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HCFA Recommendations to Health Care Bill Conference Committee

HCFA Recommendations to Health Care Bill Conference Committee

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:

  1. Improving Accuracy of Provider Directories: Families and individuals seeking care can face difficulty finding accurate, reliable information about the provider network available through their health plan, making it difficult to find an appropriate provider in a timely manner when they need one. While the Senate bill establishes a taskforce to determine ways to ensure accuracy of provider directories, section 138 of the House bill goes further – requiring provider directories to be easily searchable, available to the public and updated at least monthly. HCFA believes the inclusion of section 138 of the House Bill is vital for the final proposed legislation.
  2. Drug price transparency: Prescription drug prices are rising rapidly, resulting in increased health care costs, an unconscionable burden on consumers and significant pressure on the state’s budget. We recommend that the Conference Committee adopt the Senate language on drug price transparency in the final bill (section 35) in order to strengthen the ability of policymakers and the public to judge if we are getting good value for the billions of dollars spent on prescription drugs.
  3. Oral Health Integration: Oral health is an integral component of overall health. By taking steps to integrate oral health coverage with general medical care, we can improve access to care and increase the cost-effectiveness of our health system. We urge the Conference Committee to include oral health integration among the goals of the Health Care Payment Reform Fund (section 10) and the recommendations for the state health plan (section 26). Additionally, we urge the legislature to act on the separate dental therapy bill this which was negotiated by the Committee on Public Health.
  4. Expanding Medicare Savings Programs: Currently, an eligibility cliff drops many low-income seniors from MassHealth or ConnectorCare eligibility, leaving them with only limited Medicare coverage and expensive premiums and out-of-pocket costs. We applaud the Senate and House for recognizing the extraordinary need to address health coverage affordability for seniors by making steps towards expanding Medicare Savings Programs. However, we urge the Legislature to go even further and expand Medicare Savings Programs eligibility to 200% FPL, as was proposed in an amendment by Representative Ashe during House deliberations.
  5. Out of network billing: Out-of-network billing occurs when patients receive out-of-network care that they did not or could not intentionally choose to receive, and they are subsequently faced with unexpected medical bills. First, we recommend that the Conference Committee adopt the House language regarding comprehensive disclosures of the network status of a provider in order to decrease the likelihood of surprise bills in the first place. Second, we applaud both the House and Senate for including strong language prohibiting “balance billing” of consumers facing surprise bills, and we recommend adoption of the House language that specifies that patients cannot be billed for non-emergency services unless the out-of-network provider has obtained clearly defined prior written consent from the patient (sections 68 and 105). Third, we recommend adopting the provision in the Senate bill providing a legal remedy when a provider or carrier requests payment from an enrollee in these situations (section 138). Finally, we support the Senate bill provision that creates an independent process for the determination of non-contracted commercial rates for emergency and non-emergency services.
  6. Prevention and Wellness Trust Fund: The Prevention and Wellness Trust Fund (PWTF) began as a pilot program to test the impact of evidence-based, community-clinical partnerships to address costly, preventable chronic disease. The program increased access to preventive services for nearly 1 million people across every region of the Commonwealth and helped transform the linkages between clinical care and community-based services. We strongly urge the conferees to provide for stable and sufficient funding to operate the program.
  7. Social Determinants of Health: Section 147 of the House bill directs MassHealth to report on ACO activities regarding social determinants of health. A similar provision is included in the Senate version of the budget. We urge the Conference Committee to include this provision in the bill if it is not part of the fiscal year 2019 final budget.

HCFA is committed to advocating for affordable and quality health care coverage. We believe our comments and recommendations will be valuable as the legislature works to finalize a bill that improves our health care system while reducing costs.

                                                                                                                                             -Louis Pratt