diabetes, Alzheimer’s, and many other illnesses. When we undermine our research institutions, we sacrifice the health and well-being of our nation.”

White House Releases Memo on Medicaid State Directed Payments

On June 6, President Trump issued a presidential memorandum entitled Eliminating Waste, Fraud, and Abuse in Medicaid, which criticizes instances where state Medicaid payments are “almost three times the Medicare amount” and “threaten the Federal Treasury and Medicaid’s long-term stability.”

The memo directs the Secretary of Health and Human Services to “take appropriate action…by ensuring Medicaid payments rates are not higher than Medicare, to the extent permitted by applicable law.” White House memorandums are more messaging statements of intent than action, but on Monday the Centers for Medicare & Medicaid Services (CMS) submitted to the Office of Management and Budget for review a proposed rule related to Medicaid State Directed Payments. The details of that rule remain unknown, but it is anticipated it will apply new restrictions on these types of arrangements.

The House-passed budget reconciliation bill contains a provision lowering the permissible state directed payment rate from the “average commercial rate” to either (1) the Medicare rate for states (such as Massachusetts) that have expanded Medicaid, or (2) 110% of the Medicare rate for non-expansion states. However, existing state directed payments, and those submitted to CMS before the bill’s enactment, are grandfathered. It is unclear how the administration’s memo and proposed rule would affect any grandfathered arrangements. The Senate deliberations on these issues are underway and Medicaid-related proposals from that chamber are expected to be released within the week.

In Massachusetts, state directed payments to providers are tied to their fulfilling quality of improvement measures contained in the state’s Medicaid waiver.

A New Look for ONL

The Organization of Nurse Leaders (ONL) has streamlined its name and rolled out a new logo.

The group is now known as the Organization of Nurse Leaders – New England. ONL previously listed each New England state after its name.

The change was announced at the group’s annual meeting June 5-6 in New Hampshire.

ONL, a longtime partner of MHA and its members, convenes nursing leaders from throughout the region to advocate for the needs of the nursing profession, provide education and professional development, and share best practices.

Transition

Scott Rauch, M.D., the president and psychiatrist in chief at McLean Hospital for the past 19 years, has announced he will step down from his leadership roles later this year. Rauch will remain as a faculty member at Harvard Medical School. McLean said it will immediately search for McLean’s next president and that Rauch will remain in his role until that search is complete.

John LoDico, Editor