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Floor Number: 701 Clerk Number: 741
REQUIRING THE COMMONWEALTH TO IMPLEMENT A PROGRAM TO PURCHASE PRESCRIPTION DRUGS FROM CANADA WHEN SUCH PURCHASES BECOMES LEGAL UNDER FEDERAL LAW
Mr.
Montigny, Mr. Barrios, Ms. Melconian, Ms. Chandler, Mr. O'Leary, Mr. McGee, Ms.
Wilkerson, Mr. Nuciforo, and Mr. Joyce move to amend the bill, Senate 2400, by
inserting after section 8A the following new section: -
SECTION 8B. Said chapter
6A is hereby further amended by inserting after section 16 the following section:-
Section 16A ½. (A) Notwithstanding any general or special law to the contrary,
the Secretary of Health and Human Services in consultation with the Secretary
of Elder Affairs shall create a program to allow state employees, retirees and
their family members who are insured by the Commonwealth, Mass Health recipients
and Prescription Advantage enrollees to purchase their prescription medications
from Canada through one or more licensed Canadian pharmacies within 90 days of
such purchase becoming legal under federal law. The program shall be optional
for participants and shall provide financial incentives to enrollees in the form
of reduced co-payments or health insurance premiums.
The program shall have
the following restrictions:
1) Purchases may be made only through a licensed
Canadian pharmacy;
2) Only drugs that have been approved by the appropriate
federal agencies in Canada as to the drugs' formulation, source and specification
of active ingredients, processing methods, manufacturing controls, and the container,
closure or packaging of the drug may be purchased through this program;
3)
The Secretary shall establish standards for packaging and shipment of the drugs
to participants that include tamper proof requirements and temperature controls
for medications that need to be maintained at a specific temperature;
4) All
purchases through this program must be accompanied by a valid prescription from
the enrollee's physician;
5) An enrollee may only purchase medications through
this program that he or she has taken for at least 30 days as purchased from a
pharmacy in the United States;
6) Medications purchased through this program
may be for personal use only and may not be re-sold in any form; and
7) Purchases
may be for no more than a 90-day supply per order.
B) Within 90 days of the establishment of this program, the Secretary of Human Services shall expand the program to assist residents of the Commonwealth without adequate coverage for prescription drugs in purchasing their medications from the same licensed pharmacy or pharmacies in Canada. For the purposes of this section, a resident without adequate coverage means a resident of the commonwealth with no insurance coverage for prescription drugs or with coverage for which the annual maximum coverage limit under his health benefit plan has been reached. All the same requirements of subsection A shall apply. The Secretary may establish an enrollment fee to cover administrative costs of the program for these residents, but all cost savings shall be realized by the enrollee.
C) Any aggregate or bulk purchasing program operated by the secretary of health and human services for the purchase of prescription drugs under section 271 of chapter 127 of the acts of the Acts of 1999 or section 62 of chapter 177 of the Acts of 2001 or any other authority shall include an option for participants to purchase drugs from Canada through the program authorized by this section in order to maximize cost savings of the aggregate purchasing plan.
D) Within 180 days of the establishment of the initial program, the secretary shall file a report with the House and Senate Committees on Ways and Means and the House and Senate Clerk detailing the number of participants in the program, a break down of participants by insurance group, the medications purchased through the program, the amount of savings realized by the Commonwealth, the amount of savings passed on to enrollees and any reports of safety concerns in the implementation of this program.
D) The Secretary shall discontinue the program when medications purchased through the program can be purchased for comparable prices through Massachusetts' pharmacies. The Secretary shall determine if prices are comparable by comparing the cost of the 20 medications most commonly purchased through the program with the cost of the same 20 medications purchased by those insured by the Commonwealth who are not enrolled in the program. The Secretary shall consider prices comparable if the average cost of these 20 medications purchased outside the program are no more than 10% more expensive than the cost of the medications purchased through the program including shipping and handling costs. The Secretary shall annually compare prices in this manner to determine if such comparability exists. When the Secretary has determined that discontinuing the program is appropriate under the requirements of this section, he shall notify all enrollees, the Joint Committee on Health Care, the House and Senate Committees on Ways and Means and the House and Senate Clerk 30 days prior to discontinuing the program.
Floor Number: 702 Clerk Number: 742
PATIENT REFERRALS
Mr. Morrissey and Mr. Creedon moves to
amend the bill, by inserting after Section 353, the following new Section:-
"SECTION __. Notwithstanding the provisions of any general or special law
to the contrary, no individual physician or physician group under the solo or
group practice exclusion from the definition of "clinic" contained in
section 52 of chapter 111 of the General Laws, other than a radiologist, or any
other physician who is employed by an acute hospital, shall refer a patient for
services to an entity that operates medical, diagnostic or therapeutic equipment
that is used to provide an innovative service or that is new technology, as such
terms are defined in section 25B of chapter 111 of the General Laws, if: (i) the
physician holds a direct or indirect ownership or financial interest in such medical,
diagnostic or therapeutic equipment or entity; (ii) the physician's immediate
family holds a direct or indirect ownership or financial interest in such medical,
diagnostic, or therapeutic equipment or entity; or (iii) the physician or member
of the physician's immediate family has any direct or indirect arrangement involving
remuneration with the entity. For purposes of this section, "health care
entity" is defined as an entity that provides health care related testing,
diagnosis or treatment of individuals. For purposes of this section "financial
interest" is defined as an ownership or investment interest through equity,
debt, leasehold interest, or other means, or a compensation arrangement, regardless
of whether such interest is direct or indirect. The department of public health
shall enforce this section. The Superior Court shall have jurisdiction in equity
to enforce the provisions of this section. Upon an initial determination of a
violation of this section, the department shall forthwith seek injunctive relief
in the Superior Court A violation of this section shall be punishable by a fine
of not less than $25,000. Any continuing violation of this section shall be punishable
by a fine of not less than $25,000 and not more than $100,000 per day of operation,
and by one or both of: (i) referral of the physician to the board of registration
in medicine for appropriate disciplinary action, and (ii) revocation of the health
care entity's license.
Floor Number: 703 Clerk Number: 750
SAUGUS RT. 1 WATER MAIN TRANSFER
Mr. McGee of Lynn and Mr. Barrios of Cambridge moves to amend the bill be amended by inserting, after Section 25, the following section:-
SECTION 25A. The care, custody, control and title to all water pipes and mains located under Routes 1 and 99 in the town of Saugus are hereby transferred to the Massachusetts Water Resources Authority.
Floor Number: 704 Clerk Number: 753
MUNICIPAL HEALTH INSURANCE
Mr. Morrissey moves to amend the
bill, by inserting after Section 353, the following new section:-
Section__.
Section 11 of chapter 32B of the General Laws as so appearing is hereby amended
by inserting after the second paragraph the following paragraphs:- Notwithstanding
any charter or ordinance to the contrary, the appropriate public authority of
the cities of Cambridge, Chelsea, Everett, Malden, Melrose, Quincy, Revere, and
Somerville may notify the appropriate public authority of the City of Boston of
its election to participate in the schedule of benefits made available by said
city of Boston for its employees and, subject to the approval of the appropriate
public authority of said such city of Boston and under such terms and conditions
and rules and regulations as may be prescribed from time to time by the appropriate
public authority of the city of Boston, the employees of the city so applying
shall become insured at the earliest practicable dare as participants in a city
of Boston group health or life benefit plan. Nothing in this paragraph shall prohibit
the appropriate public authority of the city of Boston from prohibiting participation
by applying cities in certain benefit programs made available by said city of
Boston for its employees. Nothing in this paragraph shall prevent a participating
city from withdrawing from participation upon reasonable notice provided by the
appropriate public authority of the participating city to the appropriate public
authority of the city of Boston. A city granted approval to participate in the
city of Boston's schedule of benefits that incurs costs by so joining or exiting
including but not yet limited to paying for claims which have been incurred but
not yet paid may amortize such costs over a period of not more than 10 years from
the date of such approval or exit.
Nothing in this section shall abrogate any provision of chapter 150E or any collective bargaining agreement with respect to health benefits or to impact adversely the rights and benefits of public employees pursuant to any collective bargaining agreement.
Floor Number: 705 Clerk Number: 754
TOBIN BRIDGE FASTLANE
Mr.
McGee and Mr. Baddour move to amend the bill (S. 2400) by inserting, after Section
344 the following new Section:-
"SECTION____. Notwithstanding any general
or special law to the contrary, MassPort is hereby authorized and directed to
enter into a contract with the Massachusetts Turnpike Authority for the purposes
of operating, managing, and administering the FastLane toll collection system
on the Tobin Bridge. Prior to entering into said contract the Massachusetts Turnpike
Authority shall conduct a cost analysis to determine the cost for providing said
services and report back to the Joint Committee on Transportation, and the Committees
on House and Senate Ways and Means. Said report shall be filed with the Clerk
of the House and the Clerk of the Senate no later than September 1, 2004."
Floor Number: 706 Clerk Number: 766
CANNON STREET POWER STATION
Mr. Montigny moves to amend the bill by
inserting the following new section:-
SECTION ___. Section 341 of Chapter
165 of the Acts of 1997, is hereby amended by striking out the following: - "to
a non-profit, educational entity," and inserting in place thereof the following:-
"with the state entity known as MassDevelopment; provided further, that MassDevelopment
shall established the New Bedford Waterfront Development Advisory Council consisting
of, but not limited to, state and local officials, business leaders and elected
officials, including the New Bedford Chamber of Commerce, the Waterfront Historic
Area League, the SouthCoast Development Partnership, and the New Bedford Redevelopment
Authority; provided further that said Council shall examine economic development
opportunities for the Cannon Street Power Plant site through public hearings and
other means; provided further that MassDevelopment will in accordance with all
existing laws request proposals for development and in consultation with said
Council select a proposal for said site."
Floor Number: 707 Clerk Number: 787
EXTREMITY MRIs
Mr. Hedlund moves to amend the bill by inserting,
after Section _______, the following new Sections:-
"SECTION____. The
second paragraph of section 25C of chapter 111 of the General Laws, as appearing
in the 2000 Official Edition, is hereby amended by adding the following sentence:-
However, a person may use an extremity magnetic resonance imager (MRI) with the
capability of scanning all extremities; foot, ankle, knee, hand, wrist, elbow
and shoulder, but not to include head or spine capability, of the permanent magnetic
type with a field strength of less than .3 tesla and with a fair market value
of less than $450,000 in a location other than a health care facility without
a determination of need issued by the department.
SECTION ____. The department
of public health shall require those locations other than health care facilities
under the second sentence of the second paragraph of section 25C of chapter 111
of the General Laws to demonstrate that they have applied for and received American
College of Radiology, or comparable (ICAMRL), accreditation within 18 months of
commencement of operation of the above defined magnetic resonance imager.".
Floor Number: 708 Clerk Number: 628
CHANGE COMMONWEALTH'S HOLIDAYS
Messrs. Lees and Tisei and Mrs. Sprague
move to amend the bill by inserting at the end thereof the following section:-
"SECTION ____. Section 7 of Chapter 4 of the General Laws, as appearing
in the 2000 Official Edition, is hereby amended by striking the following words
contained in lines 88 and 89 of clause eighteenth:- ", with respect to Suffolk
county only,"
Floor Number: 709 Clerk Number: 629
CHANGE SUFFOLK COUNTY HOLIDAYS
Messrs. Lees, Tisei, Tarr,
Hedlund, Knapik and Brown and Mrs. Sprague move to amend the bill by inserting
at the end thereof the following section:-
"SECTION ____. Section 7
of Chapter 4 of the General Laws, as appearing in the 2000 Official Edition, is
hereby amended by striking the following sentence:- "Legal holiday"
shall also include, with respect to Suffolk county only, March seventeenth and
June seventeenth, or the day following when said days occur on Sunday; provided,
however, that the words "legal holiday" as used in section forty-five
of chapter one hundred and forty-nine shall not include March seventeenth, or
the day following when said day occurs on a Sunday."
Floor Number: 710 Clerk Number: 443
AN AMENDMENT RELATIVE TO THE CAPE COD LAND BANK
Mr. O'Leary, Ms. Walsh,
Mr. Moore, Mr. Barrios, and Ms. Wilkerson move to amend the bill by adding, at
the end thereof, the following new Section: -
SECTION___.
Section
1.(a) Any town in Barnstable County that has a Cape Cod Open Space Land Acquisition
Program established pursuant to Chapter 293 of the Acts of 1998, as amended, may
adopt the provisions of this section in accordance with the procedures set forth
in subsection (b) or (c) of this section. The adoption of the provisions of this
section by a town shall constitute the acceptance by the town of sections 3 to
7 inclusive of Chapter 44B of the General Laws, otherwise known at the Massachusetts
Community Preservation Act, and shall result in the town having all powers and
rights granted by, and being subject to all duties, obligations and restrictions
imposed under, said Chapter 44B to the same extent as if the town had adopted
said sections 3 to 7 inclusive of said Chapter 44B in accordance with the provisions
thereof, except as otherwise provided in this section.
(b) Any such town may
adopt the provisions of this section upon the approval thereof by the town meeting
of the town or, in the case of the town of Barnstable, by the town council of
the town, and the approval thereof by the voters of a ballot question as set forth
in subsection (c) of this section.
(c) Upon the approval of the provisions
of this section by the town meeting of a town or, in the case of the town of Barnstable,
by the town council of the town in accordance with the provisions of subsection
(b) of this section the town clerk or the secretary of state, as applicable, shall
place the question of approval of the provisions of this section on the ballot
at the next regular municipal election held more than 35 days after such approval
or certification, as applicable, or at the next regular state election held more
than 60 days after such approval or certification, as applicable, in the form
of the following question:
"Shall the Town of _________ adopt the provisions
of section ___ of Chapter ___ of the Acts of 2004, (as approved by the town meeting/council),
a summary of which appears below?"
("Acceptance of section ___ of
Chapter ___ of the Acts of 2004 means the Community Preservation Act shall effectively
replace the Cape Cod Open Space Land Acquisition Program. There shall be no additional
excise on real property levied, other than the current 3 % levied for the provisions
of the Cape Cod Open Space Land Acquisition Program. Acceptance of this section
shall allow the community to access state matching funds of up to 100% of the
excise on real property currently levied, which was previously unavailable to
the town. Further, it will extend the date to which the accepting communities
must remain in the Community Preservation Act/Land Bank Hybrid from 2020 to 2030.")
If a majority of the voters voting on said question vote in the affirmative, then
the provisions of this section as approved by the town meeting or town council
or as provided in the petition, as applicable, shall take effect in the town,
but not otherwise.
(d) Notwithstanding the provisions of Chapter 293 of the
Acts of 1998, as amended, to the contrary, the excise on real property in an amount
equal to 3 percent of the real estate tax levy against said property levied pursuant
to section 6 of Chapter 293 of the Acts of 1998, as amended, in connection with
the town's Cape Cod Open Space Land Acquisition Program shall terminate at the
end of the fiscal year of the town in which the voters of the town vote to approve
the adoption of the provisions of this section pursuant to subsection (c). In
the fiscal year of the town following the fiscal year in which the voters of the
town vote to approve the adoption of the provisions of this section, the town
shall impose a surcharge on real property in the amount equal to 3 percent of
the real estate tax levy against said property for the purposes of and in accordance
with the provisions of said Chapter 44B. Notwithstanding the provisions of section
16 of said Chapter 44B to the contrary, the town may not amend the amount of or
revoke such surcharge on real property in accordance with the provisions of section
16 of said Chapter 44B until fiscal year 2030.
(e) On the first day of the
fiscal year following the fiscal year in which the voters of a town approve the
adoption of the provisions of this section in accordance with subsection (c),
the town shall establish a separate account to be known as the Community Preservation
Fund in accordance with and pursuant to the provisions of section 7 of said Chapter
44B. Notwithstanding the provisions of Chapter 293 of the Acts of 1998, as amended,
to the contrary, the town shall simultaneously extinguish its separate account
known at the Land Bank Fund established pursuant to section 5 of Chapter 293 of
the Acts of 1998, as amended. Without further appropriation by the town, the town
shall simultaneously transfer all amounts then on deposit in its Land Bank Fund
to its Community Preservation Fund, and all investments thereof shall become investments
of the Community Preservation Fund. In addition to the amounts so transferred
from the town's Land Bank Fund, the town shall thereafter deposit the following
amounts into its Community Preservation Fund: (i) all amounts required to be deposited
therein pursuant to the provisions of section 7 of said Chapter 44B; (ii) all
receipts from the excise on real property levied pursuant to section 5 of Chapter
293 of the Acts of 1998, as amended, in any fiscal year prior to the fiscal year
in which the Community Preservation Fund of the town is established pursuant to
this subsection, and all interest thereon, which is received by the town after
the establishment thereof; (iii) all proceeds of bonds or notes issued pursuant
to section 7 of Chapter 293 of the Acts of 1998, as amended; and (iv) any other
grants, donations or other amounts received by the town for the benefit of, for
deposit in or for the purposes of the Land Bank Fund.
(f) Upon the adoption
of the provisions of this section by a vote of the voters of a town in accordance
with the provisions of subsection (c), the town's open space committee established
pursuant to section 4 of Chapter 293 of the Acts of 1998, as amended, shall be
abolished. Any town which has so adopted the provisions of this section shall
establish a community preservation committee by bylaw in accordance with the provisions
of section 5 of said Chapter 44B. Said community preservation committee shall
have the rights and powers, and shall be subject to the duties, obligations and
restrictions, set forth in section 5 of said Chapter 44B.
(g) All amounts
transferred to or deposited in the Community Preservation Fund of a town pursuant
to the provisions of subsection (e) shall be appropriated in every fiscal year
in accordance with the provisions of section 6 of said Chapter 44B; provided,
however, that any amount appropriated by the town from the Land Bank Fund in accordance
with the provisions of Chapter 293 of the Acts of 1998, as amended, prior to the
vote of the voters of the town approving the adoption of the provisions of this
section pursuant to subsection (c) which has not been expended prior to the establishment
of the Community Preservation Fund and the termination of the Land Bank Fund pursuant
to subsection (e) shall be expended solely for the purpose of such appropriation
pursuant to the provisions of Chapter 293 of the Acts of 1998, as amended, and
the vote of the town meeting or, in the case of the town of Barnstable, of the
town council therefore. Any such amount expended from the Community Preservation
Fund in accordance with a prior appropriation made pursuant to the provisions
of Chapter 293 of the Acts of 1998, as amended, shall not require a further appropriation
of the town and the amount and purpose of such an expenditure shall not be taken
into account for purposes of determining annual revenues of the Community Preservation
Fund and compliance by the town with the minimum spending requirements prescribed
in section 6 of said Chapter 44B. No appropriation may be made from the Land Bank
Fund by any town that adopts the provisions of this section after the date on
which the voters of the town vote to approve the adoption of the provisions of
this section pursuant to subsection (c). Any town that adopts the provisions of
this section may appropriate amounts from its Community Preservation Fund only
after the establishment of such Fund pursuant to subsection (e) and after the
establishment of its Community Preservation Committee pursuant to subsection (f).
(h) Any bonds or notes authorized by a town pursuant to section 7 of Chapter 293
of the Acts of 1998, as amended, prior to the vote of the voters of the town approving
the adoption of the provisions of this section pursuant to subsection (c) may
be issued by the town pursuant to section 7 of Chapter 293 of the Acts of 1998,
as amended, at any time prior to such vote. Notwithstanding the provisions of
section 7 of Chapter 293 of the Acts of 1998, as amended, and the provisions of
section 11 of said Chapter 44B to the contrary, a town that has adopted the provisions
of this section may pay any bonds and notes issued pursuant to section 7 of Chapter
293 of the Acts of 1998, as amended, from amounts on deposit in its Community
Preservation Fund to the same extent as if such bonds or notes were issued pursuant
to section 11 of said Chapter 44B regardless of whether such bonds or notes were
issued prior to or after the adoption of the provisions of this section by the
town. Any appropriation by a town for the payment of debt service on any such
bonds or notes from amounts on deposit in its Community Preservation Fund shall
constitute an expenditure for the acquisition, creation or preservation of open
space and shall be made in accordance with and subject to the restrictions of
the provisions of section 6 of said Chapter 44B; provided, however, that the town
meeting or, in the case of the town of Barnstable, the town council may, upon
the recommendation of the community preservation committee, appropriate and expend
the entire amount needed to pay debt service on any such bonds or notes that were
authorized by a vote of the town meeting or the or, in the case of the town of
Barnstable, by the town council which was passed on or before June 30, 2005, even
if the aggregate amount of such expenditures exceeds 80 percent of the annual
revenues of the town's Community Preservation Fund for historic resources and
half of such remaining annual revenues for community housing.
(i) With respect
to any town that adopts the provisions of this section, any real property it acquired
or acquires with funds appropriated pursuant to the provisions of Chapter 293
of the Acts of 1998, as amended, shall continue to be subject to the provisions
thereof, and any real property it acquires pursuant to said Chapter 44B shall
be subject to the provisions of said Chapter 44B.
(j) Any town that adopts
the provisions of this section may not thereafter independently adopts sections
3 to 7 inclusive, of said Chapter 44B in accordance with the provisions thereof
unless the town has previously voted to revoke the surcharge on real property
as permitted pursuant to subsection (d). The provisions of this section do not,
however, (i) require any town in Barnstable County to seek the adoption thereof,
(ii) prevent any such town from continuing to operate its Cape Cod Open Space
Land Acquisition Program in accordance with the provisions of Chapter 293 of the
Acts of 1998, as amended, or (iii) prevent any such town from continuing to operate
its Cape Cod Open Space Land Acquisition Program and independently adopting sections
3 to 7, inclusive, of said Chapter 44B in accordance with the provisions thereof.
Notwithstanding the provisions of said Chapter 44B to the contrary, any town that
adopts the provisions of this section after it has independently adopted sections
3 to 7, inclusive, of said Chapter 44B shall be subject to the provisions of Chapter
44B as adopted pursuant to and as modified by the provisions of this section beginning
in the fiscal year of the town following the fiscal year in which the voters of
the town vote to approve the adoption of the provisions of this section pursuant
to subsection (c), and the surcharge on real property and the exemptions therefrom
adopted pursuant to this section shall at such time replace the surcharge on real
property and exemptions therefrom previously adopted by the town in accordance
with the provisions of said Chapter 44B.
Section 2. Section
13 of Chapter 293 of the Acts of 1998 is hereby amended by striking the date "January
1, 2020" and replacing it with the following date: -
"January 1,
2030".
Floor Number: 711 Clerk Number: 655
RELATIVE TO TOLL RELIEF
Ms. Fargo, Ms. Resor, and Mr. Brown
move to amend the bill by inserting, after Section__, the following new Section:
-
SECTION__. (a) Section 1 of Chapter 64E of the General Law, as so appearing,
is hereby amended by adding the following clause:-
"Toll Receipts",
shall include, in addition to its usual meaning, a statement of activity issued
by a Massachusetts Turnpike Authority authorized electronic toll payment collection
vendor.
(b) Section 5 of Chapter 64E of the General Law, as so appearing,
is hereby amended by striking out, in line 18, the word "half" and inserting
in place thereof the following word:- quarter.
(c ) Section 5 of Chapter 64E
of the General Laws, as so appearing, is hereby further amended by striking out,
in line 33, the word "three" and in place thereof the following figure:-
14.
Floor Number: 712 Clerk Number: 356
MASSHEALTH HOSPITAL OUTLIER PAYMENTS
Mr. Moore moves to amend the bill, in section 2, in line item 4000-0300, by adding at the end thereof:-
"provided further, the medical assistance program shall reinstate the MassHealth hospital inpatient benefit in effect on January 1, 2003 for all MassHealth enrollees, provided further, that in determining inpatient rates for any acute hospitals the executive office shall utilize the same payment methodology, including all exemptions, rate adjustments and passthrough payments, as was in effect on January 1, 2003."
Floor Number: 713 Clerk Number: 456
EOHHS RATE PROVISIONS
Mr.
Lees moves that the bill be amended in section 2, in line item 4000-0300, by deleting
the following language: --
"provided further, that in determining inpatient
rates for any acute hospitals the executive office shall utilize the same payment
methodology, including all exemptions, rate adjustments and passthrough
payments, as was in effect on July 1, 2003; provided further that in determining
outpatient rates for any acute hospitals the executive office shall utilize the
same payment methodology, including all exemptions and rate adjustments, as was
in effect on October 1, 2003; provided further, that any hospital with a unit
designated as a pediatric specialty unit, as defined by this act, shall be exempt
from the inpatient and outpatient efficiency standards, so called, being applied
to their rate methodology; provided further, that said executive office shall
use the same pricing methodology for durable medical equipment and oxygen as was
in effect on July 1, 2003; provided further, that said executive office shall
not reduce the supplement to chronic disease and rehab hospitals administrative
day rate below that which was granted during hospital fiscal year 2004;"
Floor Number: 714 Clerk Number: 354
MASSHEALTH
DUAL DIAGNOSIS CLAIMS
Mr. Moore moves to amend the bill , in section 2, in line item 4000-0500, by adding at the end thereof:- "provided further, that said division shall work in collaboration with the MassHealth behavioral health contractor to modify its claims payment system to routinely process for payment valid claims for medically necessary covered medical services to eligible recipients with psychiatric and substance abuse diagnoses on a timely basis in an effort to avoid delay and expenses incurred by lengthy appeals processes; provided further, that said secretary shall report to the house and senate committees on ways and means not later than October 1, 2004 on the proposed modifications to said payment system and shall implement said changes by the beginning of hospital fiscal year 2005"
Floor Number: 715 Clerk Number: 762
PROVIDING HEALTH INSURANCE FOR ELDERLY AND DISABLED LEGAL IMMIGRANTS
Mr. Montigny, Mr. Moore, Ms. Wilkerson,
Mr. Barrios, Ms. Creem, Mr. Tisei, Mr. Tarr, Mr. Brown, Ms. Chandler, Ms. Melconian,
Mr. O'Leary, Mr. Morrissey, Mr. McGee, Mr. Joyce, Mr. Hart, Mr. Havern, Ms. Fargo,
Mr. Nuciforo, Mr. Antonioni, Mr. Tolman , Ms. Tucker and Ms. Resor move to amend
the bill in section 2, in item 4000-0870 by striking out the figure "$111,642,118"
and inserting in place thereof the figure "$117,242,118;"
And that
the bill be further amended by adding the following sections:
"SECTION
____. Section 16D of chapter 118E of the General Laws, as amended by section 322
of chapter 26 of the acts of 2003, is hereby further amended by striking subsection
(2) and (3) and inserting in place thereof the following subsections:-
(2)
A person who is not a citizen of the United States but who is either a qualified
alien within the meaning of section 431 of the Personal Responsibility and Work
Opportunity Reconciliation Act of 1996 or is otherwise permanently residing in
the United States under color of law may receive different benefits which shall
be not less than the same benefits provided to the eligibility group described
in subsection (2)(g) of section 9A of chapter 118E of the General Laws, unless
such person: (i) is residing in a nursing facility, as defined by 42 U.S.C. section
1396, as of June 30, 1997; (ii) was receiving services or benefits pursuant to
this chapter as of June 30, 1997; (iii) had an application for long-term care
services pending on July 1, 1997; or (iv) is eligible for federally reimbursed
services or benefits; provided, however, that services or benefits other than
emergency services shall not be provided to undocumented aliens unless required
by federal law.
(3) Benefits for aliens under this section shall not be provided
to persons age 19 through age 64 unless such aliens are disabled; but benefits
shall not be terminated for persons described in clauses (i), (ii), (iii) and
(iv) of subsection (2)."
"SECTION ____. Notwithstanding any general
or special law to the contrary, an amount equal to $5,600,000 from the Federal
Medicaid Assistance Percentage Escrow Fund, established by section 14A of chapter
101 of the acts of 2003, and amended by section 1 of chapter 118 of the acts of
2003, shall be designated for expenditure in fiscal year 2005, and shall not contribute
to the calculation of the fiscal year 2004 consolidated net surplus, as calculated
by the state comptroller as of June 30, 2004, pursuant to section 5C of chapter
29 of the General Laws. Not later than 15 days after the effective date of this
act the state comptroller is hereby authorized and directed to transfer said amount
from said fund to the General Fund."
Floor Number: 716 Clerk Number: 399
INCOME ELIGIBILITY FOR MASSHEALTH HIV HEALTH PROGRAM
Mr. Moore, Mr. Montigny, Mr. O'Leary, Ms Wilkerson, Mr Tisei and Mr. Barrios move to amend the bill, in section 2, in line item 4000-1400, by striking out the words "133 per cent of the federal poverty level;" and inserting in place thereof the words "200 per cent of the federal poverty level;".
Floor Number: 717 Clerk Number: 453
EOHHS MEDICAID PROVIDER RATES
Mr. Lees moves that the bill be amended by striking section 271.
Floor Number: 718 Clerk Number: 737
INTERGOVERNMENTAL TRANSFER - PUBLIC NURSING FACILITIES
Mr. Pacheco and Mr. Knapik move to amend the bill in Section 290 by inserting after the words "publicly-owned or publicly-operated providers" the following words:-
"including, but not limited to, Neville Communities Home, Inc., Cape End Manor, Taunton Nursing Home, Hampshire Care, Our Island Home, and the Geriatric Authority of Holyoke"
Floor Number: 719 Clerk Number: 41
MASSHEALTH MANAGED CARE ORGANIZATIONS
Mr. Moore moves to amend the bill in section 292 by adding at the end thereof the following sentence:- "Said agency shall make provisions to allow those persons enrolled in said program and meeting the eligibility requirements established under the MassHealth program to be eligible to enroll in Medicaid managed care organizations and to allow the Medicaid managed care organizations the option of enrolling program members through current managed care organization enrollment assignment guidelines if said enrollment would be cost-effective for the commonwealth."
Floor Number: 720 Clerk Number: 148
MANAGED CARE PILOT PLAN
Ms.
Melconian moves to amend the bill by striking out Section 298 and replacing it
with the following:-
"SECTION 298. Notwithstanding any general or special
law or regulation to the contrary, the secretary of health and human services
and the division of medical assistance shall seek any necessary federal waivers
or regulation changes and develop a pilot program within the MassHealth primary
care clinician plan for up to 25,000 disabled managed-care eligible MassHealth
members. The program shall be contracted by an open bidding process and reimbursed
by the division at a predetermined capitated rate for each such enrolled MassHealth
member. Such pilot program may include the provision of primary care and pharmacy
benefits through community health centers, hospital-licensed community health
centers and disproportionate share hospitals. No later than 60 days prior to the
implementation of said pilot program, the division of medical assistance shall
notify the house and senate committees on ways and means and the secretary of
administration and finance of the number of projected participants, the planned
date of implementation, any expected reduction in spending resulting from the
program, and the effect on the level of services available to participating members.
Hospitals providing services to persons participating in the pilot program shall
be required to report data on program participants, including service and billing
information, to the division of health care finance and policy and to the health
maintenance organization or managed care organization managing the care of such
participants. An evaluation of the quality and cost effectiveness of the pilot
program, including any expected reduction in spending resulting from the provisions
of this section and the effect on the level of services available to participating
members and on the uncompensated care pool, shall be completed by the secretary
in coordination with the auditor. The results of such evaluation shall be reported
by the secretary to the house and senate committees on ways and means and the
secretary of administration and finance, no later than March 1, 2005.
Floor Number: 721 Clerk Number: 342
MASSHEALTH DENTAL THIRD PARTY ADMINISTRATOR
Mrs. Chandler, Mr. Moore, Mr.
Montigny, Mr. Nuciforo, Mr. McGee, Ms. Tucker, Mr. Tisei, Mr. O'Leary and Ms.
Resor move to amend the bill by striking out Section 300 and inserting in place
thereof the following new Section:-
"SECTION 300. (a) Notwithstanding
any general or special law to the contrary, the Executive Office of Health and
Human Services shall develop and issue a Request for Proposals no later than March
31, 2005, to outsource the delivery of the MassHealth Dental Program benefits
to a third party administrator. The third party administrator shall be an experienced
dental benefits administrator capable of maintaining an adequate dental provider
panel to provide access for MassHealth clients in a cost-effective manner.
(b) The Executive Office shall utilize the information it collected to assist
in the development of a Request for Proposals to seek a third party administrator
for the MassHealth Dental Program. The Executive Office shall design the third
party administered MassHealth Dental Program with features consistent with a private
dental benefits plan.
(c) Prior to awarding any contract for the services
of a third party administrator for the MassHealth Dental Program, the Executive
Office shall file a report with the Senate and House committees on ways and means
no later than January 15, 2006 regarding the anticipated costs and benefits of
contracting with such administrator."
Floor Number: 722 Clerk Number: 6
AFFORDABLE HEALTH INSURANCE FOR MARTHA'S VINEYARD
Mr. O'Leary moves to amend the
bill by inserting, after Section 362, the following new Section:-
SECTION___.
Notwithstanding the provisions of any federal or special law, rule or regulation
to the contrary, the Division of Medical Assistance may on a Demonstration basis
in the area defined and limited under the federally funded DOHHS HRSA CAP Grant
1-G92-OA 00005-02 provide benefits described in section 9C of chapter 118E to
employees and employers who are described and limited under the terms of the program
set forth in said Demonstration, and may expend monies from any appropriation
for benefits provided under said section 9C to also provide benefits specified
in said Demonstration expanding the income limits set forth in section 9C from
200% to 300% of the federal poverty level, provided that the Division will seek
to obtain a modification of its Demonstration, as defined in subsection (1) of
section 9A of chapter 118E, that would allow for federal reimbursement for some
or all of the expenditures for providing the benefits specified in the Demonstration;
further provided that said Demonstration, without expenditure of monies from any
appropriation for benefits provided under said section 9C, also be permitted to
offer health coverage to employees between 300% and 400% of the federal poverty
level. The provision of M.G.L.c.176J, sections 3-8, inclusive, and 211 CMR 66.00
shall not apply to health coverage provided by carriers pursuant to this section."
Floor Number: 723 Clerk Number: 45
WITHDRAWN
Floor Number: 724 Clerk Number: 48
CLINICAL LABORATORIES
Mr. Moore moves to amend the bill by inserting at the end thereof the following new section:-
SECTION ____. Notwithstanding the provisions of any general or special law to the contrary, the Division of Medical Assistance is hereby directed to promulgate regulations designed to: (a) streamline and simplify signature authorization procedures for clinical laboratory services, and specifically to exclude, as a condition of payment for any laboratory test order form, a physician's handwritten signature; and (b) clarify the billing procedures for specimen referral where the referring laboratories and testing laboratories are subsidiary related. Any change to existing regulation shall require the referring laboratory to disclose on its claim forms (i) the MassHealth provider number for the testing laboratory and (ii) the tests performed by the testing laboratory.
Floor Number: 725 Clerk Number: 62
AN ACT PROTECTING PATIENT ACCESS TO MEDICALLY NECESSARY HEALTH CARE SERVICES
Mr. Moore moves to amend the bill by adding at the end thereof the following:- SECTION _____
Notwithstanding any general or special law to the
contrary, the definition of critical access services appearing in section 1 of
chapter 118G of the General Laws, shall extend to all medically necessary services
provided by acute hospitals until July 1, 2006, and after the Secretary of Health
and Human Services develops a new program for the provision of medically necessary
health care services for low income uninsured and underinsured residents of the
Commonwealth, files recommendations with the General Court, and otherwise complies
with the requirements of section 617 of chapter 26 of the Acts of 2003.
The
report required in connection with such program shall be forwarded to the House
and Senate Committees on Ways and Means, the Joint Health Care Committee, and
the House Medicaid Committee by July 1, 2005. The definition of critical access
services defined herein shall apply until July 1, 2006, following the General
Court's receipt and review of the Secretary's report.
In examining the definitions
of critical access services, free care, emergency medical condition and emergency
services, as required by said section 617 of said chapter 26 of the Acts of 2003,
the Secretary shall consult with the health care organizations outlined in the
second paragraph of section 617, and with physicians who provide care to uninsured
patients and who represent the following health care organizations and institutions:
each member hospital of the Coalition of Boston Teaching Hospitals, and a cross-section
of physicians representing hospitals and community health centers throughout the
Commonwealth to be determined by the Massachusetts Hospital Association and the
Massachusetts League of Community Health Centers..
Any program that recommends
transfer of non-urgent, non-emergent, medically necessary patient care from acute
hospitals to community health centers shall take into account longstanding patient-physician
relationships; the patient's need for continuity of care; complexity or severity
of a patient's mental or physician condition or illness; complexity of a patient's
prescription drug regimen; patient choice; academic medical center teaching mission
and programs; and geographic, capacity, transportation or other concerns regarding
the patient's access to needed medical care in the most appropriate setting. The
program shall also consider the efficacy and feasibility of implementing pilot
projects that encourage greater care of uninsured patients in the most cost-effective,
medically appropriate settings, while taking into account existing collaborations
between hospitals and community health centers. The Secretary shall file a separate
transition plan by July 1, 2005.
Floor Number: 726 Clerk Number: 105
RELATIVE TO ADULT DAY HEALTH SERVICES
Mr.
Montigny moves to amend the bill by inserting the following two sections:-
SECTION_____. Section 7 of Chapter 118G of the General Laws is hereby amended
by adding the following new paragraph after the third paragraph: The division
shall establish rates for providers of adult day health services which: recognize
two levels of care, Basic and Complex, with one corresponding rate for each; are
not less than the rates and reimbursements in effect for Adult Day Health and
for Dementia-Specific Adult Day Health Home and Community-based waiver clients
as of June 30, 2002; reimburse dementia-specific adult day health programs at
not less than the Complex rate for any participant with dementia, provided that
the Complex rate may be less than the aforementioned Home and Community based
rate for participants other than those in dementia-specific programs.
SECTION
___. Chapter 118G of the General Laws is hereby amended by adding a new Section
17B as follows:
Section 17B Adult Day Health Services
The commissioner
shall review and approve or disapprove rates for the Basic and Complex levels
of adult day health services. In addition to the eligibility criteria for the
basic level-of-care as outlined in 130 CMR 404.407, any participant requiring
nursing services as outlined in 130 CMR 456.409(C) shall be eligible for the basic
level-of-care. Any participant who meets the eligibility criteria for nursing
home placement pursuant to 130 CMR 456.409, in effect on January 1, 2004 , and
has been diagnosed with dementia shall be eligible for participation in a dementia-specific
program. The commissioner of the division of medical assistance, or its successor,
shall not restrict the number of persons participating in any dementia-specific
program based on the number of participants who have participated in previous
years.
Floor Number: 727 Clerk Number: 111
HEALTH CARE
Mr. Baddour moves that the bill by inserting,
after Section _____, the following new Section: -
"; SECTION ___. Section
2A of chapter 101 of the acts of 1999 is hereby amended by striking item 1599-1499
and inserting in place thereof the following: -
1599-1499 For a one-time loan
to the city of Quincy for the purpose of facilitating the conversion of Quincy
Hospital from ownership by the city of Quincy to ownership by a private nonprofit
corporation; provided, that such loan shall be repaid by the city in one installment,
without interest, in fiscal year 2005; provided further, that 22 per cent of said
repayment amount shall be dedicated for a payment to a municipality in Essex county
to defray debt resulting from the operation of a former municipally-owned hospital;
provided further, that the terms of the loan shall be established by and subject
to the terms of an agreement to be negotiated between the city, represented by
the mayor, and the secretary of administration and finance; provided further,
that the state comptroller shall intercept cherry sheet payments due the city
from the commonwealth upon certification by the secretary that the city is in
default on the loan or any other terms of the agreement; provided further, that
the proceeds of the loan shall be used by the city for the costs associated with
the conversion, including, but not limited to, obligations of the hospital to
the city for employee benefits and for any indebtedness incurred by the city on
behalf of the hospital; provided further, that in the event that the financial
commitments of the city to the hospital in fiscal years 2000 to 2004, inclusive,
terminate for any reason prior to fiscal year 2005, the annual installment payments
of the loan shall become due in the fiscal year following the fiscal year in which
the financial commitments terminate; provided further, that the city, in collaboration
with the corporation, shall file annually with the secretary and with the secretary
of health and human services, the house and senate committees on ways and means
and the joint committee on health care a report delineating the benchmarks and
milestones established by the corporation to achieve financial viability and the
status of the corporation in achieving the benchmarks and milestones, including
changes in patient volume and payer mix, the establishment and maintenance of
community benefits by the corporation and the results of affiliations with other
health care providers and health care entities; and provided further, that the
report shall be filed not later than the January 1 following the end of each hospital
fiscal year 2000 to 2005, inclusive......................................……………………………$12,100,000."
Floor Number: 728 Clerk Number: 141
AFFORDABLE CHILDREN'S PREMIUMS AMENDMENT
Mr. Moore, Mr. Montigny and Ms.
Resor move to amend the bill by adding at the end thereof the following new Sections:-
SECTION _____. The last sentence of section 9 of chapter 118E of the General
Laws, as inserted by section 313 of chapter 26 of the acts of 2003, is hereby
amended by striking out the word "levels." and inserting in place thereof
the words:- levels, provided, that no premiums shall be imposed on households
with children whose financial eligibility as determined by the division is below
150 per cent of the federal poverty level.
"SECTION _____. Section 10F of chapter 118E of the General Laws, as inserted by section 319 of chapter 26 of the acts of 2003, is hereby amended by striking out the fourth paragraph and inserting in place thereof the following paragraphs:-
The cost of the program shall be funded in part by premiums contributed by enrollees according to the following eligibility categories:
(a) enrollees in households ineligible for medical benefits pursuant to this chapter earning less than 200 per cent of the federal poverty level shall not be responsible for contributing to program premium costs;
(b) enrollees in households earning between 201 per cent and 300 per cent of the federal poverty level, inclusive, shall contribute not less than 20 per cent and not more than 30 per cent of the monthly premium cost according to a sliding scale established by the division; provided, that additional contributions shall not be required for any enrollee after the third enrollee in such a household;
(c) enrollees in households earning between 301 per cent and 400 percent of the federal poverty level, inclusive, shall contribute not less than eighty-five per cent and not more than ninety percent of the monthly premium cost according to a sliding scale established by the division; provided, that additional contributions shall not be required for any enrollee after the first enrollee in such a household;
(d) enrollees in households earning more than 400 per cent of the federal poverty level shall pay no more than the full premium cost of said program.
Household earnings may be defined on the basis of gross earnings, or on an adjusted basis according to criteria deemed appropriate by the division. The division shall base premium costs on an actuarially sound methodology. Premiums contributed by enrollees shall be deposited in the Children's and Seniors' Health Care Assistance Fund, established by section 2FF of chapter 29 and may be used for the program subject to appropriation.
Floor Number: 729 Clerk Number: 143
DIVISION OF MEDICAL ASSISTANCE WAIVER
Mr. Moore and Mr. Montigny move
to amend the bill by adding at the end thereof the following:- "SECTION XX.
Notwithstanding any general or special law to the contrary, the division of medical
assistance may seek a waiver under the titles XIX and XXI of the Social Security
Act to expand MassHealth comprehensive family planning services for
individuals
whose income is at least up to 200% of the federal poverty line. Said division
shall only seek said waiver if said division determines that said expansion would
be cost neutral to the Commonwealth and would not incur a deficiency in any item
funded in section 2 of this act. Said waiver shall at least include those services
currently covered as comprehensive family planning services including comprehensive
medical and gynecological examinations, contraceptive counseling and methods,
sexually transmitted disease testing and treatment, screening for breast and cervical
cancer, related laboratory screenings, non directive counseling and referral for
pregnancy and prenatal care, infertility and other health related issues. Said
division shall notify the house and senate ways and means committees within 10
days of the filing of said waiver with the Centers for Medicare and Medicaid Services
and shall notify said committees within 10 days of approval of said waiver.
Floor Number: 730 Clerk Number: 144
REPEAL AUTHORIZATION FOR MASSHEALTH ENROLLMENT CAPS
Mr. Moore moves to amend the bill by adding at the end thereof the following new Section:- SECTION________.
Section 632 of chapter 26 of the acts of 2003 is hereby repealed
Floor Number: 731 Clerk Number: 146
AN AMENDMENT IMPROVING THE INSURANCE PARTNERSHIP PROGRAM
Mr. Moore, Mr. Brewer, Mr. O'Leary and Mr. Knapik move that the bill be amended by adding at the end thereof the following section. Section _____
SECTION
1. Subsection (1) of section 9C of chapter 118E of the General Laws, as appearing
in the 2000 Official Edition, is hereby amended by striking out the phrase "200
percent of the federal poverty level" as it appears in lines 20, 27 and 35
and inserting in place thereof the following:-
300 percent of the federal
poverty level.
SECTION 2. Section 9C of said chapter 118E of the General Laws,
as so appearing, is hereby further amended by striking paragraph (4) and replacing
it with the following new paragraph:-
(4) The amount of payments for each
employer under paragraph (C) of subsection (2) shall be as follows: (i) $600 for
each eligible employee for whom the eligible employer pays 50 percent or more
of the cost of qualified medical insurance; (ii) $1,200 for each eligible employee
for whom the eligible employer pays 50 percent or more of the cost of qualified
two-person family medical insurance, and (iii) $1,500 for each eligible employee
for whom the eligible employer pays 50 percent or more of the cost of qualified
family medical insurance, provided that the division may use reasonable data sources
in determining the number of eligible employees of an eligible employer qualifying
for such payments under clauses (i), (ii), and (iii).
SECTION 3. Said section
9C of said chapter 118E of the General Laws, as so appearing, is hereby further
amended by striking paragraph (5) and replacing it with the following new paragraph:-
(5) The amount of payments for each self-employed single individual or each self-employed
husband and wife under paragraph (B) of subsection (2) may include the following
amounts: (i) $600 for an eligible self-employed single individual if the individual
purchases qualified medical insurance; (ii) $1,200 for an eligible self-employed
single individual with a dependent child or for an eligible self-employed husband
and wife filing a joint tax return and who have no dependent children, if the
individual or husband and wife purchase qualified two-person family medical insurance,
or (iii) $1,500 for an eligible self-employed individual with two or more dependent
children, or an eligible self-employed husband and wife filing a joint tax return
and who have dependent children, if the individual or husband and wife purchase
qualified family medical insurance, provided that the payment shall not exceed
the amount of the net premium cost to said self-employed persons of said insurance,
and shall be in conformity with the regulations of the division.
Floor Number: 732 Clerk Number: 225
KOSHER MEALS
Ms.
Walsh moves to amend the bill by inserting after Section _____, the following
new Section: -
SECTION ___. Chapter 140 of the Acts of 2003 is hereby amended
by striking out section 85 and inserting in place thereof, the following: -
"Section 85. Item 4000-0600 of section 2 of said chapter 26 is hereby amended
by adding the following words:- and provided further, that notwithstanding any
general or special law to the contrary, for any nursing home or non-acute chronic
disease hospitals with not fewer than 350 licensed beds, and not fewer than 90,000
Medicaid patient days in a state fiscal year, with an established geriatric teaching
program for medical students, residents and fellows, students of nursing and other
allied health professionals and with an established institute conducting multi-disciplinary
research into biomedical, psychological, cognitive behavioral and organizational
factors associated with aging, that provides kosher food to its residents, the
division of medical assistance, in consultation with the division of health care
finance and policy, is directed to approve a special innovative program, and the
division of health care finance and policy, in recognition of the unique special
innovative program status granted by the division of medical assistance, shall,
for any nursing home or such non-acute chronic disease hospital that provides
kosher food to its residents, establish up to a $5 per day increase to the standard
payment rates to reflect the higher dietary costs incurred in providing kosher
food."
Floor Number: 733 Clerk Number: 240
MEDICAID PRIOR AUTHORIZATION
Ms.
Walsh moves to amend the bill by inserting, after Section ____, the following
new Section: -
"SECTION ____. Chapter 118E of the General Laws is hereby
amended by striking out section 17, as amended by section 24 of chapter 177 of
the acts of 2001, and inserting in place thereof the following section: -
Section 17. Multiple source drugs listed in the Massachusetts list of interchangeable
drug products established pursuant to the provisions of section thirteen of chapter
seventeen of the General Laws and regulations adopted thereunder shall not be
reimbursable except for the "Massachusetts maximum allowable cost'', as defined
by regulations of the department, unless the division grants prior authorization
based upon the practitioner's assertion to the division that satisfactorily demonstrates
that a recipient's medical condition requires the use of a nongeneric drug and
unless the practitioner writes on the face of the prescription in his or her own
handwriting the words "brand name medically necessary'' under the words "no
substitution'' in a manner consistent with applicable state law; provided that
a pharmacist dispensing in accordance with this section shall be exempt from the
provisions of the fourth paragraph of section twelve D of chapter one hundred
and twelve. A request for prior authorization may be made by telephone or other
telecommunication device or in writing. The division shall act within 24 hours
of the request. If the request is denied, the practitioner or recipient may appeal
as provided for in sections 47 and 48, provided that the board of hearings hold
a hearing and render a decision within 90 days of the appeal to the division.
The division shall authorize the use of a nongeneric drug as requested by the
practitioner during the pendency of the appeal.
Notwithstanding the provisions
of the first paragraph, prior authorization shall not be required for medications
used to treat mental illness, including but not limited to schizophrenia, depression,
bipolar disorder, anxiety, or attention deficit disorder and attention deficit
hyperactivity disorder. The division shall further make available medications
for persons with mental illness, including atypical antipsychotic medications,
conventional antipsychotic medications, and other medications used for the treatment
of mental illness without restriction or without preference for one medication
over another or one class of medications over another."
Floor Number: 734 Clerk Number: 329
COMMONHEALTH
Mrs. Chandler, Ms. Resor, Ms. Creem, Mr. Tolman, Mr. McGee, Ms. Wilkerson and Mr. Barrios move to amend the bill by inserting after Section , the following new Section:-
SECTION . Notwithstanding the provisions of any general or special law to the contrary, any individual otherwise eligible for MassHealth/CommonHealth insurance program for working adults with disabilities, shall not be subject to any enrollment caps or asset test and their eligibility to enroll in the program shall not be limited by such caps or asset tests.
Floor Number: 735 Clerk Number: 382
PRIOR AUTHORIZATION OF PRESCRIPTION MEDICATIONS
Mr.
Tolman moves to amend the bill by inserting, after Section 362, the following
new Section:-
"SECTION 363. SECTION 1. Section 17 of Chapter 118E of
the General Laws, as appearing in the 2002 official edition, is hereby amended
by striking the words "provision of written documentation by the practitioner
to the division that" and inserting in place thereof:- provisions of section
53 of this chapter and
SECTION 2. Chapter 118E of the General Laws, as appearing
in the 2002 official edition, is hereby amended by adding at the end thereof the
following new section:
Section 53. Drug prior authorization process
(a)
The Division shall administer a drug prior authorization process to ensure the
timely dispensing of drugs, for any outpatient prescription drug. In administering
said process the Division shall meet the following conditions:
(1) Provide
telephone, fax or other electronically transmitted approval or denial within twenty-four
(24) hours after receipt of the prior authorization request;
(2) If in the
prescribing physician's opinion an emergency situation exists, including a situation
in which a response to a prior authorization request is unavailable, allow for
the prescribed drug to be dispensed at a physician's discretion and until such
time as the prior authorization process and subsequent appeals are determined.
Any drug dispensed in said manner shall be eligible for full coverage and payment
by the Division of Medical Assistance;
(3) Grant authorization of drugs prescribed
for a medically accepted use supported by either approved product labeling or
peer reviewed literature unless there is a therapeutically equivalent generic
drug that is available without prior authorization;
(4) Allow any patient
that receives benefits under a program of the division, and is receiving maintenance
medications for a chronic illness, to receive said medications until the existing
prescription expires, or for a period not to exceed six months, whichever is greater,
without the need for any prior approvals to be granted.
(5) Consult with
the Pharmacy and Therapeutics Advisory Committee, established in Section 3 of
this act, to develop and implement improvements to the drug prior authorization
process and make a report to the advisory committee on the status of the prior
authorization list and any changes, related hearings or other proceedings semi-annually.
(b) The division shall maintain a process for the evaluation of drugs to be placed
on the prior authorization list, which shall include: (1) A public hearing on
all medications prior to a decision being made on prior authorization; (2) publishing
conspicuous notice in at least one newspaper of general circulation and on the
division's website at least thirty (30) days prior to any public hearing on whether
such a drug should be placed on prior authorization; (3) consideration of any
information provided by any interested party, including but not limited to physicians,
pharmacists, beneficiaries, and manufacturers or distributors of the drug; (4)
consideration of the potential impact on patient care, safety and other sectors
of the state health care systems including emergency room visits and hospitalizations
as a result of placement of such drug on prior authorization. (5) receipt of written
approval by a physician who is board certified in the specialty that most commonly
treats the disease or prescribes the relevant therapeutic class of drugs. Said
physician shall not be employed by, nor have any financial relationship with,
any pharmacy benefits management company managing Medicaid prescription benefits,
nor be a member of the Pharmacy and Therapeutics Advisory Committee. Such written
ratification shall be submitted to the commissioner, members of the Pharmacy and
Therapeutics Advisory Committee, and shall be available to the public upon request;
and, (6) A final decision shall be made within 60 days of the public hearing and
published for public comment for a period of no less than 30 days. The effective
date of the decision shall not be prior to the close of the comment period and
effective notice of the decision's finality is available to prescribers.
(c)
Notwithstanding any other provision of this section, no drug shall be recommended
to require prior authorization by the division and placed on prior authorization,
which has been approved or had any of its particular uses approved by the FDA
under a priority review classification;
(d) The Division shall develop a grievance
mechanism for interested parties to appeal the Department's decision to place
a drug on prior authorization, which at a minimum shall be concluded within ten
days. After participating in the grievance mechanism developed by the Department
on the recommendations of the advisory committee, any interested party aggrieved
by the placement of a drug on prior authorization shall be entitled to an administrative
hearing before the Department;
(e) The Division shall review the prior authorization
status of a drug annually;
(f) The Division shall make a report to the house
and senate committees on ways and means and the house and senate committees on
health care at the conclusion of all prior authorization proceedings for each
therapeutic class or at least, no less often than annually. Said report shall
include but not be limited to the outcomes of all public hearings and prior authorization
decisions; a list of drugs which are and are not to be prior authorized along
with corresponding information used to make such decisions; sectors of the state
health care program that may be affected by the drug's availability for use in
treating program beneficiaries; any changes made or proposed to the prior authorization
process; and recommendations including legislation that may benefit the prior
authorization process and program beneficiaries; said report shall be posted on
the division's website.
SECTION 3. Chapter 118E of the General Laws, as appearing
in the 2002 official edition, is hereby amended by adding at the end thereof the
following new section:
Section 54. Pharmacy and Therapeutics Advisory Committee
(a) There is hereby established a Pharmacy and Therapeutics Advisory Committee
for the purpose of advising and making recommendations to the Division of Medical
Assistance's prior authorization program. Said advisory committee shall consist
of thirteen (13) members to be appointed by the Governor and shall include: five
physicians licensed in Massachusetts and actively involved in the practice of
medicine; three pharmacists licensed to do business in the commonwealth and actively
involved in the practice of pharmacy; a representative of the Massachusetts Medical
Society; a representative of the Massachusetts Pharmacy Association; a representative
of medical assistance beneficiaries in the commonwealth; and, two patient advocates.
In making physician appointments the Governor shall make his selections from
a list of nominees provided by the Massachusetts Medical Society. In making pharmacist
appointments the Governor shall make his selections from a list of nominees provided
by the Massachusetts Pharmacy Association.
Advisory committee members shall
serve staggered three-year terms. Two physicians, one pharmacist and the representative
of medical assistance beneficiaries shall each be appointed for one-year terms.
Members may be reappointed for a period not to exceed three, three-year terms.
Advisory committee members shall select a chairperson and a vice-chairperson by
a majority vote of the committee membership on an annual basis. Said committee
shall meet at least monthly and may meet at other times at the discretion of the
chairperson. Notice of any meeting of the advisory committee shall be published
thirty (30) days before such meeting; and
(b) The advisory committee shall
have the power and duty to: (1) advise and make recommendations regarding the
implementation of a drug prior authorization program for the medical assistance
program; (2) advise and make recommendations regarding rules to be promulgated
by the division regarding outpatient prescription drug prior authorization; (3)
make recommendations for a grievance mechanism for interested parties to appeal
any decision made by the Division to place a drug on prior authorization; (4)
make recommendations to the Division regarding any inpatient or outpatient prescription
drug covered by the medical assistance program that is to be prior authorized
as well as which drugs are exempt from the prior approval process. Said recommendation
shall be supported by an analysis of prospective and retrospective DUR data demonstrating
(a) the expected impact of such a decision on the clinical care likely to be received
by beneficiaries for whom the drug is medically necessary; (b) the expected impact
on physicians whose patients require the drug; (c) the expected fiscal impact
on the medical assistance program; (d) review and make recommendations on a semi-annual
basis whether drugs placed on prior authorization should remain on prior authorization;
and (e) make recommendations for a list of maintenance medications that are needed
for chronic illnesses;"
Floor Number: 736 Clerk Number: 385
MASSHEALTH RATE EQUITY FOR CHRONIC VENTILATOR PATIENTS
Ms. Wilkerson moves to amend the bill by inserting after Section 243 the following section: --
Section __. Notwithstanding any general or special law or regulation to the contrary, not-for-profit chronic hospitals located in ventilator under-bedded areas shall receive the masshealth chronic hospital inpatient per diem rate for ventilator patients classified by the division of medical assistance as on administratively necessary day (AND) status. For the purposes of this provision, "ventilator under-bedded areas" shall be defined as meeting the following criteria: (i) location in a city with a population, per U.S. Census Bureau report of 2000, in excess of 200,000, and (ii) location in an HSA with less than ten (10) licensed adult nursing home beds with a ventilator care agreement with the division of medical assistance per thousand persons aged sixty-five (65) and over.
Floor Number: 737 Clerk Number: 534
VENTILATOR DEPENDENT PATIENT CARE
Mr.
Joyce moves to amend the bill by inserting, after Section ___, the following new
Section:-
"SECTION ____. Section 13A of chapter 118E of the General Laws,
as appearing in the 2002 Official Edition is hereby amended by adding the following
paragraph:-
For any hospital fiscal year commencing on or after October first
two thousand and three, the division shall not classify any ventilator dependent
patients in a public payor-dependent non-acute hospital as an administratively
necessary day patient, unless a physician member of the hospital's utilization
review committee finds and certifies that the medical services required by any
such patient are actually available in a non-hospital facility located within
a twenty-five mile radius of the patient's principle residence and that the patient
will receive safe and effective care. The division shall not make any decision
or take any action as to the continuing necessity of hospital care in a public
payor-dependent non-acute hospital which is inconsistent with the hospital utilization
review committee findings. The division shall pay public payor-dependent non-acute
hospitals at the full hospital inpatient per diem rate for services provided to
such ventilator dependent patients entitled to medical assistance and such ventilator
dependent patients shall not be subject to administratively necessary day rates.
Floor Number: 738 Clerk Number: 593
CHILDREN'S MENTAL HEALTH OUTSIDE SECTION
Mr. McGee moves to amend the bill by inserting, after Section 362, the following new Section: -
"Section ___. Notwithstanding the provisions of any general or special law to the contrary, any prior authorization or restriction on medication policy, rule or regulation of the department of mental health, division of medical assistance or any other agency applicable to the treatment of children with mental illness shall require that the department of mental health provide telephone, fax or other electronically transmitted approval or denial with appropriate clinical reasons within forty-eight (48) hours after receipt of the prior authorization request. In the event a prior authorization request is denied and is subsequently appealed pursuant to the applicable regulations of the department of mental health, the prescribed drug may be dispensed at a physician's discretion and until such time as the prior authorization process and subsequent appeal are determined if in the prescribing physician's opinion, an emergency situation exists,. Any drug dispensed in said manner shall be eligible for full coverage and payment by the division of medical assistance."
Floor Number: 739 Clerk Number: 650
ACCESS TO PEDIATRIC ASTHMA RESCUE MEDICATIONS
Ms Resor moves to amend the bill (S2400) by inserting after section 165, the following new section:-
"SECTION 165A. Notwithstanding the provisions of any general or special law, rule, or regulation to the contrary, the division shall not require prior authorization or impose any other restriction on rescue medications used to treat pediatric asthma. The division shall make available rescue medications for children under 18 years old with asthma, and other medications used for the treatment of asthma without restriction or without preference for one medication over another or one class of medications over another."
Floor Number: 740 Clerk Number: 440
EOHHS BASE YEAR RATE
Mr. Lees moves that the bill be amended
in section 2, in line item 4000-0600, by deleting the following:
"provided
further, that effective July 1, 2004 through June 30, 2005, the division of health
care finance and policy in collaboration with the executive office of elder affairs
shall establish nursing facility payment rates using calendar year 2002 base year
costs;"
Floor Number: 741 Clerk Number: 576
AN ACT TO PROMOTE SENIORS INDEPENDENT LIVING
Mr. Tarr
moves to amend the bill (Senate bill 2400) by adding, in Section 2, in item 4000-0600,
line 1 following the word: "plan" the following:-
"provided
that $4,000,000 shall be expended for the senior housing innovations initiatives
program for the purpose of permitting the executive office of health and human
services to award grants or contracts to non-profit organizations, quasi public
agencies, or other entities to support initiatives that EOHHS in collaboration
with the Executive Office of Elder Affairs, Office of Commonwealth Development,
Department of Housing and Community Development, and the assistant secretary for
disabilities and community services determine will develop or enhance programs
that provide the elderly with supportive services that allow them to remain in
their own homes or in homelike congregate community housing, assistance in accessing
homelike, congregate community housing, assistance in transitioning out of institutional
settings, or programs that provide technical assistance, planning and evaluation
of the services and community-based housing supporting elders in the community."
Floor Number: 742 Clerk Number: 642
HOME PROGRAM
Mr.
Lees moves to amend the bill, in section 2, in item 4000-0600, by inserting in
line 2 following the words "senior care plan" the following wording:-
"provided that $4,000,000 shall be expended for the Helping our Massachusetts
Elders or HOME program, so-called, for the purpose of permitting the executive
office of health and human services to award grants or contracts to non-profit
organizations, quasi- public agencies, or other entities to support initiatives
that the Interagency Task Force determines will develop or enhance programs that
provide the elderly with supportive services that allow them to remain in their
own homes or in home-like congregate community housing, assistance in accessing
home-like, congregate community housing, assistance in transitioning out of institutional
settings, or programs that provide technical assistance, planning and evaluation
of the services and community-based housing supporting elders in the community."
Floor Number: 743 Clerk Number: 666
NURSING HOME DUE PROCESS
Mr.
Berry moves to amend the bill, in section 2, in item 4000-0600, by adding at the
end thereof the following:-
";provided, further, that in the event the
division of health care finance and policy conducts or utilizes an audit of nursing
facilities' calendar year 2002 base year costs to reduce rates below levels
that would be in effect in the absence of the audit, then (i) the results of said
audit may only be utilized if the audit is concluded prior to July 1, 2004; each
affected nursing facility is given written notice setting forth the audit findings
related to the nursing facility and specifying that the nursing facility has a
right to appeal those audit findings to the division of administrative law appeals
within thirty days of receipt of the audit findings; and rate adjustments based
upon the audit are retrospectively adjusted to reflect any decision of the division
of administrative law appeals affording a nursing facility relief on the nursing
facility's appeal of audit findings, and (ii) the results of said audit may not
be utilized to impose a reduction exceeding one percent in each of the nursing
costs cost center, other operating costs cost center, or administrative and general
costs cost center unless the sample size of the nursing facilities audited is
equal to or greater than fifty percent of the nursing facilities for which the
division maintains calendar year 2002 data and, provided further, that in no event
may the sample size of any such audit be less than ten percent of the nursing
facilities for which the division maintains calendar year 2002 data;"
Floor Number: 744 Clerk Number: 10
ELDER PROTECTIVE SERVICES PROGRAM
Ms. Tucker moves to amend the bill, in section 2, in item 9110-1636, by striking out the figure "$9,604,137" and inserting in place thereof the following figure:- "$11,604,137".
Floor Number: 745 Clerk Number: 12
ELDER PROTECTIVE SERVICES GUARDIANSHIP SERVICES
Ms. Tucker moves to amend the bill, in section 2, in item 9110-1636 by striking out the words "provided, that not more than $480,000 may be expended for guardianship services" and inserting in place thereof the following words:- "and guardianship services".
Floor Number: 746 Clerk Number: 535
ELDER RESIDENTIAL ASSESSMENT AND PLACEMENT PROGRAM
Ms. Wilkerson moves to amend the bill in section 2 by inserting after item 9110-1660 the following item:
"9110 - 1700 For the Elder Residential Assessment and Placement Program………………… $250,000"
Floor Number: 747 Clerk Number: 565
EAST BRIDGEWATER SENIOR CENTER
Mr. Joyce and Mr.
Creedon moves to amend the bill, in section 2, in 9110-1900, in line 2 after the
words "West Roxbury;" the following item:
"and provided further
that $25,000 shall be made available to East Bridgewater Council on Aging to pay
for the planning of Senior Center,"
Floor Number: 748 Clerk Number: 9
PERSONAL CARE ATTENDANT PROGRAM
Ms. Tucker, Mr. O'Leary, Mr.
Brewer and Ms. Creem moves to amend the bill by striking out Section 272 and inserting
in place thereof the following new Section:-
"Section 272. The Executive
Office of Health and Human Services shall retain in fiscal year 2005 the same
standards and regulations for personal care attendants in effect on February 1,
2004 unless an agreement to any changes is reached between the division of medical
assistance, designees of the governor's advisory commission on disability policy,
the Massachusetts office on disability and the statewide independent living council."
Floor Number: 749 Clerk Number: 244
COMMUNITY BASED WAIVER EXTENSION
Mr. Glodis, Ms. Chandler and Mr. Moore
move to amend the bill, in Section 279, by adding the following words:-
"The
Executive Office of Elder Affairs, in collaboration with the Executive Office
of Health and Human Services, shall by August 31, 2004 make whatever necessary
application for the PACE program to increase the income eligibility to up to 300
percent of the federal benefit rate under the supplemental security income program
and provide that the asset test shall not be less than $20,000."
Floor Number: 750 Clerk Number: 577
HOME AND COMMUNITY BASED WAIVER EXPANSION
Mr. Joyce, Ms. Tucker, Mr. Montigny and Mr. Nuciforo move to amend the bill in Section 279 by striking out the words:- "include in said waiver request the feasibility of offering," and inserting in place thereof the word:- "offer" and by further amending the bill in Section 279 by adding after the words:- "Said waiver" the following words:- "shall utilize additional federal financial participation from said expansion to increase the community benefit plans for eligible individuals at risk of nursing home care, while ensuring that this"