FY19 Budget Priorities, ACO Program, and more...

FY19 Budget Priorities for House Ways & Means Committee

Ever since Governor Charlie Baker released his administration’s FY19 state budget proposal, MHA and the hospital community have been digging into it to assess the document’s potential effect on the many provisions relating to healthcare and patient access. Last week, MHA weighed in with the House Ways & Means Committee as it prepares to take the next step in the state’s budget process.

A major component of the governor’s proposal is to permit non-disabled adults with incomes above 100% of the federal poverty level (FPL) to be only eligible for subsidized insurance in the Connector exchange rather than through MassHealth. This proposal was submitted to the legislature last summer for its consideration and EOHHS is also seeking federal approval through a recently filed MassHealth waiver amendment.  The FY2019 budget assumes this change will yield $60 million in net state savings given the effective date of January 1, 2019.
The eligibility change would not apply to disabled adults, pregnant women, and individuals with HIV or breast and cervical cancer.  Veterans with access to veterans’ healthcare benefits that make them ineligible for tax credits in the Connector would also be unaffected. In addition to state law changes, this proposal requires approval from the Centers for Medicare and Medicaid Services (CMS).  This provision was included in a waiver amendment submitted to CMS last September. 

In its letter, MHA notes that it shares Governor Baker’s perspective that the state is at a point in time when changes are needed to make the MassHealth program sustainable. MHA supports the directional changes the governor proposes in conjunction with steps to ensure appropriate affordability standards and guard against any loss of coverage.  

MHA’s letter also reminded legislators of the daunting costs posed by the pending statewide ballot question that would mandate nurse staffing ratios. Among the proposal’s many shortcomings is its cost; conservatives analysis shows the measure would cost well over $800 million per year without offering any benefit to patient care. The cost would have to be borne by patients and families that already are struggling to pay for healthcare, as well as by business, labor, and state government.

Other key hospital key community priorities for FY19 focus on the health safety net, funding for disproportionate share hospitals and needed investments in behavioral health services.

It is anticipated that the House Ways & Means Committee will release its proposal on or around April 11.

New Day Dawns for MassHealth Program

The MassHealth Accountable Care Organization (ACO) program went live last Thursday with more than 800,000 plus enrollees affected by new rules that change the way they are matched with providers and how those providers are paid.

As has been reported extensively over the past few months, the state and providers have been working diligently to ensure that such a massive change occurs with as minimum disruption as possible.

“This program is not the first Medicaid ACO initiative in the country, but is one of the most ambitious in terms of the percentage of our Medicaid population that will be affected, the downside risk that is required of all ACOs, and the amount of detail put into its development,” said MHA President & CEO Steve Walsh. “MHA is proud of the efforts of our member hospitals, health systems, and physician organizations in working with the Baker Administration toward a successful launch.  We look forward to seeing the MassHealth ACO program succeed in the months and years ahead.”

Lifespan Joins Talks Between CNE and Partners

The Lifespan healthcare system in Rhode Island says it has been approached by Care New England (CNE) and Partners HealthCare to “explore how all three healthcare providers might work together to strengthen patient care delivery in Rhode Island.”

Rhode Island-based Care New England and Partners announced in January that they had entered into a “definitive agreement” to have CNE become part of Partners. The parts of CNE covered under the definitive agreement are: Kent Hospital in Warwick; Women & Infants Hospital of Rhode Island in Providence; the VNA of Care New England, based in Warwick; Butler Hospital in Providence; and The Providence Center (mental health and addiction treatment services) in several Rhode Island locations. Lifespan consists of Rhode Island Hospital, Hasbro Children's Hospital, and The Miriam Hospital, all located in Providence; Newport Hospital in Newport; Bradley Hospital in Riverside,  and Gateway Healthcare in Pawtucket.

If the entities can reach agreement among themselves, they would then need state and federal approval for the merger.

Massachusetts Health Leadership College Accepting Nominations

The Massachusetts  Health Leadership College is accepting new applications until March 9. The college combines intensive and comprehensive leadership assessment, coaching, interactive lectures, and action-learning assignments to provide executives new insights about themselves, their leadership, their decision-making styles, and their effect on others. The Massachusetts Health Leadership College is designed for C-suite executives with the potential to lead their institutions or expand their roles in the next several years. It is appropriate for hospital executives as well as physician, nurse, and other clinical leaders. Candidates from throughout New England are welcome.  The nine full-day session begin in April and run through October. MHA, The Center for Creative Leadership, and Phillips, DiPisa & Associates collaborate to present this series. For further information, please contact Kirsten L. Singleton, executive director, MHA’s Center for Education and Professional Development, at (781) 262-6053 or ksingleton@mhalink.org.

New Guidelines for Pharmacy Expansions

The Board of Registration in Pharmacy has issued a new application form for any sterile compounding facilities or facilities engaging in complex non-sterile compounding that are planning any renovations, expansion, or re-configuration of existing space. The new document is available here.

John LoDico, Editor