Health Announce: Sept. 30, 2024

09/30/24

Do you need an excuse to go outside and enjoy a beautiful fall hike in the woods? Check out the treasure hunt that is Project Skydrop. Fortunately, finding updates on important developments in health law is not a treasure hunt! With a focus on amendments to Massachusetts’ 1115 Demonstration, this week’s Health Announce topics include:

  1. Major EPSDT guidance letter issued by CMS.
  2. Coverage for 90-days of pre-release services and reentry services.
  3. Support for other health-related social needs.
  4. Changes to Durable Medical Equipment Services to reduce frequency of and promote shorter turnaround for certain mobility system repairs.
  5. Steward Health Care Update.

Be well,

Jennifer Hotchkiss Kaplan

Senior Health Law Attorney

Massachusetts Law Reform Institute

Major EPSDT guidance letter issued by CMS.         

On September 26, 2024, the Centers for Medicaid and Medicare (CMS) released a guidance letter on best practices for adhering to early and periodic screening, diagnostic, and treatment (EPSDT) requirements in Medicaid.  The three broad topics covered in the guidance are:

i.                     Promoting EPSDT awareness and accessibility;

ii.                   Expanding and using the child-focused (EPDST) workforce; and

iii.                 improving care for EPSDT-eligible children with special needs.

The National Health Law Program (NHeLP) is hosting a webinar tomorrow, Tuesday, October 1, 2024, at 4 pm, to highlight the contents of CMS’ EPSDT guidance and discuss next steps for advocates.  Register for the webinar here.

 

Coverage for 90-days of pre-release services and reentry services.

MassHealth coverage for 90-days of pre-release services and reentry services was approved in April 2024. The new services were going to be phased in starting in July 2025. On August 19, 2024, MassHealth submitted its Implementation Plan to CMS. The plan is pending CMS approval. While MassHealth has been meeting extensively with the carceral facilities on the reentry initiative and implementation plan, it has not solicited broader public input. In January 2024, MassHealth invited people with lived experience and others to participate in a Community Feedback Forum on Health and Justice. Though applications were due April 30, 2024, with the expectation that the forum would begin meeting in the summer of 2024, to date, no one has been selected to serve as a member of the forum. The August implementation plan states that MassHealth is still reviewing applications and expects the forum will meet later in 2024. The last quarter of 2024 is also when MassHealth says it will be releasing more detailed Policy and Operations Guide and readiness tools. This timetable doesn't bode well for meaningful community engagement.

MLRI's Isabel Wanner has organized a working group on health and justice issues that will be going over the content of the plan and further advocacy opportunities. If you are not already on this list and would like to be, please email iwanner@mlri.org. 

 

Support for other health-related social needs.

In September 2022, when CMS approved the 1115 Demonstration for the 5-year term beginning October 1, 2022, it approved continued funding for the "Flexible Services" program that provides nutrition and housing supports in accordance with plans developed by each of the ACOs through December 2024, but stipulated a new funding structure for programs now called Health Related Social Needs (HRSNs) effective Jan. 1, 2025. A May 2024 Directory of Flexible Services and Directory Tool describes the scope and eligibility criteria for Flexible Services for each of the 17 ACOs through December 31, 2024.

Starting January 1, 2025, ACOs will be offering HRSN services in accordance with updated plans and provider directories. As of July, MassHealth was planning to pay for HRSN as part of the managed care plans monthly per capita payment for enrolled members, but that transition has been delayed. In 2025, total plan payments are capped, and provider payments cannot exceed a fee schedule to be released soon. The scope of services available in 2025 are more restrictive than they were in 2024. However, ACO-funded Community Support Programs (CSP) were liberalized for 2025. More information is in the attached slides dated September 12, 2024, and should be posted on the HRSN website soon.

 

Changes to Durable Medical Equipment Services to reduce frequency of, and promote shorter turnaround for, certain mobility system repairs.

MassHealth has amended 130 CMR 409.000: Durable Medical Equipment Services and 101 CMR 322.00: Rates for Durable Medical Equipment, Oxygen and Respiratory Equipment with the goal of incentivizing faster repairs and reducing the number of total breakdowns for certain mobility systems, like wheelchairs. To promote shorter turnarounds, MassHealth is implementing a $1000 add-on payment to eligible durable medical equipment (DME) providers for mobility system repairs completed within 12 calendar days, from intake to completion and delivery to the MassHealth member. This new emergency regulation is effective October 1, 2024, and applies to members who have primary MassHealth coverage (fee for service (FFS)) or secondary MassHealth coverage (FFS duals).

Also effective October 1, 2024, MassHealth will permit corrective system maintenance repairs to be scheduled by the DME provider or the MassHealth member. Covered maintenance repairs must (1) be performed on the manufacturer’s recommended timeline and (2) require the specialized knowledge of, and evaluation by, a trained technician. By encouraging more maintenance repairs of corrective mobility systems, MassHealth hopes to minimize the number of situations where members have broken wheelchairs that cannot be used at all.

Remote public hearings on these emergency amendments are scheduled for Monday, October 21, 2024, at 9 am for 130 CMR 409.000, and 10:30 am for 101 CMR 322.00. MassHealth is accepting written testimony on the regulatory amendments for changes to 130 CMR 409.000 and 101 CMR 322.00 through October 28, 2024.

 

Steward Health Care Update.

Today, September 30, 2024, is the day the sales of 6 Steward Health Care hospitals are to take effect. On Sunday, September 29, 2024, the bankruptcy judge in Texas held a hearing to discuss last-minute financial details. The Healey Administration committed to contribute $417 million to help the new hospital operators – all non-profit entities – keep the facilities open, which is on top of the $90 million the state has already contributed.  

Last week, the Healey Administration announced the creation of two workgroups to study and make recommendations about stabilizing and improving health care in the communities impacted by the Steward Hospital closings. Each workgroup, one for the communities affected by the Nashoba Valley Medical Center closure and the other for the communities affected by the Carney Hospital closure, will include providers and community leaders from those regions and will hold forums to collect stakeholder and community feedback.

Also last week, the United States Senate held Steward Health Care CEO, Ralph de la Torre, in criminal contempt for refusing to testify at a hearing before the Senate Committee on Health, Education, Labor and Pension, held September 12, 2024.  This past weekend, de la Torre announced that he will step down as CEO.