United States: Recent Developments In Massachusetts Health Policy

Last Updated: October 27 2015
Article by Julie Cox, Steve Weiner and Sasha Dudding

Building on the momentum of early October hearings on the state's growing health care expenditures, the Health Policy Commission (HPC), the Joint Committee on Health Care Financing, Governor Charlie Baker, and others spent the past two weeks crafting new policies for the industry and its consumers. Included among the measures under consideration are those that would give the HPC a greater role in blocking transactions it deemed anticompetitive, require equal reimbursements for telemedicine, and place additional restrictions on opioids. Following this report on recent developments in health care is a guide to the HPC's Annual Cost Trends Hearings.

HPC reports may gain legal weight

A bill that would give legal weight to HPC reports on proposed mergers between health care providers was the focus of discussion at last Wednesday's Joint Committee on Health Care Financing hearing. H3678, An Act relative to protecting health care consumers, is a joint effort between Attorney General Maura Healey and House Majority Leader Ron Mariano (D-Quincy). Under the legislation, the HPC's Cost and Market Impact Reviews on proposed mergers between providers would become a "rebuttable presumption" in a court case brought by the Attorney General, which the company would have to dispute. Both authors said the legislation would protect Massachusetts consumers from the decrease in market competition that can follow mergers and acquisitions, while letting beneficial transactions proceed. This is necessary because of a recent uptick in provider consolidation and the lack of case law in the area, Healey said. Mariano added that it furthers the legislature's intent in establishing the HPC, since they wanted to give the body more teeth but "punted" on the issue.

Representatives of Lahey Health, the Massachusetts Council of Community Hospitals, the Massachusetts Association of Health Plans, and the Greater Boston Interfaith Organization testified in favor of the bill. They praised the process's fairness, its protection of consumers, and its fulfilling of the legislature's intent. However, Tim Gens of the 90-member Massachusetts Hospital Association countered that the HPC should not create additional burdens for providers.

Massachusetts seeks to expand telemedicine

At the same Joint Committee on Health Care Financing hearing, proponents of telemedicine argued for a bill that would require Medicaid coverage of telemedicine, require equal reimbursement for these services, and create a central licensing process for telemedicine providers. The bill is H267, An Act advancing and expanding access to telemedicine services. At the hearing, bill sponsor Rep. John Scibak (D-South Hadley) said there is "no reason" that Massachusetts should be one of the nation's only three states without required Medicaid coverage for telemedicine. Telemedicine benefits rural populations, working parents, school-age children, and those with behavioral health needs, he said. Physicians and industry experts agreed it would help the state's hardest-to-reach patients, though some cited concern with the bill's logistics.

Five people affiliated with Boston Children's Hospital, including an 11-year-old-patient, said telemedicine can connect kids and parents to much-needed services and save them long trips to the doctor's office. Doctors said their hospital cannot expand its current telemedicine program statewide because participants must be certified anew at every hospital they work with, so the bill's centralized credentialing process is important. A Massachusetts Hospital Association panel also spoke in favor of the bill, noting that it does not mandate coverage of new services and is not tied to a fee-for-service payment model. Committee co-chair Rep. Jeffrey Sánchez (D-Jamaica Plain) probed the speakers for details, and said he was concerned about which provider would get reimbursed – a concern shared by the Massachusetts Association of Health Plans.

The HPC is also seeking to expand telemedicine statewide, with a year-long pilot program that will grant $500,000 to selected community-based providers and telemedicine projects.

Baker files opioid bill

Last Thursday, Governor Baker filed his own bill to complement House and Senate measures designed to fight the state's growing opioid crisis. The bill focuses on education, prevention, and expanding access to treatment. It would require doctors to spend five hours a year on continuing education surrounding opiates, while athletes, parents, and various school staff members would receive training about opiate use and misuse as part of their annual head injury safety trainings. To reduce the supply of opiates in the state, the bill limits first-time opiate users to 72 hours' worth of pills, except in an emergency. Prescribers thinking of writing an opiate prescription will also be required to check the state's Prescription Monitoring Program, which records a patient's drug history for the preceding year. Insurance companies would also have to file opioid management policies with the Division of Insurance, detailing their efforts to encourage safe prescribing and alternative pain management.

The bill also addresses those already addicted to opioids. Rather than being involuntarily committed by courts – which have set business hours and are coping with an influx of substance abuse cases – a person suffering from opiate addiction can be committed to a treatment facility by a physician, psychologist, or other specialist. These patients must have a chance to voluntarily commit themselves within 72 hours, but the facilities can petition courts for a commitment order if a patient refuses. This measure is part of a policy shift toward treating opiate addiction as a public health problem rather than a criminal one, and is complemented by a 2014 bill that mandated insurance coverage of two weeks of addiction treatment.

To find out more about the legislature's action on opiates, read Mintz Levin's recent alert.

"Performance Improvement Plans" now fall under HPC's authority

Last Wednesday, members of the HPC's Cost Trends and Market Performance Committee discussed a new way of containing spending growth: Performance Improvement Plans, or PIPs. Starting this year, the HPC has the authority to require these plans of certain payers and providers whose spending threatens the 3.6% growth benchmark due to factors within their control. The HPC can fine entities that do not make a good faith effort to implement their PIP up to $500,000.

The committee discussed how to take on this new authority in a way that is fair and transparent to providers. The current process begins with a confidential report from the Center for Health Information and Analysis (CHIA) that lists payers and providers with the highest cost growth, as measured by total medical expenses. The HPC can require listed organizations to submit a PIP to address their cost growth, if an analysis of CHIA's list shows this is warranted for a given entity. Over two dozen factors will go into the HPC's analysis– including spending trends, pricing trends, utilization, size and market share, populations served, cost-reduction initiatives, and which factors an entity can control – so the committee asked for language around which factors matter most. Commissioner David Cutler repeatedly expressed concern that the statute gives the HPC too much leeway in the process, as much cost growth is outside entities' control. The committee plans to discuss the matter further, and is not required to ask for any PIPs at all.

HPC to fund $6 million in "validated innovation"

The second HPC committee to meet last Wednesday was the Community Health Care Investment and Consumer Involvement Committee, whose members discussed the launch of a new $6 million program to fund innovations in health care. Titled the Health Care Innovation Investment Program, this competitive grant program will invest in payers and providers proposing "validated innovations," or new ideas with evidence of success. Similar programs around the nation have brought an average of 45% cost savings within three years. Griffin Jones, the program's manager, proposed a preliminary slate of eight priority areas, largely centered on high-needs patients. Commissioners Rick Lord and Ron Mastrogiovanni approved, saying helping this population is likely to yield the highest return on investment. The program is funded from gaming licensing fees, so it may grow if the state chooses to award a third casino license.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

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