HCFA’s 2019-2020 Priority Legislation
HCFA worked with a diverse group of legislators in both the House and Senate to file a broad package of legislation for 2019-2020. The proposed legislation includes the following proposals:
Reduce Prescription Drug Costs (Representative Barber & Senator Lewis)-HD3442/SD1799
Perscription drug prices are the leading factor in driving up health care costs across the system, impacting the budgets of individuals, families, employers and the state. An Act to ensure prescription drug cost transparency and affordability will: provide transparency around the underlying costs to produce prescription drugs; restrain abuses of pharmacy benefit managers (PBMs); authorize the Health Policy Commission to set upper payment limits for unreasonably high-priced drugs; require pharmacists to inform consumers if purchasing a drug at the retail price would be cheaper than using insurance; provide tools to strengthen MassHealth’s ability to negotiate lower drug prices; and support a permanent authorization and funding source for “academic detailing” to ensure doctors get accurate information to counter biased drug manufacturer marketing.
Limit the wining and dining of doctors by drug marketing sales personnel: (Senator Lewis) – SD791
Research has shown that the provision of meals is effective in influencing a doctor’s prescribing practices. In 2008, HCFA was instrumental in passing a Massachusetts law that limits these promotional efforts to “modest meals.” However, under strong pressure from drug companies and the restaurant industry, the state’s regulatory definitions have loose restrictions on meals and permit alcoholic drinks at these educational programs. An Act to define modest meals and refreshments in prescriber education settings will put reasonable limits on meals and ban all alcohol in these settings
Children’s Health Access
Expand Health Coverage for Children (Representative D. Rogers & Senator DiDomenico)-HD2615/SD1167
Currently, low-income immigrant children who are not otherwise eligible for MassHealth can access only very limited health coverage, which leaves them without adequate access to many services, including prescription drugs, mental health services, durable medical equipment, dental services, and emergency care. An Act to ensure equitable health coverage for children would expand MassHealth coverage to low-income children whose only barrier to accessing comprehensive coverage is their immigration status. Other states, including California, Washington, Oregon, Illinois and New York have already enacted this policy.
Dental Care Access
Expand Access to Dental Care through Dental Therapists (Representatives Pignatelli and Hogan & Senator Chandler)- HD3436/ SD 1942
The most vulnerable populations in Massachusetts often forgo their oral health needs due to the lack of easy access to a dentist. An Act authorizing dental therapists to expand access to oral health authorizes an additional dental professional, called the dental therapist (DT), to work with a dentist to provide oral health care to more people. DTs present a critical opportunity for Massachusetts to close gaps in dental access for seniors, low-income families, children, and people with special needs.
Restore Full MassHealth Dental Benefits (Representative Honan & Senator Chandler)- HD2690/SD677
An Act Relative to the Restoration of MassHealth Adult Dental Benefits will restore full MassHealth dental benefits to more than 1 million individuals, including over 113,000 seniors and 230,000 people living with disabilities. Important dental services that are vital for good oral health and saving teeth are not currently covered by MassHealth. Left untreated, dental disease can lead to systemic infection, hospitalization, and the worsening of other medical conditions. Oral health is an integral part of overall health and should be included in health coverage.
Private Health Insurance
Ensure Accuracy of Health Plan Provider Directories (Representative Barber & Senator Lewis)- HD2698 /SD744
Accurate provider directories are critical to ensuring that health coverage works for consumers.
An Act to increase consumer transparency about insurance provider networks establishes a task force, chaired by the Division of Insurance, to make recommendations for regulations improving the accuracy of provider directories to ensure consistency across carriers. Provider directories must also be easily
searchable, available to the public, and updated at least monthly.
Protect Consumers from Surprise Out of Network Bills (Representative Farley-Bouvier & Senator Welch)- HD1762
Surprise billing occurs when patients receive out-of-network care that they did not or could not intentionally choose to receive, and then are faced with unexpected and unaffordable medical bills. An Act to protect consumers from surprise medical bills protects consumers by requiring health plans and providers to disclose comprehensive information to consumers about the network status of providers; requiring specific patient consent for out-of-network services; and prohibiting providers from billing consumers more than their in-network cost-sharing amount.
Health Care Affordability
Reduce Out-Of-Pocket Health Care Costs (Representative Farley-Bouvier & Senator Lewis)- HD1207/SD820
An Act to keep people healthy by removing barriers to cost-effective care will eliminate co-pays and deductibles for high-value services and drugs such as insulin, inhalers, and hypertension medications, thereby improving adherence and patient outcomes. A panel of medical experts will make recommendations for medications and services that should not be subject to cost-sharing, with final approval from the EOHHS Secretary.
Preserve Affordable Health Connector Coverage (Representative Balser & Senator Jehlen)- HD1070/SD1901
Access to affordable health coverage is the cornerstone of successful health reform policy. An Act to Preserve Affordable Health Connector Coverage ensures that premiums and cost-sharing remain affordable for individuals who receive subsidies to purchase health insurance through the Health Connector.
Expand Affordable Coverage for Seniors (Representative Ultrino & Senator Lewis)- HD1218/SD741
Thousands of seniors in Massachusetts struggle to afford their health care. Medicare provides a foundation for health security to people 65 and over, but for far too many, the out-of-pocket costs and coverage gaps are severely burdensome. Medicare Savings Programs (MSPs) help lower costs for Medicare beneficiaries with limited incomes. An Act regarding Medicare Savings Programs eligibility leverages federal resources to lower premium and prescription drug expenses for more seniors by expanding income eligibility for MSPs from 135% of the federal poverty level (FPL) ($16,389) to 200% FPL ($24,240) within 3 years and eliminates the asset limit.
Sustain the Prevention and Wellness Trust Fund (Representative Vega & Senator Lewis)- HD2182/SD916
The Prevention and Wellness Trust Fund (PWTF) invests in evidence-based community interventions that keep residents healthy and safe and is helping to transform the linkages between clinical care and community-based services. An Act to promote public health through the prevention and wellness trust fund ensures sustainable funding for the PWTF.