On Tuesday The Senate Ways & Means Committee released its state budget proposal for the coming fiscal year (2018), calling for total spending of $40.8 billion and including a number of provisions of great interest to the healthcare community.
By Thursday night, a series of proposed amendments to the budget were filed, including three MHA priority amendments aimed at: overturning current MassHealth policies that limit reimbursement paid from commercial MassHealth Managed Care Organizations (MMCOs) to acute care hospitals; devoting more funding to disproportionate share hospitals; and requiring the state to study an emerging – and troubling – insurance industry practice of imposing restrictive policies on how certain pharmaceuticals are dispensed to patients. Debate on the budget and amendments is scheduled to begin Tuesday, May 23.
The MMCO amendment (sponsored by Sen. Michael Moore (D-Millbury)) would reverse recent problematic MassHealth policies that improperly limit reimbursement paid from MassHealth Managed Care Organizations to acute care hospitals. MassHealth recently has issued policies to limit negotiations between MassHealth MCOs and acute care hospitals, which puts hospitals at a significant disadvantage in the negotiation process. The amendment is budget neutral to the state as it does not affect the payments MassHealth pays MCOs. This amendment simply reestablishes the long-standing free-market practice of allowing healthcare providers to fairly negotiate with MassHealth MCOs.
The disproportionate share hospital (DSH) amendment (Sen. Jim Welch (D-West Springfield)) builds upon the Senate budget proposal that includes $13 million for DSH. The amendment would direct total additional payments for DSH to be $24 million, which equals the amount that was assumed in the FY2017 state budget. The amendment also directs $6 million of that funding to be used for behavioral health services provided in the DSHs, in particular for services provided to children and adolescents.
The amendment relating to so-called forced “brown-bagging” and “white-bagging” of cancer drugs (Sen. John Keenan (D-Quincy)) calls on the Health Policy Commission to study the practice and issue a report. Hospitals, healthcare professionals, and patient advocates decry new insurance practices that require cancer and chronic disease patients to now obtain certain injected or infused medications through a specialty pharmacy. In many cases, these medications are no longer covered by insurance companies unless the patient self-administers the medication, uses a visiting nurse, or brings the drug to their healthcare facility or physician’s office to be administered by a clinician – a practice known as “brown-bagging.” Some insurers also require “white-bagging” – where medications are required to be dispensed by a specialty pharmacy and delivered to a hospital, infusion center, or physician for administration to a specific patient. The imposition of such restrictions in certain cases raises both significant quality and safety concerns and troubling legal conflicts related to the state’s prohibition on the re-dispensing of pharmaceuticals.