Senate Passes Comprehensive Health Care Bill
Last week, the state Senate considered over 150 amendments proposed to their comprehensive health care cost control package, titled the HEALTH Act, for Health Empowerment and Affordability while Leveraging Transformative Health care (see our initial thoughts on the bill here). After spending two full days discussing and voting on amendments, the Senate approved the bill right at midnight on November 9. The final Senate bill, incorporating all the amendments, is expected to be numbered S. 2211, and so should be available online here.
The wide-ranging final bill includes over 150 sections, concerning many aspects of the state’s health care system. The bill now goes to the House. House leaders have said they will be reviewing the bill and preparing their version sometime in the new year.
HCFA was active during the amendment process, working on a number of proposed improvements to the bill. As you can see from the brief summaries below, among the many provisions are a number of long-standing HCFA priorities. Below is an outline of some of the key issues included in the bill; we apologize for the length, but this is a very large bill.
MassHealth reforms: We are thankful to the Senate for not including a package of proposed reforms to MassHealth that reduces eligibility for non-disabled adults which would limit benefits and impose barriers to keeping coverage and continuity of care. Most of these proposals also need federal approval; the Centers for Medicare and Medicaid Services is currently reviewing the 1115 waiver amendment Massachusetts submitted in September.
Oral Health: The bill allows dental therapists to practice in Massachusetts. Allowing dental therapists to work in Massachusetts would expand access to oral health. Low income children and families, older adults, people with disabilities and communities of color face the substantial barriers to accessing needed dental care. Dental therapists are licensed midlevel dental providers, working under a dentist’s supervision. As community-based providers who understand the history, culture, and language of their patients, they enable the dental team to deliver culturally competent, patient-centered care, mobilizing the strengths of underserved communities. Dental therapists could bring much needed care to underserved people and address oral health disparities.
Academic detailing: The Senate bill requires the Health Policy Commission to implement Academic Detailing, which is an evidence-based prescriber education program that focuses on the therapeutic and cost-effective utilization of prescription drugs. Academic Detailing supports prescribers to make informed decisions based on balanced research data rather than biased promotional information from drug companies. The Senate considered an amendment supported by HCFA that would have included an assessment on pharmaceutical companies to fund the program, but this amendment was not adopted.
Prevention: The Senate bill renews authorization for the Prevention and Wellness Trust Fund (PWTF) , which expired in June. PWTF is an innovative approach to address social determinants of health. It was set up as a pilot program in 2012, with the goal of reducing health costs by increasing access to community-based prevention. The pilot phase focused on hypertension, childhood asthma, elderly falls and tobacco use reduction, and operated in nine communities. PWTF is unique in addressing community factors that lead to poor health. HCFA worked with other public health advocates to add a funding mechanism to the provision, which originally had no source of funds. An amendment to the bill increases the tax on flavored cigars to fund the program.
Medicare Savings Programs: The Senate considered an amendment filed by Senator L’Italien that would leverage federal and existing state funds to expand eligibility to Medicare Savings Programs (MSPs), which help lower costs for Medicare beneficiaries with limited incomes. In the end, the Senate approved a redrafted amendment that directs the Executive Office of Elder Affairs and the Executive Office of Health and Human Services to develop plans to utilize Prescription Advantage program funding and expand MSPs, respectively, by September 2018.
Prescription Drug Price Transparency: The Senate bill includes a number of provisions to increase transparency of prescription drug pricing. The bill requires the Center for Health Information and Analysis to collect pricing information from pharmaceutical manufacturers and pharmacy benefit managers, including research and development costs, marketing and advertising costs and annual profits. The bill also requires these entities to take part in the Health Policy Commission’s annual health cost trends hearings where the Commission can solicit sworn testimony from the industry on factors driving drug price increases. An amendment supported by HCFA strengthened the reporting requirements and allows the Attorney General to compel pricing information from industry officials, subject to a financial penalty and other legal action for noncompliance.
Employer Responsibility: The Senate bill revives the “50+ report,” requiring the Center for Health Information and Analysis to publish an annual report of the 50 employers with the highest number of employees who receive MassHealth coverage or utilize the Health Safety Net.
Price Protection on copays: The bill requires a pharmacist to disclose to a consumer if a prescription’s retail price is less than the consumer’s cost-sharing amount and to charge the consumer the lower price if requested by the consumer.
Surprise Out-of-Network Bills: The Senate bill includes strong protections for consumers facing surprise out-of-network bills. The legislation prohibits providers from balance billing consumers when they receive care outside of the health plan’s network, when an in-network provider is unavailable or the consumer did not know the provider was out-of-network. The bill also includes a legal remedy under chapter 93A for unfair methods of competition or anticompetitive behavior if a provider or carrier requests payment from an enrollee in situations of surprise out-of-network billing other than for the applicable out-of-pocket cost.
Hospital Care Quality: The Senate bill sets a requirement that hospitals substantially reduce readmission rates. Readmissions – when a patient must return to the hospital within 30 days after being discharged – are among the highest in the country in Massachusetts, and are an indicator of poor quality care and a major driver of preventable health care cost growth. The Health Policy Commission can direct hospitals that don’t meet the readmissions standard to improve their performance, and assess penalties on hospitals that don’t comply.
Medicaid Buy-In: The Senate bill allows MassHealth to offer a plan that individuals or employers can purchase. MassHealth can set alternate eligibility, benefit, premium and cost-sharing rules for this plan for those who are otherwise not eligible for MassHealth. The bill requires MassHealth to file a plan with the Legislature by October 1, 2018 stating whether they plan to implement a Medicaid buy-in program, and if so, the parameters of the program.
Children’s Behavioral Health Services: The final Senate bill includes identical language to the FY2017 close-out supplemental budget, which requires commercial health insurers to certify whether they include certain community and home-based mental health services that are typically only covered by MassHealth’s Children’s Behavioral Health Initiative. The original iterations of both the Senate bill and the supplemental budgets required that commercial insurers cover these services. HCFA and our partners in the Children’s Mental Health Campaign are continuing to advocate for legislation that would ensure commercial health insurance cover these critical home and community-based mental health services.
Health plan provider directories: The Senate bill creates a task force, which includes a seat for HCFA, to investigate timely updating of provider directories by health insurance carriers and determine ways to ensure that the general public is able to view all of the current health care providers for a health plan. While we support this initial step, we had advocated for an amendment to require carriers to ensure the accuracy of the information in their provider directories through periodic updates and to expand the information included in the directories, but this provision was not adopted.
Standard quality measures, including oral health: The bill establishes a permanent task force to recommend aligned quality measures, including oral health measures, and requires the Center for Health Information and Analysis to adopt the aligned measures for use when analyzing quality data.
Telemedicine, also including oral health: The bill extends the definition of telemedicine to include oral health as well as requires all payers, except MassHealth, to provide coverage of services provided via telemedicine technologies that are also covered for in-person visits.