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A Healthy Blog

Massachusetts health care – wonky with a dose of reality

July 19, 2018

Oral Health = Overall Health

Yesterday, the state legislature approved the Massachusetts state budget for fiscal year 2019, which started July 1 and runs through next June. Included in the bill was funding to restore MassHealth coverage of periodontal care - treatment of gum disease - for adults. The new coverage benefit begins in June 2019.

MassHealth is the state’s Medicaid program, and covers 1.1 million adults. While children are guaranteed full dental care under federal law, states are permitted to make their own decisions about dental benefits for adults. Massachusetts previously offered adults comprehensive dental care, but in 2010 the benefits were severely cut. Over the past years, advocacy has resulted in benefits being restored on a piecemeal basis.

Restoring periodontal care is major step forward in improving both oral health and general health.  Periodontal disease is a chronic bacterial infection of the gums and bone that surround teeth. When left untreated, this disease causes irreversible gum and bone loss, leading to tooth loss. It also directly impacts chronic disease outcomes including those of diabetes, heart disease, and stroke. Periodontal disease can also lead to low birth weight and premature birth.

Additionally, the lack of comprehensive adult dental coverage wastes millions of dollars in extensive and costly services in emergency and inpatient hospital settings and places an added burden on MassHealth and the Health Safety Net. In its report from August 2016, the Health Policy Commission found that MassHealth members disproportionately use ED visits for preventable oral health conditions, including periodontal disease, at a cost four to seven times the cost of a dental office visit. Non-elderly adults on MassHealth use the ED for preventable oral health conditions seven times more frequently than commercially-insured adults.

The decision to restore MassHealth coverage of periodontal treatment for adults is a major victory for HCFA and the Oral Health Advocacy Taskforce  which we lead. The Taskforce, a broad coalition of consumer groups, dental  providers and health organizations has been working on improving oral health in Massachusetts, including a focus on restoring adult dental benefits.

The budget also funds the DPH Office of Oral Health at just over $2 million, and includes a $300,000 grant to the Forsyth Institute for the ForsythKids program.

Now the Governor has10 days to approve or veto budget items. Any vetos can be overridden by a two-thirds vote of both branches.

 

 

 

 

July 18, 2018

Health Equity

After weeks of delays, the conference committee reconciling the House and Senate budget bills released the final state budget proposal for this fiscal year. The budget includes two strong steps for health equity that we have been actively pushing for:

First the budget establishes an Office of Health Equity within the state’s Executive Office of Health and Human Services. While Massachusetts continues to lead nationally in health coverage, racial and ethnic minority residents continue to have lower rates of health care access and use in Massachusetts, and worse health outcomes.

The Office will coordinate resources throughout state government with the goal of eliminating racial and ethnic health disparities.  The Office will create a state health equity plan, collaborate with other agencies (including housing, transportation, environment, education and labor), and facilitate development of interagency initiatives. Following annual hearings, it will issue an annual report to evaluate progress and identify best practices.

The provision mirrors language we first drafted over a decade ago, had HCFA looks forward to working closely with the new office to advance health justice.

Second, the budget also included a provision requiring MassHealth to report on the impact of its ACOs on social determinants of health. MassHealth ACOs will be responsible for screening their 800,000 members for health-related social needs, such as housing insecurity, food insecurity, transportation needs, and exposure to violence – issues directly related to poor health outcomes, health inequities, and high health care costs. These reports will allow policymakers and the public to assess the progress being made by ACOs, and strengthen their accountability.

This provision was a priority of the ACHI Coalition (Alliance for Community Health Integration) that HCFA plays a major role in.

The text of the two provisions is below.

July 16, 2018

Health Care For All, along with MassPIRG, Health Law Advocates, Community Catalyst and the Massachusetts Senior Action Council recently wrote a letter on the issue of drug transparency to the conferees meeting to work out a final health care bill. We urged the Conference Committee to include strong transparency measures to help tackle the problem of skyrocketing prescription drug prices.

Prescription drug costs are currently the fastest growing healthcare expense – by far. For both public and private plans, increases in pharmacy costs far outpace every other expense. Rising drug prices are increasing health care costs, placing significant burden on consumers and putting pressure on the state budget.

A major obstacle in controlling drug price growth is a lack of transparency on pricing trends, rebates, discounts, and pharmaceutical benefit managers. Actual prices paid for drugs are hidden behind a complex veil of intermediaries, and effective transparency provisions would allow the public and policymakers to understand the causes of high prices and cost growth.

We urge the Conference Committee to adopt the Senate language, which provide for more extensive disclosures and would strengthen the ability of policymakers and the public to judge if we are getting good value for our billions spent on prescription drugs. We believe that Massachusetts should join a number of other states that have enacted strong transparency requirements to further the goals of affordable care.

If you are interested in understanding the extent of these factors, read the complete letter here.

-Louis Pratt

July 10, 2018

With both the House and Senate having passed ambitious health care bills this session, now a joint House-Senate conference committee is hammering out the differences to reconcile the two bills for final passage. Health Care For All recently provided comments to the legislature on our recommendations for provisions  to reduce health care costs, protect consumers, and strengthen our state’s health care system.

While Massachusetts has the highest insurance coverage rate in the country, there is still progress to be made to improve the quality and affordability of health care in the Commonwealth. Some of the reforms that HCFA believes are important which were included in both the House and Senate bills are:

  • establishing an academic detailing program to provide independent evidence-based education that focuses on the therapeutic and cost-effective utilization of prescription drugs;
  • requiring the Center for Health Information and Analysis (CHIA) to develop and adopt a uniform methodology to communicate information on how health care providers are assigned to tiers;
  • requiring pharmacies to charge consumers the off-the-shelf price (the price people would pay with no insurance) if it is lower than their copay;
  • requiring insurers to continue coverage past age 26 for dependents with substantial disabilities.

For our full letter to the Conference Committee with detailed explanations of our positions, please click here. Here are summaries of HCFA’s recommendations regarding the legislation:

June 6, 2018

The Massachusetts Senate recently approved their version of the Fiscal Year 2019 (FY19) state budget. The Senate version and the House version must now be reconciled through negotiation between the two chambers. Health Care For All (HCFA) has a number of budget priorities related to health care that have made it this far and should continue on to the final budget.

To find HCFA’s full FY19 Conference Committee letter with detailed explanations of our positions, please click here. You can find summaries of each budget priority that HCFA supports below:

  1. Restore Coverage for Periodontal Care For Adults on MassHealth

We urge the Conference Committee to direct MassHealth to reinstate coverage for periodontic services for adult MassHealth enrollees so that they are able to get the appropriate care that they need to maintain good oral, and overall, health.

  1. Establish a strong Office of Health Equity within EOHHS, and provide funds for the Office’s operation

We urge the Conference Committee to include Section 7 and line item 4000-0009 of the House budget, which would establish and fund an Office of Health Equity to reduce the serious racial and ethnic health disparities that exist in Massachusetts.

  1. Provide expanded authority to MassHealth to negotiate for fair prescription drug prices

We urge the Conference Committee to include authority for MassHealth to seek supplemental prescription drug rebates, and require pharmaceutical pricing information from manufacturers if reasonable rebates are not provided to MassHealth. The provision should also allow EOHHS to assess penalties on manufacturers who refuse to provide the required information, or who do not offer fair rebate amounts to MassHealth.

  1. Direct MassHealth to provide information on ACO outcomes and activities addressing social determinants of health

We urge the Conference Committee to include language in the MassHealth line item (4000-0500) directing MassHealth to provide information on ACO outcomes and performance, particularly data on ACO activities addressing the social determinants of health.

  1. Fund critical children’s mental health programs

We urge the Conference Committee to fund the MHAP for Kids program at $50,000 (within line item 4800-0200).

We urge the Conference Committee provide level-funding for Return to School “Bridge” Programs at $250,000 (within the School Health Services line item 4590-0250).

  1. Preserve Sunset on Prescription Drug Marketing Coupons on Rebates

We urge the Conference Committee to maintain the state’s prohibition on drug industry marketing “coupons” by 2019 and direct the Health Policy Commission to engage in a substantive study of the long-term costs and benefits of drug coupons on the Massachusetts health care market.

  1. Provide Unbiased Information about the Cost and Efficacy of Prescription Drugs

We urge the Conference Committee to provide funding for Health Policy Commission to operate the Academic Detailing program (line item 1450-1266 of the Senate budget) at $150,000.

  1. Require data collection on pediatric continuous skilled nursing services

We urge the Conference Committee to include Section 16 of the Senate budget, which directs the Center for Health Information and Analysis and MassHealth to regularly report data about pediatric patients requiring Continuous Skilled Nursing services.

  1. Fund pediatric palliative care programs

We urge the Conference Committee to fund Pediatric Palliative Care Programs (4590-1503) at $3,816,053, to ensure that all children and families who need these services can get them.

  1. Adequately fund DPH’s Office of Oral Health and the successful ForsythKids Program

We urge the Conference Committee adequately fund the general operations of DPH’s Office of Oral Health, and continue to earmark $300,000 for the ForsythKids program (line item 4512-0500).

Each of these provisions serve important purposes in supporting health care in Massachusetts. As always, HCFA is committed to advocating for affordable and quality health care coverage. All ten of these proposals do just that.

-Brian Rosman and Davis Jackson

May 23, 2018
In the worlds of health care policy and delivery, there is increasing recognition that addressing the social determinants of health (SDOH) –access to nutritious foods, affordable housing, safe neighborhoods, dependable transportation, well-paying jobs and safety from violence—is essential to improving health outcomes, containing health care costs and addressing health inequities across race and income. In other words, health care is about even more than having insurance coverage and receiving traditional medical care. 
 
The Massachusetts Budget and Policy Center (MassBudget) recently released issue briefs on the health effects of the Earned Income Tax Credit (EITC) and Paid Family & Medical Leave (PFML). MassBudget presents research showing that both policies improve the health of individuals, families and communities by addressing economic hardship and promoting the family and social support that contribute to better health. 
 
These are live issues now. The Senate budget being debated this week includes an increase in the state EITC, as did the House budget and Governor’s Baker’s budget proposal. In addition, PFML is a proposed initiative to be before state voters this fall.
 
Each year over 400,000 Massachusetts tax filers claim the EITC, a refundable tax credit that goes to families and individuals, primarily workers with children, who have income from paid work. The Massachusetts EITC partially matches the EITC at the federal level which “keeps administrative costs and complexity to a minimum, while rewarding and encouraging work.” MassBudget found that increases in EITC payments are associated with:
 
Reduction in occurrences of low birthweight
Increased gestation time for pregnant women
Increased educational attainment for children – which is linked to better health outcomes
Improvements in children’s behavioral index scores which measure behaviors such as peer conflict, anxiousness and depression
Avoidance of the early onset of disabilities and other illnesses associated with low family income
Increased in the self-reported health of mothers  and improved blood pressure, heart rate, cholesterol and inflammation levels for these mothers
Increased prenatal care
Increased spending on healthy foods such as fruits and vegetables
Increased economic  activity in neighborhoods with a high concentration of households receiving the credit
 
A policy that allows workers to take paid time off from work to care for themselves, a new child, or a family member with a serious illness or injury, PFML influences the ability of individuals and families to live healthy lives. The MassBudget report shows that access to PFML can have both short-term and longer term health benefits across the lifespan, including:
 
A decline in infant mortality
Increased rate and duration of breastfeeding
Improved physical, cognitive and behavioral outcomes for children – including higher rates of vaccination
Decreased likelihood of behavioral and adjustment problems for adolescents and adults
Faster recovery from both inpatient and outpatient procedures for children
Fewer depressive symptoms for new mothers in the short-term and the long-term
Reduced  nursing home utilization by elders
 
Tackling the complexities of social determinants of health is essential to realizing our vision of a Massachusetts in which everyone has the equitable, affordable, and comprehensive care they need to be healthy. While we must always stand firm in protecting and expanding coverage and care, we must also identify and champion policy solutions that extend beyond this classic framework to address the multitude of factors that so powerfully affect the health of the Commonwealth.
 
-Natalie Litton
May 17, 2018

Just last week, the Massachusetts Senate released their budget proposal for fiscal year 2019, which begins on July 1 of this year. Senators will be debating and voting on many amendments in the short term, including a number of important health care related amendments. 

HCFA is supporting a number of amendments that will improve access to affordable and quality health care coverage; there are also some proposed amendments we oppose that would move our state backwards.

With debate in the Senate starting, it is critical that your Senator knows how constituents feel about these critical health care related amendments. To find your State Senator's contact information, click here. A summary of these key amendments is below:

[For full explanations of each amendment, see our complete budget amendment fact sheet here]

 

HCFA Supports:

Health Insurance:

Amendment #599 (Monitoring Accountable Care Organization Use & Efficacy of Non-Medical Services): Sponsored by Senator Welch, directs MassHealth to work to report data on ACO activities to address social determinants of health.

Amendment #491 (Office of Health Equity): Sponsored by Senator Lewis, allows existing EOHHS funds to support activities of an Office of Health Equity.

Amendment #580 (Academic Detailing): Sponsored by Senator Lewis, increases funding for a physician education program on cost-effective utilization of prescription drugs to $500,000.

Amendment #515 (Smoking Prevention & Cessation Program): Sponsored by Senator Lewis, restores funding to the FY2007 level of $8,500,000 to provide adequate funding for this vital tobacco control program.

Children's Health:

Amendment #620 (Protecting Medically Fragile Children): Sponsored by Senator Friedman, provides an additional $16 million investment in the Continuous Skilled Nursing Program.

Amendment #414 (Mental Health Advocacy Program for Kids): Sponsored by Senator Crighton, increases funding by $150,000 for the Mental Health Advocacy Program for Kids, providing $200,000 to support this valuable program.

Amendment #614 (Return to School "Bridge" Programs): Sponsored by Senator Friedman, provides $250,000 to maintain and expand these Bridge programs.

HCFA Opposes:

Amendment #484 (Health Connector Coverage For Non-Disabled Adults): Opposing this amendment, sponsored by Senator Tarr, would prevent disruptions in coverage for 140,000 adult MassHealth enrollees.

Amendment #496 (Moratorium on Mandated Benefits): Opposing this amendment, sponsored by Senator Tarr, excludes a blanket moratorium on new mandated benefits from the FY18 budget.

Amendment #422 & #488: (Prescription Drug Copay Coupons): Opposing these amendments, sponsored by Senator Demacedo and Senator Tarr, prevents pharmaceutical companies from using rebates and coupons to influence consumer choice and drives up health care spending. 

 

Again, we strongly encourage each of you to contact your State Representative regarding each of these amendments. Make sure that your voice is being heard by those making the decisions!

-Davis Jackson

May 11, 2018

By Jake Murtaugh, Public Affairs Associate

Massachusetts Society for the Prevention of Cruelty to Children

 

The Children’s Mental Health Campaign began as a call to action to inspire mental health reform in Massachusetts and has evolved into a leading voice- so that children and youth get the right care, at the right time.


In 2006, The Massachusetts Society for the Prevention of Cruelty to Children (MSPCC) and Boston Children’s Hospital (BCH) published “Children’s Mental Health in the Commonwealth: The Time is Now.” The study highlighted that the mental health system in Massachusetts was not providing appropriate care to children and teens and that “for too long the healthcare system, including its reimbursement structures, has minimized mental health as a core component of health care”. To answer the call for systemic reform, the Children’s Mental Health Campaign was born, and children’s health advocates created a broad-based mechanism to respond to an inadequate system of care for children and teens with mental and behavioral health needs.

 

On May 7th, 2007, the Campaign testified on increasing access to mental health services for children and teens before a State House audience. You may recognize some familiar faces!

The Campaign quickly gained support from providers, educators, consumers, and organizations, becoming an important driver for the passage of landmark legislation in the Commonwealth; Chapter 321, An Act Relative to Children’s Mental Health & Chapter 256, An Act Relative to Mental Health Parity. The Campaign grew from a collaboration of 34 organizations into a dynamic advocacy network of over 160 organizations dedicated to creating a system in which every child in the Commonwealth receives the highest quality mental health care, in the right place, at the right time.



The Children’s Mental Health Campaign continues its fight for mental health parity and for access to compassionate, effective care for children and teens in Massachusetts. Despite significant gains over the last decade, children and families continue to experience barriers to community-based behavioral health services in Massachusetts. The Campaign advocates for legislation and state budget funding in order to improve access to behavioral health care for children and teens across the Commonwealth.

The Campaign believes that Massachusetts must:

1. Support children in the community.

Because of the Children’s Behavioral Health Initiative (CBHI), children and teens in Massachusetts who have MassHealth coverage now have greater access to community-based treatment than their peers with commercial health insurance coverage.

 

Private insurers are not required to cover community and home-based care. This is a violation of mental health parity. Children and teens seeking mental and behavioral health support should have access to, and health coverage for, appropriate care, including community-based services. An Act to Increase Access to Children’s Mental Health Services in the Community (S.547) would mandate commercial insurers to cover community and home-based care, and would help strengthen parents’ ability to navigate the mental system and then access appropriate care for their children.

 

2. Make sure children and families know where to get care.

Too often health provider network directories are outdated and inaccurate. An Act to Increase Consumer Transparency About Insurance Provider Networks (S.538) will make sure parents know where to get the right services for their children. Provider directories should be tools for accessing the right care, and not a barrier.

3. Support young children- don’t expel them.

May 10, 2018

By Kate Ginnis, MSW, MPH, Director of Behavioral Health Advocacy & Policy, Boston Children’s Hospital

 

Children in Crisis

One in five children suffers from a diagnosable mental health disorder.  Half of all lifetime cases of mental illness are diagnosed by age 14.[i]  The prevalence of mental health disorders among children and adolescents indicates the need for a robust treatment system that allows families to access appropriate care for their children when and where they need it.  Any parent who has tried to get care for their child knows that it is not that simple.

Kids and Families in Crisis

Children with mental and behavioral health disorders and their families across Massachusetts are in crisis. Nowhere is it more evident than in Emergency Rooms throughout the Commonwealth, where parents and caregivers bring their children when they are having a behavioral health emergency.  As with any patient in the ER, children are evaluated by professionals who make recommendations about the best next step, which may include inpatient psychiatric care, an intermediate level of care, or outpatient care.  The similarity between what happens in the ER for youth with physical health conditions and those with behavioral health conditions stops there.  For children with physical health conditions, more complex conditions with more acute symptoms warrant the most immediate and most intensive care.  For children with behavioral health conditions, the most complex patients are more likely to spend days or even weeks in the ER awaiting care.[ii]  Psychiatric “boarding,” was first observed in 2000,[iii] and has been a problem for youth and their families ever since.  Most days in Massachusetts, there are children sleeping in EDs because they cannot access the care that they need.

Why is there a boarding crisis?

Psychiatric boarding is the most severe and apparent symptom of the inadequacies in access to behavioral health care that the Children’s Mental Health Campaign (CMHC) has prioritized for more than a decade.  In 2006, the CMHC was launched with the publication of a paper entitled, “The Time is Now,” which laid out a set of recommendations to improve children’s mental health care in Massachusetts.  Since that time, the CMHC, a coalition of advocates led by the Massachusetts Society for the Prevention of Children, Boston Children’s Hospital, the Parent-Professional Advocacy League, Health Care for All, Health Law Advocates and, more recently, the Massachusetts Association for Mental Health, has advocated with leaders in Massachusetts to make substantial policy changes to improve access. 

Though we understood that boarding was indicative of a larger system failure, the CMHC leadership realized that in order to advocate for much-needed change, we needed to better understand what was driving the problem. Over the past three years, the CMHC embarked on a research project funded by the CF Adams Charitable Trust to look at boarding from the perspective of hospitals, families, and the community.  We knew that this problem was multi-faceted and that we needed a multi-pronged solution.  We wanted to make sure that we understood both the data and the family experience in order to identify essential policy changes that would have real impact. 

Our research elucidated a trend that we knew existed but for which we previously had mostly anecdotal evidence: youth with more complexity board longer.  In December 2016, the CMHC brought together key stakeholders at a pediatric boarding “summit,” to present project outcomes and to get feedback from key stakeholders which enabled us to develop a plan for next steps in legislative, administrative, and budget advocacy to eliminate boarding.  At the same time, the Executive Office for Health and Human Services, with the leadership of Secretary Marylou Sudders, embarked on a statewide workgroup to solve the boarding problem for both children and adults.  CMHC leaders have been delighted at the attention paid to this critical issue and have been engaged at every step of the way.  Perhaps the most immediate result of our collective work is the creation of inpatient units to treat youth with Autism Spectrum Disorders who are in psychiatric crisis, the first of which will open later this year.

What’s next?

Boarding as a symptom allowed the CMHC leadership to unpack several other advocacy priorities that we believe will improve access at all levels of the mental health care system, and that you can read about on the CMHC website or by subscribing to our monthly newsletter. New issues are brought to our attention by the advocacy of our engaged providers and families, and we depend on your insight, expertise, and activism to combat the inequities that exist in the children’s behavioral healthcare system. Contact the CMHC or you may contact me directly at kate.ginnis@childrens.harvard.edu.

 

May 9, 2018

  

By Marisol Garcia, Esq., Director/Managing Attorney,

Mental Health Advocacy Program for Kids, Health Law Advocates

On a spring day in 2017, elementary school staff called an ambulance to transport Ashley—a fourth grader experiencing an acute mental health crisis—to the emergency room. In the ambulance, Ashley hit an EMT in the face. As a result, charges were pressed against Ashley for assault and battery. Ashley’s mother was shocked when she received court documents instructing her that her nine year old daughter had a clerk’s magistrate hearing. Ashley would have to appear in court in a delinquency proceeding for behavior that happened while her family and providers were actively seeking treatment for her mental health needs.

Just like Ashley, many children involved in—or at risk of entering—the juvenile justice system end up there because of unmet mental health needs. Health Law Advocates’ Mental Health Advocacy Program for Kids (MHAP for Kids) has a proven track record of significantly improving the lives of these children and their families while also reducing unnecessary costs for the Commonwealth.

MHAP for Kids embeds staff attorneys in Family Resource Centers (FRCs) in Lowell, Lynn and Boston. The state created the statewide network of FRCs in 2012 with the goal of increasing children’s access to mental health care, special education and other services that play a significant role in diverting children from juvenile court. Our attorneys are trained in overcoming systemic barriers to mental health services by working with young people and their families to begin or improve special education services, secure and/or coordinate community-based mental health services, collaborate with the Department of Children and Families, the Department of Mental Health and the Department of Developmental Services, advocate for general education accommodations and assist with health insurance coverage.

MHAP for Kids serves young people and parents who have a “significantly elevated risk profile.” Of the children served:

  • 83% diagnosed with one or more mental illness (average of 3.5 mental health related conditions)
  • 89% experienced a barrier to mental health treatment
  • 63% accessed crisis or emergency mental health care services in the past year
  • 44% hospitalized for psychiatric care in the past year
  • 37% admitted to a residential mental health facility in the past year
  • 28% did not attend school at all or missed almost every day in the past three months
  • 61% missed school more than one day per week in the past three months

MHAP for Kids works. The Boston University School of Public Health conducted a two year study on the efficacy of MHAP for Kids. The study found that when MHAP for Kids intervenes in a child’s life, children experience:

  • Improved school attendance (31% missing more than one day per week, reduced to 6%)
  • Decreased use of emergency mental health services (70% with recent need, reduced to 24%)
  • Lowered use of overnight hospital stays (44% with recent need, reduced to 14%)
  • Reduced use of emergency shelters (10% with recent need, reduced to 0%)
  • Improved families’ self-reported mental health (children and parents/guardians), family conflict and family difficulties

In Ashley’s case, her therapeutic providers contacted the MHAP for Kids staff attorney immediately. The attorney felt strongly that Ashley was being punished for her unmet mental health needs. The attorney explained the entire juvenile court procedure to both Ashley and her mother so that they would know exactly what to expect. At the hearing, the attorney explained to the magistrate that Ashley is working with MHAP for Kids to get her the mental health treatment that she needs. The magistrate dismissed the charges. The MHAP for Kids attorney helped Ashley find placement in a therapeutic day school. Today Ashley is attending classes successfully and learning new coping skills.

MHAP for Kids is a lifeline – out of the juvenile justice system and into the treatment and care that creates brighter futures. As MHAP for Kids expands, it is our hope that one day soon, this program will be available to every Massachusetts child in need of its services and support.
 

This blog is part of HCFA’s Children’s Mental Health Week series.

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