Health Update: August 27, 2024
Hello to All!
As we wind down summer and enter the start of a new school year (for some) and cooler days (for all), here is this week’s Health Announce, featuring:
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MassHealth confirms major changes to the Independent Assessment Entity (IAE) Request for Response at the Dignity Alliance Public Information Session – a victory for advocates!
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MassHealth announces postponement of September MSP closings for CommonHealth members who received notice at the beginning of August.
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Flexibilities granted for patients affected by closing of Carney Hospital and Nashoba Valley Medical Center.
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Update on Steward Bankruptcy.
1. MassHealth confirms major changes to the Independent Assessment Entity (IAE) Request for Response at the Dignity Alliance Public Information Session – a victory for advocates!
On August 21, 2024, Dignity Alliance Massachusetts hosted a public listening session on MassHealth’s Request for Response (RFR) for an Independent Assessment Entity (IAE). The session began with a presentation summarizing the IAE, the RFR timeline, and the comments submitted for the IAE Request for Information (RFI). Then there were two panel presentations, one with people with lived experience and the other with representatives from community-based providers and agencies. The session ended with comments by Mike Levine, Assistant Secretary for MassHealth, and Leslie Darcy, Director of the Office of Long-Term Supports and Services. A video of the listening session is available on the Dignity Alliance website.
Notably, Mike Levine announced at the listening session that MassHealth is dropping the plan for a single entity to perform the clinical eligibility assessments for the eight in-scope, LTSS programs – those assessments will remain with community-based providers and agencies. He also said that they are using the comments and suggestions submitted in response to the RFI to rethink the RFR. Leslie Darcy said that MassHealth would work with the IAE Implementation Advisory Council to amend the RFR and address the concerns regarding access to LTSS as described in the RFI document.
In an RFR amendment and communication posted on CommBuys on August 15, 2024, MassHealth announced its intention to significantly amend the RFR. A new RFR will post no sooner than October 2024, and the bid due date has been changed to January 17, 2025.
2. MassHealth announces the postponement of September MSP closings for CommonHealth members who received notice at the beginning of August.
As we discussed in our August 19 Health Announce, MassHealth has begun the process of closing Medicaid Savings Program (MSP) benefits for CommonHealth members determined to have income above 135% FPL, approximately 8,900 people. MassHealth began sending termination notices mid-August to a first batch of CommonHealth members, informing them that their MSP would end. However, it appears that these termination notices listed the wrong termination date. To correct this error, MassHealth is postponing the September terminations and resending corrected notices to that first group of CommonHealth members, with a revised termination date of October 1.
The corrected first batch notices will be sent out with the second batch of notices, the second week of September. More information about the MSP terminations can be found here.
3. Flexibilities granted for patients affected by closing of Carney Hospital and Nashoba Valley Medical Center.
As part of Steward Health Care’s bankruptcy plan, Carney Hospital in Dorchester and Nashoba Valley Medical Center in Ayer will close on August 31, 2024. The plan approved by the bankruptcy court waived the statutory and regulatory notice requirements for closure of an essential service. MassHealth and the Division of Insurance have put out bulletins to ensure continued access to care for patients impacted by these closings.
MassHealth’s All Provider Bulletin 394 requires that members should get assistance in finding alternative providers for care; MassHealth will transfer prior authorization and pre-admission screenings for previously approved surgeries, procedures, and behavioral health or non-behavioral health admissions to alternative facilities; for healthcare providers seeking to join other hospital or provider systems, MassHealth will expedite credentialing.
MassHealth’s Managed Care Entity Bulletin 121 provides requirements for how managed care entities (MCEs) and PACE organizations must support members and providers, such as assisting impacted members find network providers, or if an alternative network facility is not available in advance of a scheduled stay or treatment, find non-network facilities; forgo prior authorizations for previously approved health care that needs to be transferred to another facility; and examine their credentialing systems and develop flexibilities to expedite credentialing for all health care providers who worked at Carney Hospital and Nashoba Valley Medical Center.
Bulletin 2024-09 from the Department of Insurance provides that insurance carriers are expected to provide clear information and guidance on their websites and in emails and newsletters about obtaining access to care. If requested, carrier staff should help customers with identifying in-network providers. For the 60 days following the issuance of the bulletin on August 16, 2024, insurance carriers must use their best efforts to help individuals who are in inpatient beds or in active outpatient treatment at Carney Hospital and Nashoba Valley Medical Center find alternate care in another network facility and, if an in-network facility cannot be located, they must help locate a non-network facility and notify the consumer that in-network cost-sharing will apply. Also, for the next 60 days, carriers are to take steps to eliminate prior authorization reviews for previously approved surgeries, procedures, and behavioral health or non-behavioral health admissions to Carney Hospital and Nashoba Valley Medical Center that need to be transferred to another facility. And carriers should also adopt modifications to their credentialing procedures to expedite network credentialing for all health care practitioners seeking such.
4. Update on Steward Bankruptcy.
With respect to the other five Steward Health Care hospitals in Massachusetts, Governor Healey announced on August 16, 2024, that there are agreements in principle for the purchase of the hospitals, if the deals are finalized and approved in the U.S. Bankruptcy Court. (One of the hospitals would have to be seized by eminent domain and transferred to a new owner.) Hearings on the sale of the hospitals have been delayed several times, with the next hearing now scheduled for September 4, 2024.
MassHealth has set up a Steward Health Care call center at (617) 468-2189, or toll-free at (833) 305-2070, available Monday through Friday from 8 am until 6 pm (excluding holidays).
Be well,