Task Force on the Discontinuation of Essential Health Services
December 18, 2014
Task Force on the Discontinuation of Essential Health Services
Meeting Agenda
- Review of Legislative Mandate
- Overview of Recent Closure History
- Review of Current Closure Process
- Review of Sample States
- Staff Considerations for Task Force Discussion
- Next Steps
Legislative Mandate: Section 229 of the FY15 GAA
Establishes a task force to:
•Investigate the causes and effects of discontinuations and closures
•Review recent discontinuations of essential health services and recent hospital closures
•Review practices in other states
•Provide recommendations on ways to:
–Improve the notification process
–Ensure access to services
–Ensure uniform reporting of hospital costs and financial conditions
–Impose penalties on hospitals who discontinue essential services prior to DPH approval
•Report to the Legislature by January 31, 2015
Legislative Mandate: Section 229 of the FY15 GAA
Task Force membership:
•Secretary of Health and Human Services, or designee (chair)
•Commissioner of Public Health, or designee
•Executive Director, Center for Health Information or Analysis, or designee
•Attorney General, or designee
•Secretary of Labor and Workforce Development, or designee,
•Executive Director, Health Policy Commission, or designee
Context:
•Massachusetts health care delivery system is rapidly changing
•Trend of community hospital closures has continued
–35 hospitals have fully closed since 1980
–All recent hospital closures in Massachusetts have been community hospitals
•Task Force’s work is timely and important
What Are Essential Services?
105 CMR 130.020 provides that Essential Health Services include the following outpatient services:
–Dental;
–Psychiatric and mental health;
–Reproductive health.
Essential Health Services also include any other campus or service(s) a hospital is licensed for that is not an exempted service. The “Exempted Services” are:
–Skilled nursing facility service;
–Intermediate care facility service;
–Cardiac catheterization service;
–Chronic care services;
– Hematopoietic progenitor/stem cell collection, processing, and transplant services or clinical transplant programs;
–Trauma services provided in designated trauma centers;
–Primary stroke care; and
–Medical control services.
The Commissioner of Public Health can require a public hearing if he/she determines an exempted service is essential or if all services are being discontinued at a campus.
Notification Process
Source: MGL Chapter 111, Sections 51G and 56; Chapter 105 CMR 130
Days Before Closure/Action Required:
•90 Days: Hospital Notifies DPH of a closure or discontinuation of a licensed service. Public Hearing Scheduled and Noticed.
•81 Days: DPH must publish public hearing notice.
•60 Days: Public Hearing.
•45 Days: DPH determination: necessary service?
•30 Days: If necessary, hospital submits closure plan for transition.
•20 Days: DPH completes plan review, approves or sends back for improvement(s). Hospital replies in a “timely manner”.
•0 Days: Closure. DPH begins to monitor post-closure community health needs.
Recent Full Hospital Closures
•Over the last decade, three hospitals have completed full closure of a campus
•Two full service acute hospitals (NARH, Hubbard)
•One specialty hospital (Radius)
•All failed to comply with 90 day notification requirement
•Hindered thorough DPH review of each case
•In one case, a public hearing was unable to be held
•In two of the last three completed full closures (Hubbard, NARH), some services remained, or were restored in some capacity
•One hospital announced its closure date as this Task Force was created (QMC)
Recent Service Discontinuations
•In the last two years, DPH conducted seven hearings regarding full or partial discontinuance of an essential service
•In each case, hospital notified DPH 90 days in advance
•Public interest varied from case to case
•In cases of increased public interest, the public process was able to affect important changes to discontinuation proposals (Faulkner, CHA, Morton, etc.)
Practices in Other States
•Review of policies from a sample of 7 other states (CT, NY, NJ, MN, CA, OR, WA)
•Notification requirements vary from 1-90 days
•5 states, including MA, require analysis of available alternatives for essential service access
•None of the sampled states requires a public hearing
•CA included a public comment period
•MN laws provide powers to enforce compliance with process
•Some states have similar health planning functions as MA, and invest more per capita
•NY requires state approval of a proposed closure
•Several states are empowered to issue fines
•Two of the sampled states have employee notification requirements
Areas for Consideration: Staff Discussion Document
•Based on cross-agency review, staff identified areas for further consideration by the Task Force
•Developed document to help support Task Force discussion
•Staff have proposed considerations around three broad categories:
•Process: Current limitations and steps that can be taken to improve the current “Essential Health Services” review and determination process;
•Planning: Program linkages, cross-government convening, and data which could be leveraged and potentially wrapped around the essential services process
•Policies: Potential opportunities for future discussions regarding the sustainability of critical health services within our Commonwealth’s communities and how state government can better support and incentivize their continuation.
Proposed Next Steps
•How best to structure and support Task Force discussion of considerations?
•Format and scope of required January 31, 2015 report?
•Next meeting?