July 2018

July 26, 2018

health care budget

Governor Baker signed the state budget for Fiscal Year 2019 today. The budget funds state programs and also includes numerous policy changes. Massachusetts budget procedures allow the Governor to veto specific provisions of the budget However, for the most part, the Governor did not veto our key health care priorities.

We are very pleased that the budget does not call for cuts in MassHealth or other state-funded health programs, and adds a new periodontal (gum care) dental benefit for adults in MassHealth.

Here are some of the issues that we have been working on that were included in the budget signed today:

  • Restore coverage for periodontal care for adults on MassHealth – the budget provides for periodontal (gum care) benefits to be provided to adults in the MassHealth program effective June 1 of 2019. Coverage for the treatment of periodontal disease is critical to improving the oral and general health of the adult population.  
  • Establish an Office of Health Equity within EOHHS – the budget includes a long-standing HCFA priority by funding a permanent, codified Office of Health Equity that would work to improve the health of racial and ethnic minority populations in the Commonwealth by establishing statewide goals and a plan to meet those goals. The Office would coordinate resources throughout state government, as well as evaluate the effectiveness of statewide and regional programs.
  • Direct MassHealth to provide information on ACO outcomes and activities addressing 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. This provision directs MassHealth to report on the impact of the ACO program, including data concerning screening and interventions related to the social determinants of health.
  • Fund critical children’s mental health programs, including the Mental Health Advocacy Program for Kids (MHAP for Kids) and Return to School “Bridge” programs – the MHAP for Kids program improves the mental health of vulnerable youth who have been diverted from juvenile court or are already court-involved and have unmet mental health needs by providing these children with a legal advocate trained in removing barriers to treatment. Return to School “Bridge” programs ensure that youth who have been out of school for psychiatric or other hospitalizations can successfully transition back to school.
  • Fund pediatric palliative care programs – these programs provide invaluable services to over 344 ill children and their families, including consultation for pain and symptom management, nursing care, case management, social services, counseling, volunteer support, respite, complimentary therapies and bereavement services for families.

In signing the budget, the Governor vetoed several provisions that we prioritized. The vetoes included funding for the “academic detailing” program, which is an evidence-based prescriber education program on the therapeutic and cost-effective utilization of prescription drugs. The program helps doctors make decisions based on balanced research data rather than biased promotional information.

The Governor also proposed to cut in half the the $300,000 allocated to the ForsythKids program. This program provides preventive oral health services for kids in 51 schools to provide school-based oral health care.

We will be calling on the legislature to override both of these vetoes.

The Governor also returned a section of the bill with a request that the legislature amend the provision. The issue is prescription drug discount “coupons.” Drug companies use these to entice consumers into purchasing more expensive brand-name drugs, often when cheaper and equally-effective alternatives are available. When the coupons run out, patients are left with high copays. Massachusetts originally banned these coupons, then temporarily authorized them several years ago. The budget provision, which HCFA opposed, would have extended permission for these coupons until 2021. The Governor’s requested amendment would limit the extension just to 2020, and set up a study to make recommendations on the issue. HCFA supports the Governor’s request.

With the budget completed, eyes now turn to the big health care package still pending before a House-Senate conference committee. The legislature adjourns at midnight (more or less) on July 31, so there's not much time left to complete work on the bill.

                                                                                                           -- Brian Rosman

 

July 19, 2018

Oral Health = Overall Health

 

[Update - July 26 - The Governor signed the fiscal year 2019 budget into law, and did NOT veto the provision restoring periodontal care. The new benefits will start on June 1, 2019. HCFA is thankful for the Governor's support of this provision.]

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

 

[Update - July 26 - The Governor signed the Fiscal Year 2019 budget today, and did NOT veto either of the health equity provision. Both of the provisions described below are now a part of state law. We are very thankful to the Governor and the Executive Office of Health and Human Services for their support of these important steps forward.]

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 is directed to 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, and 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: