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T-Minus 1 Week: Payment Reform and Prescription Abuse Bills Waiting Action

T-Minus 1 Week: Payment Reform and Prescription Abuse Bills Waiting Action

July 24, 2012

With one week to go and around 4 formal session left in the legislative cycle, it's not yet time to haul out The Final Countdown. But it's getting close. Two key bills await action - the comprehensive delivery system reform proposal, usually called "payment reform" for short, and an important bill to curb prescription drug abuse.

Payment Reform: Experts Say Consider Data and Policy Options on Employer Fair Share. Will Legislators Act Anyway?

The payment reform bill is still being considered by the House-Senate conference Committee. We hear the conferees are "making progress." But we don't expect a bill to emerge until Monday or Tuesday of next week, the last days of the session.

One issue in the bills has nothing do with cost control or payment reform. Both the House and Senate bills make major changes to the Employer Fair Share law, enacted as part of chapter 58 in 2006. The House bill makes dramatic changes, by removing the employer responsibility payment obligation for firms with 11-20 employees who don't provide coverage to their workers that meets state standards.

We oppose these changes now. Of course, there will need to be changes to the employer assessment in 2014, as part of fitting Massachusetts law into the ACA. But these changes should come out of a stakeholder process that includes employers, advocates, labor and the agencies involved. For the legislature to make changes now, without a consensus-building process, is an end run around the ongoing process that has been built up over ACA implementation. Legislation should be based on analysis that looks carefully at the data, continues the principle of shared responsibility, and involves the agencies who have the most expertise. None of this happened here.

We think all of these provisions should be deferred (technically, held in conference) so that they can be looked at later in the context of the broad ACA implementation bill that the state will need to enact early next year. Last week, the Blue Cross Foundation issued a report written by Urban Institute researchers looking at some of the complex issues involved, like state revenues and coverage distribution. The report highlights the complexity of the decisions, and the need to consult data to inform policy decisions.

We have lots of urgent priorities in payment reform. On this topic, policy experts counsel more analysis, and we hope the legislature agrees.

Before we are done, let’s make progress on substance abuse disorders.

One segment of health care that often gets overlooked is substance use disorders, and how policy can address the issues from a systems level.

Back in February, the Senate unanimously passed S. 2125, a comprehensive approach to reducing prescription drug diversion, abuse and addiction. Massachusetts struggles with a severe opioid problem.  Approximately 10 Massachusetts residents a week die from opioid and prescription drug abuse. Hundreds more overdose and require emergency care. Investments in substance abuse disorder prevention and treatment is a demonstrated cost saver.

The legislation is pending in the House Ways and Means Committee. We hope action happens in the final week, to get this bill to the Governor.

The bill is a multifaceted omnibus package to address the prescription drug abuse epidemic gripping our communities. Specifically, it:

  • Requires prescription painkillers come with an easily-understood pamphlet explaining the dangers of prescription drug abuse, where to turn for help, and how to safely store and dispose of the medications.
  • Ensures that prescriptions for painkillers are written on secure, tamper-resistant prescription pads to discourage tampering.
  • Requires doctors, dentists and other practitioners to check patient drug histories through an existing database once before prescribing painkillers, while providing exemptions for emergency situations.
  • Sets up a working group of doctors, nurses, and other health care providers to establish best practices for the prescribing of painkillers.
  • Increases opportunities for pharmacists to check patient drug histories to prevent fraud.
  • Makes sure parents or guardians are notified when their child is treated in the emergency room for an overdose
  • Bans the sale, manufacture and use of “bath salts.”
  • Strengthens the state’s Medicaid prescription drug fraud program
  • Establishes new professional substance abuse training for court personnel and attorneys.
  • Provides for a pilot substance abuse education curriculum for five school districts with high prescription painkiller abuse rates.

We urge people to call your Representative today to support this bill (find your Representative here).

- Brian Rosman and Paul Williams