State Budget, federal drug costs legislation, and more...

FY2020 State Budget

The Fiscal Year 2020 budget is now on Governor Charlie Baker’s desk, after the Legislature kicked off its work week last Monday by passing a $43.1 billion package
MHA has sent a letter to the governor urging his support for a number of MHA priority items contained in the budget, including $250,000 for the Massachusetts Consultation Service for Treatment of Addiction and Pain to offer case management and care navigation support to help providers find continuing community-based substance use disorder treatment for patients; $300,000 to provide nasal naloxone rescue kits in emergency departments for patients being treated for substance use disorder to take home; language to help preserve the benefits of the federal 340B drug discount program for safety net hospitals and the commonwealth; and encouraging the state to make the full transfer of the budget-directed $15 million to the Health Safety Net prior to the beginning of the program’s fiscal year in October. 
The letter also calls for support for a number of items relative to behavioral health, including $2 million for a loan forgiveness program for mental health professionals and a $10 million transfer to the newly created Behavioral Health Outreach, Access and Support Trust Fund to kick-start a $500,000 public awareness campaign to address the stigma surrounding behavioral health treatment. 
Furthermore, the request asks for the inclusion of language that would prevent insurers from retroactively denying claims for behavioral health services and supports an increase in funding for the Division of Professional Licensure to eliminate the existing backlog of licensure applications for behavioral health professionals and to assist these providers through the licensure process. 
Governor Baker now has until Wednesday of this week to decide whether to veto provisions in the budget and/or make amendment recommendations.

Federal Drug Costs Compromise Legislation Advances in the Senate

The US Senate Finance Committee advanced bi-partisan, compromise drug cost legislation on Thursday, despite opposition from a majority of the committee’s Republican members. The bill, sponsored by Senators Chuck Grassley (R-Iowa) and Ron Wyden (D-Oregon), aims to reduce prescription drug costs for Medicare recipients with “Part D” prescription coverage, while also providing savings for state and federal health programs for seniors and low income individuals.
The Grassley-Wyden proposal caps Medicare Part D patients’ out-of-pocket expenses at $3,100 a year starting in 2022, and requires pharmaceutical companies to pay a penalty to Medicare if cost increases for their medications outpace inflation. It does not include a cap on out-of-pocket costs for the popular Medicare prescription benefit, leaving patients taking very expensive drugs to bear for 5% of the cost, with no limit on what they pay. 
The senators said preliminary estimates from the Congressional Budget Office (CBO) show that the Medicare program would save $85 billion over 10 years, while seniors would save $27 billion in out-of-pocket costs over the same period, and $5 billion from slightly lower premiums. The government would save $15 billion from projected Medicaid costs, and individuals with private insurance should also see some savings, according to the CBO.

Baker Administration Provides Funding for Health Safety Net in FY2019

Massachusetts has done an exceptional job expanding coverage to the uninsured, but there are still thousands of residents that remain without comprehensive insurance. To protect these individuals and the providers that care for them, the commonwealth continues to rely on the Health Safety Net program. Financing the Health Safety Net has been largely the responsibility of acute care hospitals and insurers and the state over the years has also provided a modest contribution. When there is not sufficient funding in the trust, hospitals alone finance the shortfall. 
Last year’s FY2019 state budget provided for the transfer of up to $15 million in state funding to the Health Safety Net. This month, the Baker Administration fulfilled that transfer, helping to reduce the estimated funding shortfall in the program from $74 million to $59 million. “MHA greatly appreciates the Baker Administration completing the FY2019 transfer, providing needed relief to hospitals across the commonwealth and additional stability to this important program,” said Steve Walsh, MHA’s President & CEO. The FY2020 budget allows for a state transfer of no more than $15 million to the Health Safety Net and MHA continues to advocate that this commitment also be fulfilled to provide added financial support. 

HPC Releases Final Report and Recommendations on Third-Party Specialty Pharmacy Issues

At its July 24 board meeting, the Health Policy Commission (HPC) released its final report (required by Section 130 of Chapter 47 of the Acts of 2017) on the use of third party specialty pharmacies for certain clinician-administered medications. The report considers “the prevalence and impact of health insurers’ policies that seek to reduce overall pharmaceutical spending by requiring alternative methods of distribution and payment for certain costly specialty drugs.” It also includes several recommendations regarding the use, payment, and public oversight of such measures in Massachusetts. 
As the report lays out, under the new policies introduced by insurers, payers now contract with third-party specialty pharmacies to purchase pharmaceuticals, removing the provider from the drug acquisition process. The payer then reimburses the third-party specialty pharmacy for the drug and pays the provider only for the drug’s administration. 
The three most common alternative distribution methods are referred to as “white bagging,” “brown bagging,” and “home infusion.” “Brown bagging” is when a third-party specialty pharmacy dispenses a prescribed drug directly to the patient, and the patient then transports the drug to their provider for administration. “White bagging” is when a third-party specialty pharmacy dispenses a particular drug and sends it directly to the hospital pharmacy or physician’s office. With “home infusion,” payers may contract with home care services for a clinician to administer a drug in the patient’s home. 
The HPC found that third-party specialty pharmacy treatment methods have costs and cost-sharing amounts that can vary widely, and each method poses different potential challenges to safety that must be addressed to ensure that patients are receiving the most appropriate treatment in the right setting. The commission’s recommendations included: i) a prohibition of insurer-compelled brown bagging for any drugs; ii) home infusion should be an optional benefit for patients – not a requirement from insurers; iii) minimum safety standards and capabilities must be utilized by insurers with the third-party specialty pharmacies with whom they contract to protect patient safety when white bagging; iv) adoption of best practices and site neutral payment policies for white bagging; v) the passage of legislation to increase public transparency and scrutiny of the drug entire distribution chain; and vi) adoption of best practices in this area by the state’s Group Insurance Commission, Health Connector and MassHealth for all plans with which they contract. 
The report also lays out additional concerns that providers identified during the public hearing process on these methods, including the fact that white and brown bagging can have unintended consequences of creating uncompensated provider expenses as well as increasing administrative complexity in the healthcare system. The HPC held a public hearing and consulted with MHA, hospitals, other providers and insurers in the development of their findings. 

MHA Offers Testimony on Behavioral Health Workforce Bill

MHA testified in support of HB1737 / SB1147, An Act Establishing a Behavioral Health Workforce, during Tuesday’s meeting of the Legislature’s Joint Committee on Mental Health, Substance Use & Recovery. This MHA priority bill would create a behavioral health workforce commission composed of state officials, as well as provider and consumer groups, to identify reasons for behavioral health workforce shortages in inpatient and community-based settings and make recommendations to address such shortages. 
“Massachusetts is facing a shortage of behavioral healthcare providers. This shortage results in an inability to fully open units and facilities for lack of necessary behavioral healthcare professionals, difficulty in recruiting staff for existing inpatient and community-based services, and, ultimately, delays in care for individuals seeking behavioral healthcare,” said Leigh Simons Youmans, MHA’s Director of Behavioral Health and Healthcare Policy. “It is our hope that convening this Behavioral Health Workforce Commission will provide a forum for state officials, providers, consumers, and payers to solve this problem so that all residents of the Commonwealth are able to access the behavioral health services they need when they need them.” 
MHA participated in the hearing as part of a panel that also included the Massachusetts Association of Behavioral Health Systems, the Association for Behavioral Healthcare, and the National Association of Social Workers – Massachusetts Chapter. 

CDC Updates Its Measles Prevention and Control Recommendations for Healthcare Settings

The Centers for Disease Control (CDC) has updated its Interim Infection Prevention and Control Recommendations for Measles in Healthcare Settings, which are designed to help clinicians protect against the spread of measles. The CDC's interim guidance should be implemented as part of a comprehensive infection prevention program to prevent the spread of germs among patients, healthcare providers, and visitors. 
Measles is most commonly spread from person to person either at home or in public settings, but it can also spread in healthcare settings. The most important way to prevent the spread of measles is community vaccination.

The Final 2020 Inpatient Hospital PPS Rule

Join us Friday, August 16, 9 a.m. to 12 noon, at the MHA Conference Center, for our annual program to review the final IPPS inpatient rule. We’ll cover all of the critical changes and updates important to hospitals, including: inflation and program financial updates; changes to the value-based and quality programs; proposals on price transparency; MS-DRG grouping and significant ICD-10 changes; and how to examine other Medicare legislative and regulatory issues applicable to acute care hospitals. Valerie Rinkle, president, Valorize Consulting will lead the discussion. Sign up today by clicking here.

John LoDico, Editor