Modifier 25

H.4338, An Act to Reduce Inequities in Access to Medical Procedures (Modifier 25) will increase efficiency and reduce inequities in access to medical procedures by prohibiting insurers from reducing reimbursement when health care providers perform needed medical procedures on a patient during an appointment for an unrelated issue.  MAD, as part of the Modifier 25 Coalition, has worked hard to grow the bills base of support which now includes 14 health care providers and facilities. Efforts to advance the bill further will be a top priority for MAD when the legislature returns to formal session in early September, including working with the AAD on a Call to Action.

Status: H.4338 is a Financial Services Committee redraft of H.1162 (technical changes only). That bill was reported out favorably and is currently pending before Health Care Financing. S.810 (Oliveira) is still pending before Financial Services.

Prior Authorization Reform

Several bills to implement prior authorization reform were heard by two different Committee’s in mid July.  H.1136/S.1403 An Act Improving the Health Insurance Prior Authorization Process (Decker/Friedman) would put in place comprehensive legislative protections for patients and providers to reduce and streamline prior authorization processes uniformly across all commercial insurance carriers in Massachusetts. MAD submitted written testimony supporting the following provisions to to reduce administrative burden and promote access to quality, timely care:

•            Prohibit PA for generic medications and medications and treatments that have low denial rates, low variation in utilization, or an evidence-base to treat chronic illness;

•            Require PA to be valid for the duration of treatment or at least 1 year;

•            Require insurers to honor the patient’s PA from another insurer for at least 90 days;

•            Prohibit retrospective denials if care is preauthorized;

•            Establish a 24-hour response time to authorize urgent care;

•            Regulate the use of artificial intelligence (AI) in PA programs, including prohibiting the use of AI as the sole basis for denial of authorization for care, and

•            Require insurers to adopt software to facilitate automated, electronic processing of PA and the Division of Insurance to implement standardized PA form.

H.1136 is pending before Financial Services. S.1403 is before Health Care Financing.

Co-pay assistance and Co-pay accumulator

• The recently signed state budget includes an important extension of the sunset provision for the patient co-pay assistance program (H.4240, Section 94). The program’s expiration date has been moved from January 1, 2026, to January 1, 2031. This was officially signed into law this month. As part of the Patients for Prescription Access Coalition (PFPA), MAD will continue advocating for H.1364/S.724, An Act Relative to Promoting Healthcare Access and Affordability for Patients (Fiola/DiDomenico) By passing this legislation, the Legislature would finally eliminate the sunset and give certainty to patients that they will be able to access co-pay assistance to help them afford rising out-of-pocket costs for necessary medications.
• H.4333, An Act Relative to Consumer Deductibles (redraft of H.1101/S.698, Cahill/Crighton), the co-pay accumulator bill, would ban insurers from utilizing patient co-pay assistance to pay for their portion of the cost of drugs, rather than applying it against the co-pay or deductible the patient has to pay. Supported by MAD in written testimony, this bill was favorably reported out of the Financial Services Committee and is currently pending before Health Care Financing.

Non-Medical Switching

MAD submitted written testimony in support of H.1125/S.693, An Act Relative to Non-Medical Switching (Day/Crighton). These identical bills would ban nonmedical switching of covered prescription drugs for individuals who are medically stable on drugs that were previously covered and that were prescribed within the last six months. The bill would also prohibit changing maximum coverage of benefits, increased cost sharing, or moving the covered individual to a more restrictive tier. The bill was heard by the Financial Services Committee on June 10^th and remains pending before that committee.

Notice and Disclosure/Price Transparency

H.1126/S.762, An Act to Streamline Patient Disclosure Requirements (Day/Friedman). This legislation is intended to align state and federal notice and disclosure requirements. And enhance transparency regarding health care providers' participation in patients' health benefit plans and related cost information. It requires health care providers to disclose their participation status in a patient's health plan upon scheduling non-emergency medical services, or upon the patient's request. Providers must update patients if their participation status changes during ongoing treatment. Participating providers are obligated to supply a good faith estimate of expected billing and diagnostic codes, enabling health insurance carriers to inform patients about their estimated financial responsibility. Penalties for non-compliance includes limitations in reimbursement and financial penalties up to $2,500 for violations not covered by federal penalties. Heard by the Financial Services Committee on July 15^th. No further action.

Working closely with our national partners, the American Academy of Dermatology (AAD) and the American Society for Dermatologic Surgery Association (ASDSA), MAD weighed in in support of the following bills:

• H.600/H.619/S.334, An Act Relative to Youth Skin Health (Hogan/Kearney/Cyr), SUNucate model legislation that would allow students to possess and utilize sunscreen at school and day camps without a prescription or physician’s note; and includes optional enabling clauses that permit the use of sun-safe clothing (long-sleeved shirts and hats) and incorporating sun-safe behavior into school curriculum. This legislation was a priority of MAD at our Skin Check Day at the State House in early May. The bill was heard by the Education Committee on 7/21 and remains pending before that Committee.
• H.2513/S.1500, An Act Relative to Health Care Transparency (Plouffe/Cronin) and H.2512 An Act Relative to Truth in Advertising (Plouffe). Cumulatively, these bills increase health care transparency and benefit patients by limiting the use of medical specialty titles in advertisements and clinical settings to physicians and requiring physicians and nonphysician clinicians to disclose in advertising and through photo identification their name, the type of state-issued license, and expiration. Public Health.

Scope of Practice Bills Opposed by MAD

• H.444, An Act Enabling Trained Dental Hygienists to Administer Dermal Fillers and Botox (F. Moran). Would permit dental hygienists to administer botulinum toxins and dermal fillers, provided they do so under the direct supervision of a licensed dentist. Pending before the Committee on Consumer Protection and Professional Licensure. Public Hearing before the Committee on Consumer Protection and Professional Licensure was held on September 9^th.
• H.1140/S.801, An Act to Remove Barriers to Patient Care (D. Donahue/M.Moore). This bill directs private health insurers to accept diagnostic evaluations, medical necessity determinations, certifications, written orders, prescriptions, and treatment recommendations from advanced practice registered nurses (APRNs) as they would similar determinations by a physician. The bill applies to individual and small group insurance, Blue Cross/Blue Shield coverage, and HMO plans. Additionally, the bill authorizes APRNs to make clinical decisions regarding a patient's care. Hearing before the Financial Services Committee on July 15^th, no further action.
• H.2371 and S.1502, An Act Relative to Removing Barriers to Care for Physician Assistants (Barber/Cyr).These identical bills would eliminate the statutory requirement for physician supervision of physician assistants (PA’s), thus granting PA’s the authority to practice independently, including prescriptive authority and the ordering of tests and therapeutics. Hearing before the Public Health Committee on July 14^th, no further action.

Looking forward, we’ll keep an eye on S.868, An Act Enhancing Health Care Market Oversight and Pharmaceutical Access (Friedman) which seeks to build on legislation passed last year to increase state oversight of drug companies, private equity and management service organizations. S.868 contains numerous provisions to further reform and regulate health care costs, pharmaceutical pricing, and medical provider operations within Massachusetts. It includes provisions to calculate and limit health care spending growth rates, and outlines a process for pharmaceutical companies to provide advance notice regarding new drugs or changes in drug pricing. The bill has been reported out of Health Care Financing and is pending before Senate Ways and Means.

The Legislature will continue to hold public hearings throughout the fall. The legislature is expected to resume formal sessions the week of September 22^nd.

LASTLY, SAVE THE DATE!  MAD SKIN CHECK DAY AT THE STATE HOUSE ON TUESDAY MAY 5^TH 10AM – 4PM.

Looking back, the 2023-24 legislative session was a busy one for the MAD as the Academy continues to grow its presence on Beacon Hill.

Shortly before the end of the session, the House and Senate came to agreement and passed two important health care bills: the Healthcare Market Review bill, and the Pharmaceutical Access, Costs and Transparency.  Both bills had been in the works for most of the session but were stuck in conference committee since late July.

 
Here’s a link to the full text and summaries of the new laws:
H.5159, An Act Enhancing the Health Care Market Review Process.

S.3012, An Act Relative to Pharmaceutical Access, Costs and Transparency (PACT Act)

The PACT Act increases state oversight of pharmaceutical manufacturers and pharmacy benefit managers by bringing them under the Health Policy Commission and the health care cost trends process.  It will also ensure that patients will pay less for medication by limiting out-of-pocket costs for essential diabetes, asthma and cardiac prescription drugs, and promote transparency and affordability of health insurance premiums for consumers.

H.5159, the Market Review bill, is intended to address the ongoing fallout from the collapse of Steward Health Care, and to prevent another such occurrence by increasing state oversight and regulation of private equity investors and management service organizations by the Health Policy Commission, the Center for Health Information and Analysis, the Attorney General and the Division of Insurance. It also requires the licensure of Urgent Care Centers and of a new category called Office Based Surgical Centers that perform ambulatory, surgical or other invasive procedures requiring general anesthesia, moderate sedation, or deep sedation, excluding minor procedures and procedures requiring minimal sedation.

Of importance to dermatologists is that the final Market Review bill does not include the more onerous provisions in the Senate bill that would have prohibited certain contractual relationships with private equity investors, real estate investment trusts and management service organizations, and focuses more on reporting and transparency.

Moving forward in the new session, the Modifier 25 bill will continue to be a top priority for MAD. Passage of the bill will put in place important protections for Massachusetts physicians against policies being implemented by some health insurance carriers to inappropriately reduce physician reimbursement when a modifier 25 code is applied.  Our advocacy efforts focus on the importance of the legislation to patients who benefit from the convenience and quality care that same day care allows. Preserving a patient’s ability to have multiple issues resolved during the same encounter allows physicians to provide effective and efficient, high quality care, in many cases saving patients a return visit and the expense of additional co-pays and deductibles.

While battling strong opposition from the health insurers, our Coalition of support for the Modifier 25 bill continues to grow. In addition to the Mass Medical Society and state and national physician specialty societies representing otolaryngologists, gastroenterologists, orthopedists, pediatricians, emergency physicians and several hospital systems. We are also pleased to note the support of the Massachusetts Coalition of Nurse Practitioners.  MAD will continue our advocacy efforts in the new session and work to build on our progress and base of support in the legislature and with other health care provider organizations.

Another MAD priority is prior authorization reform.  In the last session, MAD supported legislation to implement broad reforms to the prior authorization process to ensure patient access to timely, safe and affordable evidence-based care, and to reduce administrative burden for physicians and staff.  Like the Modifier 25 bill, the prior authorization reform legislation is intended to push back against insurer interference in the practice of medicine and is strongly supported by the physician community.  Unfortunately, prior authorization reform was not included in the Market Review bill and will need to be revisited this year.

These are just two of MAD’s legislative priorities moving forward.  Other issues include support for parity in reimbursement for telehealth services, clear scope of practice standards for non-physician health care providers, the co-pay accumulator bill which bans insurers from utilizing patient co-pay assistance to pay for their portion of the cost of drugs, rather than applying it against the co-pay or deductible the patient has to pay, reducing racial and ethnic disparities and support for gender affirming care, and several public health initiatives such as promoting the use of sunscreen.

Lastly, mark your calendars! Tuesday May 6^th is “Skin Check Day” in the State House where MAD promotes the practice of dermatology and importance of preventative skin care by providing free skin checks for legislators and staff.  More soon on this event and how you can participate!

The Massachusetts State Legislature is nearing the end of the 2023/24 legislative session.

The first half of the year has been a busy one for MAD! The highlight was in May with the return of "Skin Cancer Screening Day" in the State House where MAD promoted the practice of dermatology and importance of preventative skin care by providing free skin checks for legislators and staff.

The day was a huge success, and included not only over 60 private screenings, but also a presentation of awards to several legislative leaders who have been supportive of MAD, a tour of the State House and group and individual legislative meetings. The event also gave MAD an opportunity to promote a few legislative priorities including the Modifier 25 Bill and Prior Authorization Reform.

Many thanks to Dr. Avery LaChance and other MAD Board Members, and the Brigham and Woman's Hospital Dermatology Department! We hope to see you all again next year!

In turning to legislative developments, top on the list is the passage of a healthcare market reform bill in the House. The bill seeks to accomplish the following:

• protect community hospitals
• create a State Health Plan to identify and address anticipated needs for health services
• expand the authority of the Health Policy Commission and Department of Public Health in healthcare resource allocation
• create a new Division of Health Insurance to regulate the health insurance sector
• increase regulation of certain aspects of physician practices

In addition, the proposal addresses a number of recent issues, including the role of private equity and for-profit interests in healthcare, which have arisen as a result of the Steward Health Care crisis.

Of particular interest to physicians are provisions to license facilities providing office-based surgery and urgent care centers. This includes a requirement for physician group practices with 10 or more physicians to register with BORIM and require certain disclosures.

Additionally, all physicians who intend to terminate a bona fide physician-patient relationship, where the physician has a role in the ongoing care and treatment of a patient, must notify the patient in writing no less than 90 days prior to termination of the relationship.



The bill is now pending before the Senate, which is expected to develop its own reform bill. To become law, differences between the House and Senate bill will need to be resolved and a final, compromised bill enacted before the Legislature's formal session ends on July 31st.

In the face of strong opposition from health insurers, and given the time constraints at this stage of the legislative process, further action on the Modifier 25 Bill is unlikely. MAD is pleased with the progress made in this session. While in the last session, the bill failed to clear the Health Care Financing Committee, this year it was favorably acted on by that Committee and advanced to House Ways and Means. MAD will continue to work with a Coalition of physicians specialty societies in support of the bill and will hit the ground running in the next session.

Another priority of MAD is legislation to reform the prior authorization process. Again, given time constraints and competing legislative issues, action on standalone bills is unlikely. However, efforts by the medical community and hospital association to include some of the provisions of the prior authorizations bills in the Senate health care bill are underway.

The healthcare market reform bill is only one of several healthcare bills competing for House and Senate attention before the clock runs out. Pending before the House is legislation passed by the Senate intended to rein in Pharmacy Benefit Managers and increase state oversight of drug costs. On the Senate side, two bills passed by the House are awaiting action, one to boost access to naloxone and to license recovery coaches, and another to reduce disparities in maternal health. Non-health care issues also pending before the legislature include gun reform, housing, economic development, a climate/clean energy bill, and others.

Busy time on Beacon Hill! More soon!

The Massachusetts State Legislature is in the second year of the 2023/24 legislative session.  All legislation filed for consideration in 2023 carries over to 2024. The session will run through the end of July. 

2023 was a busy year for the MAD as the Academy continues to grow its presence on Beacon Hill.

The Modifier 25 bill continues to be a top priority for MAD. Passage of the bill would put in place important protections for Massachusetts physicians against policies being implemented by some health insurance carriers to inappropriately reduce physician reimbursement when a modifier 25 code is applied. In written and oral testimony, MAD also stresses the importance of the legislation to patients who benefit from the convenience and quality care that same day care allows. Preserving a patient’s ability to have multiple issues resolved during the same encounter allows physicians to provide effective and efficient, high quality care, in many cases saving patients a return visit.  Moreover, such policies are inconvenient and possibly harmful to patients by delaying access to care, and oftentimes costly when the patient incurs the expense of additional co-pays or deductible.

Joining MAD in support of the Modifier 25 bill is a broad-based Coalition which includes the Mass Medical Society and state and national physician specialty societies representing otolaryngologists, gastroenterologists, orthopedists, pediatricians, emergency physicians and several hospital systems. We look forward to working with the MAD membership and the Coalition to grow support for the bill, while battling strong opposition from the health insurers.

Another priority of MAD is H.1143/S.1249, An Act Relative to Reducing Administrative Burden.  These identical bills would implement broad reforms to the prior authorization process to ensure patient access to timely, safe and affordable evidence-based care, and to reduce administrative burden for physicians and staff. Like the Modifier 25 bill, the prior authorization reform legislation is intended to push back against insurer interference in the practice of medicine and is strongly supported by the physician community.

These are just two of MAD’s legislative priorities in this session.  Other bills supported in written and oral testimony include parity in reimbursement for telehealth services, health care consumer price transparency, reducing the cost of prescription drugs, eliminating co-pay accumulator programs, clear scope of practice standards for non-physician health care providers, reducing racial and ethnic disparities and support for gender affirming care, and several public health initiatives such as promoting the use of sunscreen. Like we said, we’ve been busy advocating for you and your patients!

Lastly, stay tuned in 2024 for the return of “Skin Check Day” in the State House where MAD promotes the practice of dermatology and importance of preventative skin care by providing free skin checks for legislators and staff.  More soon on this event and how you can participate!

MAD LEGISLATIVE & REGULATORY UPDATE

The 2023/24 state legislative session is off and running – albeit it, slowly. 

The session formally began on January 3^rd with a new governor and administration.  Several key administrative appointments have yet to be made, including the Commissioner of the Department of Public Health.

On Beacon Hill, Representative Ronald Mariano (D, Quincy) and Senator Karen Spilka (D, Framingham) remain House Speaker and Senate President, respectively.  House and Senate Committee appointments were just made last week.  That means a delayed start to the hearing season, during which the Massachusetts constitution requires that each of the approximately 7000 bills filed must get a public hearing.  Expectations are that hearings will begin in early April and will continue through the end of the year.

Tops on the Mass Academy’s list of legislative priorities is the Modifier 25 bill. 

The Academy is an active member of a physician coalition in support of the Modifier 25 bill, HD.145/SD.404, An Act Relative to Fair and Equitable Compensation for Medical Services (Galvin/Oliveira). These identical bills would provide important protections for Massachusetts physicians against policies being implemented by some health insurance carriers to inappropriately reduce physician reimbursement when a modifier 25 code is applied.

Importantly, HD.145/SD.404 would benefit patients because performance of a medically necessary procedure on the same day as an evaluation and management service is generally done to facilitate a prompt diagnosis or streamline treatment of a complex condition. Preserving a patient’s ability to have multiple issues resolved during the same encounter allows physicians to provide effective and efficient, high-quality care, in many cases saving patients a return visit.  Moreover, such policies are inconvenient and possibly harmful to patients by delaying access to care, and oftentimes costly when the patient incurs the expense of additional co-pays or deductible.

The Academy is working with our colleagues in other specialties to build legislative support for the Modifier 25 bill.  You can help by reaching out to your local state representative and senator, or legislators that you may know personally or professionally. Feel free to reach out to our Lobbyists Ronna Wallace and Ed Brennan for more information.

A new bill supported by the Academy is HD.3720, An Act to Improve Health Insurance Prior Authorization Process (Santiago) and SD.2231, An Act Relative to Reducing Administrative Burden (Friedman).  These identical bills would implement broad reforms to the prior authorization process to ensure patient access to timely, safe and affordable evidence-based care, and to reduce administrative burden for physicians and staff.

These are just two of the Academy’s legislative priorities in this session.  Others include parity in reimbursement for telehealth services, health care consumer price transparency, cost of prescription drugs and several public health initiatives such as promoting the use of sunscreen.

Stay tuned for more information on these and other advocacy priorities.

July 31^st marked the end of the formal sessions for the 2021/22 state legislative session.  Informal sessions will continue in the House and Senate through early January, giving lawmakers the opportunity to keep moving bills as long as there's unanimous consent among legislators present.  That makes action on any substantive matter a challenge. 

Here’s where we are with legislative and regulatory priorities and next steps:

GOOD NEWS -

LEGISLATION PASSED TO DELAY IMPLEMENTATION OF PRICE TRANSPARENCY

Legislation to delay implementation of the state price transparency/notice and disclosure law until 2025 has been signed into law.  The original law, passed in January 2020, required providers to determine and notify patients of their network status, disclose allowed amounts, facility fees, and give patients the opportunity to obtain more information about out-of-pocket costs.  A broad coalition of health care providers and facilities, including MAD, urged the legislature to delay implementation due to similar requirements being rolled out on the federal level.

Specifically, Chapter 107 of the Acts of 2022 delayed implementation of the law by the Department of Public Health, including penalties for violations, until January 1, 2025. This is a huge win for physicians, hospitals, and other health care providers still struggling with post pandemic challenges including significant workforce shortages.  From the perspective of the provider community, it would be best if the state in 2025 deferred to the feds, or at least make them consistent. We will continue to monitor this issue.

OTHER WINS THIS LEGISLATIVE SESSION-

PRESCRIPTION CO-PAY ASSISTANCE

Language to prevent the sunsetting of the pharmaceutical co-pay assistance program and to extend it until January 2026 was adopted as part of the FY’23 state budget. The Academy supported this provision as it eases the financial burden of high co-pays and deductibles on patients. 

THE "CROWN" ACT

The CROWN Act, which stands for Creating a Respectful and Open World for Natural hair makes discrimination against hair a violation of civil rights. Ch. 117 of the Acts of 2022 prohibits discrimination based on "natural and protective hairstyles such as braids, locks, twists, Bantu knots, and other formations” in workplaces, schools, and organizations. Massachusetts is now the eighteenth state to adopt the CROWN Act.

STILL PENDING -

STEP THERAPY

Both the House and Senate passed versions of the Step Therapy bill and efforts to reconcile the two differing versions continued throughout the waning hours of the last formal legislative session on July 31st. Unfortunately, despite strong advocacy from numerous providers, including MAD, those efforts failed to produce a compromise and stalled.

The bills differ around proposed timelines for appeals. The Senate bill sets the timeline for insurers to respond at 72 hours and 24 hours in an emergency (“If additional delay would result in significant risk to the insured’s health or well-being.”). The House bill would allow insurers up to 3 business days and 1 business day for emergencies. In a letter to the House, MAD unsuccessfully urged the House to adopt the Senate language. The 72/24-hour timeline requirements are consistent with Medicare requirements for health plans’ responses to appeals, so many plans are already accustomed to this timeline. Also, most appeals processes are handled electronically, thereby streamlining the process for patients, physicians, and insurers to go through an appeals process within 72 or 24 hours. According to the Step Therapy Coalition, of which MAD is an active member, negotiations will continue throughout the summer and fall. It is possible that if a compromise is reached, the bill could pass in an informal session. So hopefully, more on this important issue soon.

TELEHEALTH

The Academy continues to monitor the Massachusetts Division of Insurance (DOI) which released draft regulations in May to implement the telehealth provisions passed by the legislature in early 2021. This includes parity in reimbursement (equal to face-to-face services) for chronic disease management through the year 2022. The proposed regulations have a very limited definition of chronic diseases that would exclude chronic skin conditions treated by dermatologists (the exception being cancer). In written testimony submitted to the DOI, the Academy urged the Division to revise its proposed definition of chronic disease management to that utilized by the CDC which state that “Chronic diseases are defined broadly as conditions that last 1 year or more and require ongoing medical attention or limit activities of daily living or both.”

The testimony also requested that the DOI utilize its authority to broaden the proposed definition to ensure that skin diseases treated by dermatologists are included in the definition of chronic disease management. If the DOI embraces either approach, then dermatologists will benefit from parity in reimbursement for such services performed virtually or through phone calls through the end of the year.

MODIFIER 25 AND MOVEMENT ON OTHER PRIORITIES

Following a great showing at the Financial Services Committee public hearing on H.4268, An Act Relative to Fair and Equitable Compensation for Medical Services (Galvin), the bill advanced to the Health Care Financing (HCF) Committee. Jennifer Toyohara, M.D and Avery LaChance, M.D. along with lobbyists, Ed Brennan, Esq. and Ronna Wallace, met virtually with HCF staff to brief them on the Modifier 25 issue, the purpose of the bill, and its value to dermatologists and their patients.

While it was felt that meeting was productive, unfortunately the Committee did not have the time to fully process the bill and voted to put it in a study. This is not unexpected for a late-file bill at this stage of the legislative session, and the Academy is pleased with the bill’s progress to date.

The Academy will continue working with the HCF Committee on the bill and refile it for the 2023/24 state legislative session. We’ll also work with our membership and colleagues in other specialties to grow our base of support for next year. The bill must be refiled in early January, so more to come on this important issue for the Academy after the November elections.

Other bills supported by the Academy that have been put into a study include:

• H.1237, An Act relative to non-medical switching (Day)
• H.4812, An Act Relative to Health Care Transparency (Cassidy)
• S.309, An Act Relative to the Availability of Sunscreen for Students (Cyr)
• S.644, An Act Relative to Consumer Deductibles [co-pay accumulator bill] (Crighton)

MAD’s legislative advocacy is year-round.  As such, we’ll be back at it early this fall.

More soon!

The Mass Academy has invested a great deal of energy into advocating on your behalf with legislators, third-party payers, and regulators. A big thank you to those who submitted testimony at the virtual hearing and to Ed Brennan, Esq and Ronna Wallace for their work and guidance in these efforts throughout the year. MAD had a great showing at the public hearing on H.4268, An Act Relative to Fair and Equitable Compensation for Medical Services (Galvin, D-Canton). The bill was reported favorably by Committee on Financial Services and will now proceed to the Healthcare Finance Committee.

Learn about the progress we are making in the latest newsletter - plus more content! 

As of May 18th, the Commonwealth is issuing new guidelines to hospitals and health care providers in accordance with the state’s four-phase reopening plan, to allow some non-emergency procedures or deferred care that may now need attention. Hospitals and Hospital-Licensed and Federally Qualified Health Centers may begin this reopening starting on May 18th, and all other providers may begin starting on May 25th. 

Under these guidelines, high-priority preventative services and urgent procedures that, if left untreated, would lead to high risk or significant worsening of the patient's condition, based on the provider's clinical judgment, may resume.

Relevant examples of in-person services that should start in Phase 1: 

• Diagnostic procedures where delay would lead to high risk
  Example: Biopsy for concerning lesions/potential cancers

• Medical procedures that if deferred lead to substantial worsening of condition
  Example: Removal of malignant skin lesions 
  

To begin offering these in-person services, providers must attest that they are able to deliver these services safely while preserving the healthcare system’s ability to treat COVID-19. This includes specific safety standards such as social distancing, personal protective equipment use, and infection control. More information on those requirements HERE.

Read the Health & Human Services One-Pager Here!

From Left: Kathryn Bowers, MD, Lori Trahan, Eileen Deignan, MD, and Ira Skolnik, MD.

Volunteer leaders from the Massachusetts Academy of Dermatology met with Congresswoman-elect Lori Trahan in December 2018 to discuss key issues affecting the practice of medicine, and the specialty of dermatology, in Massachusetts.

The Academy is looking forward to continuing the dialogue with Lori and her office about a wide range of issues, including venture capital, physician shortages, changes in medical staffing, the rising costs of prescription medicine, the importance of prevention and early detection of skin cancer, and regulatory issues, among others.

A special thank you to Congresswoman-elect Lori Trahan for her generous invitation to discuss these timely issues with her on behalf of all dermatologists in Massachusetts.

Please see the important update below from the American Academy of Dermatology regarding the Hawaii Sunscreen Ban Actions. If you have any questions, please do not hesitate to contact our office at info@massacademyofdermatology.org. 

On May 1 the Hawaii state legislature passed a bill that bans the sale and distribution of sunscreens containing oxybenzone and octinoxate.  While Governor David Y. Ige has not yet signed the bill, it will become law in early July unless the governor vetoes it.  Although the governor has not commented on the bill specifically, he has made comments supporting avoidance of sunscreens with these ingredients and AADA Government Affairs staff does not expect him to veto the bill. If the bill is signed or proceeds without a veto, the law will go into effect in 2021. 

While many of us are horrified at the vilification of one of our favorite compounds, we should be aware that there is at least some evidence that oxybenzones are not good for the environment.  How good that evidence is, we do not know, but it is mounting. For years diving associations have outlawed these sunscreens on their boats.  I think it’s likely coral reef bleaching will end up being multifactorial, with climate change and many contaminants contributing significantly to the problem — not just the oxybenzones.  However, we don’t want to toss out the baby with the bath water, insisting on oxybenzones being safe, and then having people tune out our basic message of sun protection.  The truth is that we want people to protect themselves from excessive sun exposure and there are many ways to do that including physical blockers, clothing, and avoidance of noonday sun.  We will continue to focus messaging around this while also advocating for FDA to approve more sunscreen ingredients. 

Click here to view the American Academy of Dermatology Association statement on sunscreen access.

A summary of the actions delivered by the AAD staff in the past couple of weeks can be found here.

We encourage all of you as you have conversations with your staff and patients, to bring up both the AAD's position statement and push our communication sites in the attached document.