MaineHealth Word from Government Affairs - Monday, March 29, 2021

 

MONDAY, MARCH 29, 2021 Katie Fullam Harris, Chief Government Affairs Officer  Sarah Calder, Director of Government Affairs  Emily Kovalesky, Policy Associate   This is a regular update on relevant state and federal legislative and regulatory issues. We encourage you to disseminate these updates to your care teams. This is an overview of issues, so do not hesitate to contact one of us directly if there is something missing or with any questions, comments or concerns. Thank you for your time, interest and input. All of the bills the Government Affairs team is following in Augusta and all of MaineHealth testimony MaineHealth can be found on our Government Affairs website.  State Legislative Update, March 29, 2021   Going It Alone Last week, Democrats took action necessary to pass a biennial budget with only a simple majority. This is rare, and likely the outcome of difficult negotiations during the supplemental budget discussions that were previously reported.   In moving ahead, the Democrats plan to pass a biennial budget that makes only limited changes to the existing Fiscal Year 2021 budget, which expires June 30.  The deadline for passing the budget by simple majority is April 1st in order for it to take effect by the beginning of the next fiscal year, July 1.   Of importance to health systems, the proposed biennial budget does not include the originally proposed cuts to the 340B Program, nursing home “bed hold” reimbursement, Institutions of Mental Disease (IMDs - Spring Harbor Hospital and Acadia Hospital), or inpatient psychiatric units at St. Mary’s and Northern Maine Medical Center that were included in the Governor’s proposed budget. On the negative side, it also does not include the full match for the hospital tax (an impact of approximately $530,000 per year across Maine’s hospitals) or sustained funding for the Doctors for Maine’s Future Scholarship Program ($400,000 per year, or 4 scholarships annually).     The Appropriations Committee passed the newly proposed budget along party lines last week, and the Legislature is scheduled to vote on it this week and adjourn sine die. They can then come back into Session at the call of the Governor or if leaders from both parties agree.   Reports suggest that a supplemental budget would be considered by the Legislature once further clarification from the federal government is provided to states on how the federal stimulus funds can be spent, and when an updated state fiscal analysis is provided to the Legislature in May. Maine is expected to receive approximately $1.4 billion in additional federal stimulus dollars, though the money is allocated for specific purposes.    The Government Affairs Team will continue our efforts to address the Doctors for Maine’s Future Program, rates for behavioral health services, and the hospital tax at that time. Joint Standing Committee on Judiciary  LD 366, “An Act Regarding Emergency Guardianship”   The Committee recorded a divided vote on Maine Hospital Association-sponsored legislation that would standardize the conditions for appointment of a temporary emergency guardian by acknowledging the situation in which a patient’s hospital discharge is delayed until the appointment of a guardian constitutes substantial harm. Committee members that voted against the legislation argued that it would not solve the problem of patients “stuck” in hospitals and would remove the discretion of the judge to determine what is considered “substantial harm.” The vote was not along party lines.    As previously reported, Dr. Chris Wellins, Senior Medical Director of Utilization Management at Maine Medical Center and Internal Medicine Physician with Maine Medical Partners Cape Elizabeth, testified in strong support of this legislation.    The legislation will now be considered by the full Legislature and the Government Affairs Team will continue to advocate that acute care hospitals are not designed, equipped, or staffed to best meet the needs of patients who require a long-term care setting, and keeping patients who no longer need acute care in the acute care setting is not patient-centered care.   LD 642, “An Act to Ensure That Children Receive Behavioral Health Services”   Dr. Roslyn Gerwin, Child and Adolescent Psychiatrist at Maine Medical Center, testified in strong opposition to legislation that would require parents to enter mediation if one parent opposes providing behavioral health services to a minor child. She shared that this legislation will ultimately delay care, such as putting the conflict of parents ahead of the health and wellbeing of the child, or relying on dissenting parents being physically accessible or having the capacity to participate in a mediation process.   A work session is scheduled for Thursday.   Joint Standing Committee on Health and Human Services  LD 629, “Resolve, To Establish the Task Force to Study Improving Safety and Provide Protection from Violence for Health Care Workers in Hospitals and Mental Health Care Providers”   Sarah Calder joined the Maine Hospital Association and Northern Light Health in supportingamended legislation that would convene stakeholders, including local law enforcement, district attorneys, and hospitals to review the process by which criminal law cases may be brought related to incidents of violence in hospitals, in particular, where patients or individuals related to patients assault hospital or medical staff.   Sarah shared that our current system does not provide a clear path in which to hold accountable individuals who commit acts of violence against health care workers. LD 629 will convene stakeholders to identify what information is needed to ensure that a crime is pursued by the District Attorney, to explore the options for hospitals when there has been an assault on hospital grounds, but the victim does not want to press charges, and to discuss how the victim can be kept apprised of the status of the pending case.   No one testified in opposition to the bill, and a work session has not been scheduled.    LD 674, “An Act To Support Early Intervention and Treatment of Psychotic Disorders”   Dr. Doug Robbins, child psychiatrist at Maine Behavioral Healthcare, and Sarah Lynch, PIER Program Manager, testified in support of MaineHealth-sponsored legislation that would create a MaineCare reimbursement rate for Coordinated Specialty Care (CSC), which is the standard of treatment of First Episode Psychosis. The Portland Identification and Early Referral (PIER) Program at Maine Medical Center uses the CSC model, and has demonstrated a marked reduction in re-hospitalization rates, in addition to providing quality and effective care for the last 20 years.   Dr. Robbins and Sarah Lynch were joined by families, PIER clients, Northern Light Health, the Alliance for Addiction and Mental Health Services, and others in testifying in support. The Office of Behavioral Health submitted a letter stating that the Department is developing a bundled rate for CSC and working to identify cost neutral implementation, and determining cost savings from services that CSC would replace for  transition age youth in the early stages of psychosis.   A work session has not been scheduled.    LD 590, “An Act To Require MaineCare Coverage for Ostomy Equipment”   The Committee voted unanimously in support of legislation that would increase the MaineCare reimbursement rate for ostomy equipment to 85% of the 2021 Medicare reimbursement rate – or an increase of approximately 30% over current MaineCare rates.    Tricia Foley, Certified Wound Ostomy Continence Nurse at Maine Medical Center, testified in support of this legislation and shared that MaineCare often denies coverage of ostomy equipment or only covers a portion of the cost. Oftentimes, families cannot afford the co-pay and, therefore, providers, like Tricia, have to place them with an inferior product, which can lead to more frequent changes, skin irritation, and even rehospitalization.    The Office of MaineCare Services submitted a letter stating that it currently reimburses for these products at 85% of the 2011 Medicare Rate, and reimbursing based on cost removes any incentive for providers to find cost efficiencies.   The legislation will now be considered by the full Legislature, and, if approved, will be placed on the Appropriations Table where it will be considered with other legislation for funding.   LD 265, “An Act to Provide Women Access to Affordable Postpartum Care”   The Committee reconsidered its vote last week and voted unanimously in support of legislation that would extend MaineCare coverage for pregnant women from six weeks to twelve months postpartum, with a five year sunset.  The legislation will now be considered by the full Legislature, and, if approved, will be placed on the Appropriations Table where it will be considered with other legislation for funding.  As previously reported, Nancy Green, Certified Nurse Midwife, testified in support of this legislation. The Office of MaineCare Services submitted an informational letter, but did not take a position on the bill.  LD 269, “An Act to Prohibit Smoking in Bus Shelters” The Committee voted unanimously in support of legislation that would prohibit smoking in bus shelters.  As previously reported, Sarah Calder testified in support of this legislation and shared that MaineHealth supports public policies that limit the public’s exposure to unwanted secondhand smoke.  LD 624, “An Act to Amend the Laws Governing Tobacco Specialty Stores” The Committee voted along party lines with Democrats opposing legislation that would allow for the sale and consumption of drinks in tobacco specialty stores. Republicans supported an amended version of the legislation that would allow the sale and consumption of water in tobacco specialty stores.  Sarah Calder joined the American Cancer Society and the American Heart Association in testifyingin opposition and shared that this legislation represents regressive efforts to roll back Maine’s strong support of tobacco-free environments.  LD 510, “Resolve, To Reduce Stigma Regarding Substance Use Disorder by Requiring the Use of Respectful Language in the MaineCare Benefits Manual and Other Department of Health and Human Services Publications” The Committee voted against legislation that would require the Department of Health and Human Services to update the MaineCare Manual with respectful language regarding substance use disorder and, instead, requested a letter be sent to the Department requesting regular updates on the status of these changes.  Sarah Calder joined the Alliance for Addiction and Mental Health Services in testifying in support of this legislation and explained that the language we use in describing substance use disorder must reflect the respect, dignity, and compassion for those who face this challenging disease. The Office of MaineCare Services testified that it has been complying with this law, deleting references to “substance abuse” and adding “person first” language whenever rules are opened for other changes. Joint Standing Committee on Innovation, Development, Economic Advancement and Business LD 149, “An Act To Facilitate Licensure for Credentialed Individuals from Other Jurisdictions”   Sarah Calder joined Northern Light Health in supporting legislation that is a result of the Working Group to Study Barriers to Credentialing formed by Resolve 2019, Ch. 79. The group, which included Dr. Linda Butler, Administrative Director of Psychiatry at Maine Medical Center, worked to identify barriers and recommend ways to enable foreign-credentialed and foreign-skilled individuals and out-of-state license holders to become part of Maine’s workforce and economy. Sarah shared that this legislation is an important step to help ensure new Mainers are able to access employment opportunities using their relevant experience, education, and licensure or credential.   No one testified in opposition, and a work session is scheduled on Thursday.    LD 612, “An Act to Recognize Occupational Licenses and Certifications from Other States to Attract New Residents and Businesses to Maine”   Sarah Calder joined Northern Light Health in testifying in support of LD 612 and shared that it is imperative that we look at innovative programs and policy changes that support, attract and retain individuals new to the State in order to address our current workforce shortage.   A work session is scheduled on Thursday.  Joint Standing Committee on Health Coverage, Insurance and Financial Services  LD 523 and LD 617, “An Act Regarding Prior Authorizations for Prescription Drugs”   The Committee voted in unanimous support of legislation that would require insurance carriers adopt an electronic tool that would provide real time electronic transmission of certain prescription drug benefit information. Carriers would need to integrate with one electronic health record tool in 2022 and all platforms in 2023.    Sarah Calder joined Northern Light Health and the Maine Medical Association in testifying in support of this legislation. No one testified in opposition.    The legislation will now be considered by the full Legislature.    LD 631, “An Act to Provide Funding for Maine’s Health Insurance Consumer Assistance Program   The Committee voted unanimously in favor of legislation that would provide funding for Consumers for Affordable Health Care (CAHC), but the Committee disagreed along party lines about the funding source. Democrats supported the funding coming from the Bureau of Insurance, while Republicans supported the funding coming from General Funds.    Sarah Calder submitted written testimony in support of this bill and shared that CAHC is a critical partner to MaineHealth Access to Care and its work to ensure that individuals have access to affordable, high quality health coverage.    The legislation will now be considered by the full Legislature, and, if approved, will be placed on the Appropriations Table where it will be considered with other legislation for funding. Joint Standing Committee on Energy, Utilities and Technology  LD 83, “An Act to Clarify the Meaning of ‘Unserved Area’ within the State’s Broadband Service Laws”    Sarah Calder submitted written testimony in support of legislation that would expand access to high-speed Internet and broadband infrastructure because it will help increase access to health care for rural Mainers by removing broadband barriers that are limiting the use of telehealth.    A work session has not been scheduled.   Federal Legislative Update, March 29, 2021   Thursday, under the leadership of Senators Collins and Shaheen, the Senate passed critically important legislation to hospitals, nursing homes and other providers the rely upon Medicare payments. The bill, an amendment to HR 1868, further delays the 2% Medicare payment reductions that were suspended due to COVID.  The impact of Sequestration cuts to Medicare providers nationally is $12.3 billion annually, and it represents approximately $8 million to MaineHealth providers annually. A special debt of gratitude to Senator Collins for leading along her caucus to support this very important bill.  Of significant importance to MaineHealth, the bill also fixes an error in the omnibus CARES Act/budget package passed in December. The error would have prevented two of Franklin Community Health Network’s Rural Health Center practices from qualifying for cost-based reimbursement, a potential negative impact of nearly $7 million annually to Franklin.   The House is expected to pass the amended bill when it reconvenes in April after the Easter recess.  A huge thank you to both of Maine’s senators and Congressman Golden, as they have been working to address this problem since it was discovered in early January. We will continue our advocacy efforts to ensure that it passes in the House. Thank you for your interest, and please do not hesitate to reach out with questions!

 

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