Health Care Financing

Sponsored Legislation

S.768 An Act to protect medically fragile children

This bill would require the Executive Office of Health and Human Services, subject to appropriation, to increase the budget for continuous skilled nursing care in a stepwise fashion over 2021, 2022, and 2023 with the goal of filling at least 85% of continuous skilled nursing hours authorized by MassHealth by 2023. It would also require MassHealth to submit an annual report detailing the number of filled and unfilled hours authorized by MassHealth, the number of reductions in hours, and the number of appeals of reductions or modifications of hours of continuous skilled nursing care. Finally, the bill would direct the Office of Medicaid to review the wage payment rates established by home health agencies that provide continuous skilled nursing care, conduct an analysis and make recommendations on criteria to be included in any future reporting by these home health agencies.

S.769 An Act relative to collaborative care

This bill recognizes the psychiatric collaborative care model (CoCM) billing codes established by the American Medical Association and requires Massachusetts carriers to cover mental health or substance use disorder benefits that are delivered through the CoCM and that are billed under CoCM codes. The CoCM delivers effective behavioral health care with a care team that is led by a primary care provider and includes a behavioral health care manager and consulting psychiatrist.

S.770 An Act relative to primary care for you

This bill would require a shift in health care spending to achieve a significant increase in investment in primary care services over the course of 3 years. The initial investment target would be based on a 30% increase over baseline primary care spending, as calculated by the Center for Health Information and Analysis (CHIA). This spending target would be in effect for 3 years. Thereafter, subsequent 3-year targets would be set by the Health Policy Commission (HPC) based on input and calculations from CHIA and after holding a public hearing. The system-wide health care cost growth benchmark would still apply as an upper limit on total health care spending.

Health care systems and insurers would be held accountable for achieving the primary care investment target through the same process currently in effect for the health care cost growth benchmark – i.e., through the HPC cost growth hearing process and the performance improvement plan process.

Additionally, the bill would establish a Massachusetts Primary Care Alliance for Patients working group to develop recommendations to assist health care entities in meeting their annual primary care expenditure target. Their recommendations would include legislation to establish a global payment program that includes incentive payments for evidence-based primary care transformation activities.

S.771 An Act relative to pharmaceutical access, cost and transparency

This bill takes a comprehensive approach to pharmaceutical cost control that focuses on access and cost improvement, transparency and oversight. First, the bill would add drug costs to the scope of health care cost analysis conducted by the Center for Health Information and Analysis (CHIA). This information would provide policymakers and consumers with an objective data source to understand drug cost drivers and to assess the impact of cost control initiatives. Similarly, pharmaceutical manufacturing companies and pharmacy benefit managers (PBMs) would be included in the Health Policy Commission’s (HPC) annual Health Care Cost Trends hearing process and would testify publicly on the factors that influence drug costs and provide supporting documents. The HPC, in turn, would use this information to develop an analysis on how pharmaceutical costs impact the state’s health care market and its residents.

The bill would create a licensing process for PBMs, and would require pharmaceutical companies to notify the state in advance of new drugs and biosimilars coming to market and of significant price increases for existing drugs.

The bill would impose a number of provisions designed to reduce the burden of high prescription drug costs on consumers. It would direct the HPC, in consultation with stakeholders, to establish a process for identifying drug price changes that pose a public health threat to our residents and the state, and it would allow HPC and manufacturers to enter into access improvement plans to help mitigate those costs; HPC would also be able to recommend pricing measures the state could employ to increase patient access to much-needed medications. The bill would establish a prescription drug cost assistance program funded by an assessment on drug manufacturers doing business in the Commonwealth. This program would eliminate out-of-pocket prescription drug expenses, for those meeting income guidelines, for certain essential drugs. This bill would also create a pilot program limiting out-of-pocket insulin spending, for any resident with diabetes, by eliminating deductibles and coinsurance and capping co-pays at $25 per month.

Finally, the bill would build upon recent federal action by requiring pharmacists to alert consumers if the retail cost of a medication is less than their cost-sharing amount (i.e., the co-pay, deductible or other amount required through their insurance plan).

Cosponsored Legislation

S.756 An Act relative to step therapy and patient safety (Cyr)