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Senate Update - Rx Issue Pending in Budget; Payment Reform Bill Amendments Posted

Senate Update - Rx Issue Pending in Budget; Payment Reform Bill Amendments Posted

May 25, 2012

This morning the Senate will reconvene at 9 am to finish up its work on the FY 2013 budget. Last night the Senate approved an amendment by Senator Chandler to begin the process of restoring some of the dental benefits that were eliminated for  adults in MassHealth. We're grateful to Senators for understanding the critical role dental care plays in overall health.

Still unresolved are two proposed amendments that would increase drug spending in Massachusetts. One amendment would allow pharma "coupons," marketing ploys meant to entice people into using high-cost brand name drugs. Research shows that repeal of the drug coupon ban would increase costs in Massachusetts by $750 million over the next decade. Drug manufacturers claim the coupons are intended to help patients, yet they've rejected proposals that require them to make the coupons available for as long as a patient needs the drug.

The second pending amendment would gut our restrictions on aggressive marketing to doctors, and allow the wining and dining of physicians by drug companies. Nothing should come between the patients and their physicians. In order for patients to have confidence in our health care system, they need to know that the treatment plans recommended by their doctors were not influenced by fancy dinners or gifts. Repealing or weakening our state’s gift ban law would not only increase health care costs, but also put relationships between doctors and their patients in jeopardy.

The gift ban does not outlaw all contact between sales representatives and physicians – doctors are still free to work with the industry toward innovation and attend educational meetings with meals as long as such meetings occur within the provider settings or if the prescriber pays his or her own meal tab at a restaurant.

We urge the Senate to reject both of these cost-increasing amendments.

Meanwhile, the Senate has posted the final version of the Senate payment reform bill, S. 2270, incorporating all the amendments made during their debate last week. For the record, here are some of the amendments that Health Care For All and the Campaign For Better Care worked on that were incorporated into the final Senate bill. We thank the Senators involved for their advocacy and support:

Sponsor Issue
Chang Diaz 1. Require ACOs to show competence in care coordination.

2. ACOs have to demonstrate an ability to provide culturally and linguistically appropriate care.

3. ACO benefits have to include patient education and outreach provided by community health workers.

4. ACO mental health care must include services provided by peer support workers, certified peer specialists and licensed alcohol and drug counselors.

5. ACOs must include group visits and chronic disease self-management programs.

6. ACOs must protect provider choice, and allow out-of-ACO care.

Rush Private plans using alternative payment methods must report on their use of patient protection standards, including using risk adjustment based on functional status, socio-economic status or cultural factors, integration of behavioral health, use of cultural and linguistically appropriate care, and others.
Brownsberger 1. Decisions on challenges to ACO decisions should be in writing and inform the patient of right to appeal.

2. DPH required to set up external review process for ACOs.

3. Patients contesting an ACO decision get benefits while their appeal is pending.

Jehlen ACOs must share savings with consumers.
Montigny 1. ACO governance must include standards related to financial conflicts of interest and transparency.

2. ACOs must use incentives to reduce avoidable hospitalizations, avoidable readmissions, adverse events and unnecessary emergency room visits.

Rodrigues 1. Quality measures must include patient confidence.

2. Website must implement usability standards that are relevant for low-income consumers and consumers with limited literacy.

3. The website must comply with the Americans with Disabilities Act, and indicate which provider services are physically and programmatically accessible, including access to physical examination equipment for people with disabilities.

Joyce Dual eligible program must include independent long term care services coordinator
Richard Moore Providers required to help terminally-ill patients with end of life options.
Jehlen Checklists for hospital procedures must be encouraged by DPH, and their use must be publicly reported.
Tarr 1. Commonwealth Care coverage should not be cut off for an enrollee who has submitted review form documentation while the paperwork is being reviewed.

2. State to let people losing unemployment benefits about health coverage options.

Keenan Behavioral health and substance abuse defined as medically necessary and a  substance abuse representative will serve on Behavioral Health Task Force.

We also worked to defeat amendments we judged would hurt the health care system. Among the amendments we opposed that were not accepted into the final bill were amendments that would let broker fees be counted as medical expenses, that would have repealed the employer fair share assessment for firms of under 50 workers, and that would have taken out language to fund the Prevention Trust.
-Brian Rosman