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Floor Number: 451 Clerk Number: 627
ALLOCATION FROM DISTRESSED PROVIDER EXPENDABLE TRUST FUND
Ms. Wilkerson moved that the bill be amended, in Section 91, by inserting in the first paragraph after the first sentence the following: "that the secretary shall provide a $750,000 one-time grant from the fund to a not-for-profit long term acute care hospital located the Roxbury section of the City of Boston"
Floor Number: 452 Clerk Number: 628
ALLOCATION FROM DISTRESSED PROVIDER EXPENDABLE TRUST FUND
Ms. Wilkerson moved that the bill be amended, in Section 91, by inserting in the first paragraph after the first sentence the following: "provided further, that the secretary shall provide a $400,000 one-time grant from the fund for Dimock Community Health Center located in the Egleston Square neighborhood in the Roxbury Section of Boston for health care and traditional housing to medically underserved patients from the Roxbury, Dorchester and Jamaica Plain sections of the city of Boston."
Floor Number: 453 Clerk Number: 630
ALLOCATION FROM DISTRESSED PROVIDER EXPENDABLE TRUST FUND
Ms. Wilkerson and Mr. Barrios moved that the bill be amended in Section 91, by inserting in the first paragraph after the first sentence the following: "that the secretary shall provide a $400,000 one-time grant from the fund for a community health center located in the south end of boston which is the largest provider of community based mental-health services, and serves significant homeless and latino populations"
Floor Number: 454 Clerk Number: 632
ALLOCATION FROM DISTRESSED PROVIDER EXPENDABLE TRUST FUND
Ms. Wilkerson moved that the bill be amended in Section 91, by inserting in the first paragraph after the first sentence the following: "that the secretary shall provide a $200,000 one-time grant from the fund for Whittier Street Community Health Center located in the Roxbury section of Boston for adult and child behavioral health services to homeless, immigrant and refugees populations"
Floor Number: 455 Clerk Number: 633
ALLOCATION FROM DISTRESSED PROVIDER EXPENDABLE TRUST FUND
Ms. Wilkerson moved that the bill be amended in Section 91, by inserting in the first paragraph after the first sentence the following: "Said secretary shall provide a one-time grant of $200,000 to South Cove Community Health Center located in the Chinatown section of the City of Boston which provides health care to immigrant and linguistically diverse populations"
Floor Number: 456 Clerk Number: 634
ALLOCATION FROM DISTRESSED PROVIDER EXPENDABLE TRUST FUND
Ms. Wilkerson moved that the bill be amended, in Section 91, by inserting in the first paragraph after the first sentence the following: "Said secretary shall provide a one-time grant of $200,000 to Fenway Community Health Center located in the Fenway section of the City of Boston which provides health care to gay and lesbian populations"
Floor Number: 457 Clerk Number: 635
ALLOCATION FROM DISTRESSED PROVIDER EXPENDABLE TRUST FUND
Ms. Wilkerson moved that the bill be amended in section 91, by inserting in the first paragraph after the first sentence the following: "Said secretary shall provide a one-time grant of $200,000 to Mattapan Community Health Center located in the Mattapan section of the City of Boston which provides health care to caribbean and immigrant populations"
Floor Number: 458 Clerk Number: 636
ALLOCATION FROM DISTRESSED PROVIDER EXPENDABLE TRUST FUND
Ms. Wilkerson moved that the bill be amended in section 91, by inserting in the first paragraph after the first sentence the following: "Said secretary shall provide a one-time grant of $200,000 to Benjamin Health Care Center located in the Mission Hill section of the City of Boston that operates the only non-profit rest home health care provider for seniors of color in the city of Boston."
Floor Number: 459 Clerk Number: 637
ALLOCATION FROM DISTRESSED PROVIDER EXPENDABLE TRUST FUND
Ms. Wilkerson moved that the bill be amended, in Section 91, by inserting in the first paragraph after the first sentence the following:
"that the secretary shall provide a $2,000,000 one time grant from the fund for a pediatric unit of an acute care hospital in Suffolk county in which the ration of licensed pediatric beds to total licensed hospital beds shall exceed 0.20. Provided further, that the secretary shall provide a $750,000 one-time grant from the fund to a not-for profit long term acute care hospital located the Roxbury section of the City of Boston. Provided further, that the secretary shall provide a $400,000 one-time grant from the fund for Dimock Community Health Center located in the Egleston Square neighborhood in the Roxbury Section of Boston for health care and traditional housing to medically underserved patients from the Roxbury, Dorchester and Jamaica Plain sections of the city of Boston. Provided further, that the secretary shall provide a $400,000 one-time grant from the fund for a community health center located in the south end of boston which is the largest provider of community based mental-health services, and serves significant homeless and latino populations. Provided further, that the secretary shall provide a $200,000 one-time grant from the fund for Whittier Street Community Health Center located in the Roxbury section of Boston for adult and child behavioral health services to homeless, immigrant and refugees populations. Provided further, that said secretary shall provide a one-time grant of $200,000 to South Cove Community Health Center located in the Chinatown section of the City of Boston which provides health care to immigrant and linguistically diverse populations. Provide further, that said secretary shall provide a one-time grant of $200,000 to Fenway Community Health Center located in the Fenway section of the City of Boston which provides health care to gay and lesbian populations. Provided further, that said secretary shall provide a one-time grant of $200,000 to Mattapan Community Health Center located in the Mattapan section of the City of Boston which provides health care to caribbean and immigrant populations. Provided further, said secretary shall provide a one-time grant of $200,000 to Benjamin Health Care Center located in the Mission Hill section of the City of Boston that operates the only non-profit rest home health care provider for seniors of color in the city of Boston."
Floor Number: 460 Clerk Number: 663
PEDIATRIC REHABILITION
Mr. Tolman moved that the bill be amended in Section 91 by adding the following words: "provided further, that the secretary shall provide a $1,000,000 one-time grant from the fund for a pediatric rehabilitation hospital located in Suffolk County." REDRAFT
Floor Number: 461 Clerk Number: 689
MILTON HOSPITAL RELIEF
Mr. Joyce moved that the bill be amended in Section 91 by adding the following words: - ", and provided further, that the secretary shall provide a $500,000 one time grant from the fund for Milton Hospital."
Floor Number: 462 Clerk Number: 692
DISTRESSED PROVIDER EXPENDABLE TRUST FUND
Ms. Tucker and Mr. Baddour move that the bill amend Section 91 in line 7, by inserting after the word "community" the words "The secretary of the executive office of health and human services shall provide a $4,000,000 one-time grant from the fund to a disproportionate share hospital provider located in the county formerly known as Essex county that has a family practice residency program in partnership with a federally qualified community health center, which program enhances the coordination of cost-effective care delivery in ambulatory settings and at the hospital to underserved populations".
Redraft
Floor Number: 463 Clerk Number: 393
QUINCY MEDICAL CENTER
Mr. Baddour moved that the bill be amended in Section 93 by striking out the figure "$2,662,200" and inserting in place thereof the following figure "$5,463,540".
Floor Number: 464 Clerk Number: 52
NURSING HOME TAX
Mr. Lees moved that the bill be amended by inserting, after Section ___, the following new Section:-
"SECTION ____. Chapter 118G, as amended by Chapter 184 of the Acts of 2002, is hereby amended by repealing Section 25."
Floor Number: 465 Clerk Number: 138
MEDICAID WAIVER FOR COMPREHENSIVE FAMILY PLANNING
Mr. Moore and Ms. Chandler , Mr. Knapik, Ms Resor, Mr. O'Leary moved that the bill be amended by adding at the end thereof the following new Section:-
Section xxx. That the executive office shall seek a waiver under Titles XIX and XXI of the Social Security Act to expand MassHealth comprehensive family planning services for individuals and families whose incomes are at least up to 200% of the federal poverty line. Said waiver shall 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 office shall notify the house and senate ways and means committee and the health care financing committee within ten days of the filing of the waiver with the Centers for Medicare and Medicaid Services and shall notify said committees within ten days of a decision on the waiver."
Floor Number: 466 Clerk Number: 140
CONTINGENCY FEE FOR SCHOOL HEALTH MEDICAL SERVICES
Mr. Moore moved that the bill be amended by adding at the end thereof the following new Section:-
SECTION________. chapter 44, section 72 of the Massachusetts General Laws as appearing in the 2000 Official Edition is hereby amended by adding in line 18 after the word "fee" the following:- "which shall be not less than 6 per cent."
Floor Number: 467 Clerk Number: 141
DUALLY ELIGIBLE NON ELDERLY SAFETY NET PLAN
Mr. Moore moved that the bill be amended by adding at the end thereof the following new Section:-
SECTION________. Notwithstanding any general or special law, the Secretary of the Executive Office of Health and Human Services is hereby authorized and directed to review requests by Massachusetts based Medicare Advantage Special Needs Plans caring for Medicare and Medicaid (dually) eligible residents of the Commonwealth. Upon determination that appropriate financial standards have been met according to the program requirements, the Secretary shall so certify to the Center for Medicare and Medicaid Services. The Secretary may require a Plan that is requesting review and certification to pay a reasonable fee.
Floor Number: 468 Clerk Number: 145
THE MASSACHUSETTS CENTER FOR NURSING
Messrs. Moore and. Tarr moved that the bill be amended by adding at the end thereof the following new Section:-
SECTION________. Notwithstanding any general or special law to the contrary, the Executive Office of Health and Human Services and all agencies, departments and boards within said secretariat, the Department of Labor and Workforce Development, the Board of Higher Education and any other state agency, board or department that collects data, conducts surveys or gathers information related to the practice of nursing, the supply of nursing workforce, the supply of nursing faculty or other nursing workforce issues shall regularly submit said data and information to the Massachusetts Center for Nursing, Inc.
Floor Number: 469 Clerk Number: 146
PROMOTE EFFICIENCY AND PROMPT PAYMENTS TO HEALTH CARE PROVIDERS
Mr. Moore and Ms Fargo moved that the bill be amended by adding at the end thereof the following new Section:-
SECTION____. Subsection 4(c) of section 108 of chapter 175 of the General Laws, as appearing in the 2004 official edition, is hereby amended by striking the provision in its entirety.
Section 2: Subsection (G) of section 110 of chapter 175 of the General Laws, as so appearing, is hereby amended by striking the provision in its entirety.
Section 3: Subsection (e) of section eight of chapter 176A, of the General Laws, as so appearing, is hereby amended by striking the provision in its entirety.
Section 4: Section 7 of chapter 176B of the General Laws, as so appearing, is hereby amended by striking the second, third and fourth sentence in the second paragraph in its entirety.
Section 5: Section 6 of chapter 176G of the general laws, as amended by section 20 of chapter 141 of the acts of 2000, is hereby further amended by striking the second paragraph in its entirety.
Section 6: Section 2 of chapter 176I of the General Laws, as amended by section 24 of chapter 141 of the acts of 2000, is hereby further amended by striking the third full paragraph in its entirety
Section 7: Chapter 176O of the general laws, as so appearing, is hereby amended by adding after section 10 the following section: --:
Section 10A Timely Payment of Claims
(a) No later than 15 calendar days after the date on which a carrier has received a claim that is submitted electronically, or no later than 30 calendar days after the date on which a carrier has received a claim that is submitted on paper from a provider of health care services, the carrier shall: (1) pay the total amount of the claim, or any undisputed portion thereof, in accordance with the contracted fee agreed to by the provider and the carrier, (2) notify the provider in writing of all the reason or reasons for nonpayment of the claim or any unpaid portion, and (3) notify the provider in writing of what additional information or documentation is necessary to complete the claim form and receive payment for the claim or any unpaid portion thereof. All claims that are resubmitted by providers to a carrier shall be processed and paid by the carrier based on the timelines included in this subsection (a).
(b) Any carrier subject to the provisions of this section that fails to comply with subsection (a) for any claim or portion of a claim related to the provision of health services shall pay all unpaid portions of the claim, and any underpayment resulting from such carrier’s payment at a rate or fee below the contracted rate or fee agreed to by the provider and such carrier, together with interest on any unpaid or underpaid amount, which interest shall accrue beginning 30 calendar days after the carrier’s receipt of the claim form at the rate of 1.5 percent per month, not to exceed 18 percent per year. The provisions of this subsection relating to interest payments shall not apply to a claim that the carrier is in good faith investigating because of suspected fraud.
(c) In addition to any other penalty or remedy authorized under any general or special law applicable to a carrier subject to the provisions of this chapter, if the commissioner finds that any such carrier has engaged in a pattern of non-compliance with this section, the commissioner shall subject such carrier to an administrative penalty of no less than $10,000 per day until said carrier has demonstrated that it has taken corrective action and has resolved the pattern of non-compliance.
(d) A carrier shall disclose to a contracted provider of health care services, at said provider’s request, all information that is necessary for such provider to determine whether it has been compensated according to the terms of its contract with the carrier. Such disclosure shall include, but not be limited to, all applicable billing policies, procedures and guidelines used in paying claims for covered services; fee schedules applicable to the provider contract; and a clear explanation of all methodologies and rules that will be used by the carrier to pay claims, including payment rules used to combine multiple codes or reduce codes in procedures commonly referred to as “bundling” and “ downcoding” of procedures. Such carrier shall provide any addendum, schedule or attachment necessary to provide a reasonable understanding of the information disclosed to the contracted provider. For the purposes of this subsection, such information shall be disclosed to the contracted provider at the sole expense of the carrier, which may require that the provider sign a confidentiality agreement prior to the release of such information.
(e) A carrier shall be required to ensure that access to and coverage for services continue in the event that an organization that does business with or is contracted by said carrier through a carveout arrangement, so called, is no longer capable of meeting its obligations regarding access and coverage for services provided to the carrier’s insured. Said carrier shall be responsible to ensure that the insured has access to necessary care and said carrier shall pay all unpaid claims at the contracted rate for covered services provided to its insured during the coverage period that said insured’s premium has been paid to the carrier or the carveout arrangement. For the purposes of this subsection, a carveout arrangement shall include any arrangement by which an organization other than the insured’s carrier provides access to and coverage for medically necessary services on behalf of said carrier either through a contract between the carveout organization and the carrier or through a contract between the carveout organization and the provider of health care services. Provided further that said organization shall be required to comply with the timely payment provisions of this section and shall incorporate such provisions in its contracts between the carrier or the provider of heath care services.
SECTION 8:
A carrier, so called, shall include the provisions of Section 7 of this Act in any contract between the carrier and a health care provider, so called, which is entered into, renewed, or amended on or after the effective date of the Act. Nothing in said section 7 shall be construed to prohibit carriers and providers from entering into contracts that include claims payment provisions that meet or exceed the provisions of Section 7 of this Act.
Floor Number: 470 Clerk Number: 147
MASSHEALTH TECHNICAL AMENDMENT CLARIFYING COVERAGE FOR VENTILATOR DEPENDENT PATIENTS
Mr. Moore moved that the bill be amended by adding at the end thereof the following new Section:-
SECTION________.Section 13A of Chapter 118E of the General Laws, as amended by section 162 of Chapter 149 of the Acts of 2004, is hereby amended by deleting the term "public payor-dependent non-acute hospital" as it appears in the third paragraph, and inserting in its place the following term "non-acute hospital."
Floor Number: 471 Clerk Number: 149
UNCOMPENSATED CARE POOL FUNDING
Mr. Moore moved that the bill be amended by adding at the end thereof the following new Section:-
SECTION________. Notwithstanding any general or special law to the contrary, the division of health care finance and policy and the secretary of health and human services, shall verify any surplus funds from fiscal years 1998 and 1999 within Uncompensated Care Trust Fund established pursuant to section 18 of chapter 118G of the General Laws. The division of health care finance and policy, shall expend $17.5 million of such funds, without further appropriation, for the purpose of reimbursing hospital uncompensated care pursuant to Section 61 of this act." and that the bill be further amended in Section 64, by striking the figure "$48,700,000" in line 4, and inserting in place thereof the figure "66,200,000" and that the bill be further amended in Section 61, by striking the figure "$500,000,000" in line 70, and inserting in place thereof the figure "535,000,000"
Floor Number: 472 Clerk Number: 184
SURGICAL PROCEEDURES
Messrs. Brown, Lees, Tisei, Tarr, Hedlund and Knapik moved that the bill be amended by inserting, after Section ___, the following new Section:-
"SECTION ____. Notwithstanding any general or special law to the contrary the state shall prohibit all surgical or medical procedures for persons incarcerated in the state and county correctional facilities if said surgical or medical procedures are not eligible for benefits defined by MassHealth.
Floor Number: 473 Clerk Number: 529
PRIOR AUTHORIZATION
Ms. Walsh moved that the bill be amended by inserting, after Section _____, the following new Section: -
"SECTION___. .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 boards 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, antidepressants, anticonvulsants, 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: 474 Clerk Number: 533
EXTENSION OF MASSHEALTH BENEFITS
Messrs. Tisei, Lees, Knapik, Tarr, Hedlund, and Brown moved that the bill be amended by inserting, after Section 109, the following new Section:-
"SECTION ____. The secretary of the executive office of health and human services shall conduct a study to determine the costs of allowing MassHealth participants who care for elderly parents to obtain additional benefits to offset the expenses paid for caring for elderly parents. The secretary shall submit this report no later than March 1, 2006 and shall submit said report to the senate president, senate minority leader, chairman of senate ways and means committee, speaker of the house of representatives, house minority leader and chairman of the house ways and means committee."
Floor Number: 475 Clerk Number: 534
TRANSFER OF ASSETS I
Mr. Creedon, Ms. Creem and Mr. O'Leary moved that the bill be amended by inserting, after Section 109, the following new Section:-
"Section___. Chapter 118E of the General Laws is hereby amended by striking Section 9E."
Floor Number: 476 Clerk Number: 535
TRANSFER OF ASSETS II
Mr. Creedon, Ms. Creem and Mr. O'Leary moved that the bill be amended by inserting, after Section 109, the following new Section:-
"SECTION____. Section 28 of Chapter 118E of the General Laws is hereby amended by adding the following sentence at the end of the section: The division shall not seek by waiver of federal statute, regulation or other means to impose penalties or define transfers of assets in ways which are broader than the minimum required by federal statute."
Floor Number: 477 Clerk Number: 590
PROTECTING BLOOD DISORDER PATIENTS
Ms. Fargo, Messrs. Havern, Moore, Ms. Resor, Messrs. McGee, Barrios, and Tarr moved that the bill be amended by inserting, after Section 109, the following new Section: -
"SECTION__. Chapter 118E of the general laws, as appearing in the 2002 official edition, is hereby amended by inserting after section 17 the following section:- Section 17A. Notwithstanding any general or special law to the contrary, prior authorization shall not be required for any anti-hemophilic factor drugs prescribed for the treatment of hemophilia and blood disorders."
Floor Number: 478 Clerk Number: 614
BULK PURCHASING OF PRESCRIPTION DRUGS
Mr. Montigny moved that the bill be amended by striking section 5, and further moves to amend the bill by inserting the following section:-
"SECTION __. Notwithstanding any general or special law to the contrary, the Secretary of the Executive Office of Health and Human Services shall take all steps necessary to implement section 271 of chapter 127 of the Acts of 1999 no later than February 1, 2006. The Secretary shall submit reports detailing the Executive Office's progress in implementing this section on the last day of every month between August 31, 2005 and March 31, 2006 to the clerks of the House and Senate, the chairs of the House and Senate Committees on Ways and Means, the Chairs of the Joint Committee on Health Care Finance and the Chairs of the Joint Committee on Elder Affairs.
Floor Number: 479 Clerk Number: 618
Mr. Montigny moved that the bill be amended by inserting the following the new Section:-
SECTION ___. Chapter 6A of the General laws, as amended by section 15 of chapter 26 of the Acts of 2003, is hereby amended by inserting after section 16 the following new 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:
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.
Floor Number: 480 Clerk Number: 652
BULK PURCHASING OF PRESCRIPTION DRUGS
Mr. Montigny moved that the bill be amended by striking section 5, and further moves to amend the bill by inserting the following section:-
"SECTION __. Notwithstanding any general or special law to the contrary, the Secretary of the Executive Office of Health and Human Services shall take all steps necessary to implement section 271 of chapter 127 of the Acts of 1999 no later than February 1, 2006. The Secretary shall submit reports detailing the Executive Office's progress in implementing this section on the last day of every month between August 31, 2005 and March 31, 2006 to the clerks of the House and Senate, the chairs of the House and Senate Committees on Ways and Means, the Chairs of the Joint Committee on Health Care Finance and the Chairs of the Joint Committee on Elder Affairs.
Floor Number: 481 Clerk Number: 695
Mr. Montigny moved that the bill be amended by inserting the following new Section:-
Section _____. Chapter 118E of the General Laws is hereby amended by inserting after section 12 the following sections:
Section 12A. Consumer Protection Rules; Prior Authorization of Prescription
Drugs
(a) Any prior authorization process required by the division before it authorizes coverage for a prescription drug shall comply with the consumer protections in this section and with 42 U.S.C. section 1396r-8(d).
(b) Coverage for a prescription drug that is not covered by the division without prior authorization shall be authorized if a patient’s health care provider certifies, in a manner determined by the division, that:
(i) the drug is medically necessary; and
(ii) in the case of a prescription drug that is not the preferred choice in a therapeutic category on the preferred drug list,
(A) the preferred choice has not been effective, or with reasonable certainty is not expected to be effective in treating the patient’s condition; or
(B) the preferred choice causes or is reasonably expected to cause adverse or harmful reactions in the patient.
(c) The prescriber’s certification concerning whether a particular drug has been ineffective, is expected to be ineffective in treating the patient, or is expected to cause an adverse or harmful reaction shall be final.
(d)(1) The division’s prior authorization process shall be designed to minimize administrative burdens on prescribers, pharmacists, and consumers.
(2) The prior authorization process shall ensure real-time receipt of requests, by telephone, voice mail, facsimile, electronic transmission, or mail on a 24-hour basis, seven days a week.
(3) The prior authorization process shall provide an in-person response to emergency requests by a prescriber with telephone answering queues that do not exceed 10 minutes.
(4) Any request for authorization or approval of a drug that the prescriber indicates, including the clinical reasons for the request, is for an emergency or urgent condition shall be responded to in no more than 4 hours from the time the program or participating health benefit plan receives the request.
(5) In emergency circumstances, or if the response to a request for prior authorization is not provided within the time period established in subdivision (4) of this subsection, a 72-hour supply of the drug prescribed shall be deemed to be authorized by the program or the participating health benefit plan, provided it is a prescription drug approved by the United States Food and Drug Administration, and provided, for drugs dispensed to a Medicaid beneficiary, it is subject to a rebate agreement with the Centers for Medicare and Medicaid Services.
(6) The division shall provide to participating providers a prior authorization request form designed to permit the prescriber to make prior authorization requests in advance of the need to fill the prescription, and designed to be completed without unnecessary delay. The form shall be capable of being stamped with information relating to the participating provider and, if feasible, at least one form capable of being copied shall contain known patient information.
(e) The division’s prior authorization process shall require that the prescriber, not the pharmacy, request a prior authorization exception to the requirements of this section. The division may exempt a prescriber from the need to secure prior authorization for a specific drug category if the division determines that the prescriber has written a minimum number of scripts in that category, and the prescriber prescribes prescription drugs on the preferred drug list at or above the minimum threshold for that category.
(f) If the patient is denied authorization of coverage, the denial shall be subject to an administrative fair hearing and to all rights under section 14 of chapter 30A of the general laws.
(g) The division shall, using bulletins, manuals, notices or other appropriate means, educate prescribers and pharmacists who treat MassHealth patients about the requirements of the prior authorization process, including the obligations of providers and pharmacists and the rights of consumers.
Section 12B. Supplemental Rebates
(a) The commissioner, separately or in concert with the authorized representatives of any health benefit plan participating in the prescription drug fair pricing program established by chapter 118H, shall use the division’s preferred drug list of prescription drugs covered without a prior authorization requirement to negotiate with pharmaceutical companies for the payment to the commissioner of supplemental rebates or price discounts for Medicaid. The commissioner may also use the preferred drug list to negotiate for the payment of rebates or price discounts in connection with drugs covered under any other health benefit plan within or outside this state participating in the prescription drug fair pricing program established by chapter 118H. Such negotiations and any subsequent agreement shall comply with the provisions of 42 U.S.C. section 1396r-8. The program established by chapter 118H, or such portions of the program as the commissioner shall designate, shall constitute a state pharmaceutical assistance program under 42 U.S.C. section 1396r-8(c)(1)(C). The provisions of this section do not authorize agreements with pharmaceutical manufacturers whereby financial support for medical services covered by the Medicaid program is accepted as consideration for placement of one or more prescription drugs on the preferred drug list or for excluding a drug from any prior authorization requirement.
(b) The commissioner shall provide quarterly reports on the progress of negotiating supplemental rebates pursuant to this section to the joint committee on health care and the house and senate committees on ways and means. By September 1, 2003, the commissioner shall provide with the next occurring quarterly report a cost-benefit analysis of alternative negotiation strategies, including strategies used by the state Medicaid agencies in states of Florida and Michigan to secure supplemental rebates and any other alternative negotiation strategy that might secure lower net prescription drug costs.
(c) The commissioner shall prohibit the public disclosure of information revealing company-identifiable trade secrets obtained by the department, and by any officer, employee or contractor of the department in the course of negotiations conducted pursuant to this section. Such confidential information shall be exempt from public disclosure.
Section 12C. Discount Program Waiver
(a) The division shall seek a prescription drug discount program waiver from the Centers for Medicare and Medicaid Services pursuant to section 1115(a) of the Social Security Act. The prescription drug discount program shall provide eligible individuals with a financial subsidy for prescription drugs equal to the average rebate paid to the Medicaid program by pharmaceutical manufacturers. Eligible individuals shall include Medicare-eligible individuals whose financial eligibility exceeds 188 per cent of federal poverty level and who do not have an insurance policy that covers drugs and other individuals whose financial eligibility does not exceed 300 per cent of the federal poverty level who do not have an insurance program that includes a prescription drug benefit.
(b) The division may establish, as part of the discount program, an annual enrollment fee. Subject to appropriation, the division shall make a payment of at least 2 percent of the cost of each prescription or refill dispensed to individuals enrolled in the program.
(c) In implementing the program, the division may contract with a nonprofit corporation or other entity to administer the program. Such corporation or entity shall agree to assist individuals enrolled in the program to access other free or discount prescription drug programs offered by private entities, including pharmaceutical manufacturers.
(d) The division shall report to the house and senate committees on ways and means and the joint committee on health care, not later than 60 days after the effective date of this section, on the division's progress in implementing this section and shall report every 90 days thereafter on its progress in obtaining the waiver to those committees.
SECTION 2. The General Laws are hereby amended by inserting the following new chapter:
Chapter 118H. The Massachusetts Prescription Drug Fair Pricing Program
Section 1. Program Established
(a) There is hereby established a program to reduce the cost to the Commonwealth of providing prescription drugs to its citizens while maintaining high quality in prescription drug therapies. The program shall include, but shall not be limited to, the following components:
(1) the development and use of a statewide, uniform preferred list of covered prescription drugs that identifies preferred choices within therapeutic classes for particular diseases and conditions, including generic and therapeutic equivalents;
(2) the creation of a single purchasing unit for the purchase of prescription drugs by the commonwealth;
(3) the use of strategies to negotiate with pharmaceutical manufacturers to lower the cost of prescription drugs for program participants, including a supplemental rebate program;
(4) the development of educational programs, including a counterdetailing program, designed to provide information and education on the therapeutic and cost-effective utilization of prescription drugs to consumers, physicians, pharmacists and other health care professionals authorized to prescribe and dispense prescription drugs;
(5) the utilization of any available cost containment tools that meet program objectives by reducing the cost to the commonwealth of obtaining and providing prescription drugs, including clinical management tools, utilization review procedures, a prior authorization review process, duplicate prescription monitoring, and refill and supply controls;
(6) the observance of consumer protection rules to maintain high quality in prescription drug therapies and to protect access to needed prescriptions; and
(7) the operation of a discount program to provide the benefit of negotiated price discounts to uninsured citizens.
(b) The following state agencies shall participate in the program authorized in this chapter, to the extent permitted by federal law:
(1) the division of medical assistance;
(2) the executive office of elder affairs;
(3) the group insurance commission;
(4) the department of public health;
(5) the department of mental health;
(6) the department of mental retardation;
(7) the department of corrections; and
(8) the division of employment and training.
(c) Any other public or private health benefit plan that purchases prescription drugs may elect to participate in all or portions of the program.
Section 2. Bulk Purchasing Agreements(a) State agencies and other participants in the program shall act as a single purchasing unit for the negotiation of a contract to purchase prescription drugs on behalf of the commonwealth.
(b) The prescription drug procurement unit created by section 62 of chapter 177 of the Acts of 2001 shall implement all or part of the program to the extent permitted by federal law. The secretary of the executive office of elder affairs, the commissioner of the group insurance commission and the commissioners of the departments of public health, mental health and mental retardation may renegotiate or amend existing contracts for the purchase of prescription drugs, including a contract made in conformance with said section 62, if such renegotiation or amendment is necessary to implement all or part of the program and will be of economic benefit to the health benefit plans subject to such contracts, and to the beneficiaries of such plans. Any renegotiated or substituted contract shall be designed to improve the overall quality of integrated health care services provided to beneficiaries of such plans.
Section 3. Pharmaceutical Benefits ManagerSection 4. Cost Containment Tools
(a) The program shall include the following components:
(1) A preferred list of covered prescription drugs that identifies preferred choices within therapeutic classes for particular diseases and conditions, including generic alternatives.
(i) The preferred drug list shall be implemented as a uniform, statewide, preferred drug list for use by state agencies participating in the program and health benefit plans in the Commonwealth shall be encouraged to participate in the program.
(ii) The program may utilize the MassHealth Drug List developed by the division of medical assistance as its preferred drug list. In order to assist the state agencies participating in the program with the development, modification and timely revision of the preferred drug list, such agencies shall appoint a Drug List Review Board. The board may be comprised in whole or in part of representatives of state agencies, including the Drug Use Board established by the division of medical assistance pursuant to federal law, or may be established by contract with a public or private non-profit organization. The board shall:
(A) make recommendations for the adoption and maintenance of the preferred drug list based upon considerations of clinical efficacy, safety, and cost-effectiveness;
(B) meet at least quarterly;
(C) to the extent feasible, review all drug classes included in the preferred drug list at least every 12 months, and recommend additions to or deletions from the preferred drug list;.
(D) establish board procedures for the timely review of prescription drugs newly approved by the federal Food and Drug Administration, including procedures for the review of newly-approved prescription drugs in emergency circumstances, including early refill review standards, a prior authorization review process, duplicate prescription monitoring, and quality and supply controls;
(E) encourage health benefit plans to implement the preferred drug list as a uniform, statewide preferred drug list by inviting the representatives of each health benefit plan providing prescription drug coverage to residents of the commonwealth to participate as observers or nonvoting members in the commissioners drug utilization review board, and by inviting such plans to use the preferred drug list in connection with the plans’ prescription drug coverage.
(iii) Members of the board shall receive per diem compensation and reimbursement of board related expenses. The board shall consult with a preferred drug list advisory group which shall include 1 designee of the commissioner of mental health; 1 designee of the commissioner of public health; 1 designee of the secretary of the executive office of elder affairs; 1 physician with experience treating MassHealth patients; 1 practicing pediatrician with experience treating MassHealth patients; 1 practicing pharmacist with experience serving MassHealth patients; 1 pharmacologist with expertise in psychiatric drugs; 1 representative of a senior citizens advocacy group; 1 representative of a disability advocacy group; and 1 representative of a statewide advocacy group representing the interests of MassHealth members.
(2) A series of educational programs including a counterdetailing program, designed to provide information and education on the therapeutic and cost-effective utilization of prescription drugs to consumers, physicians, pharmacists and other health care professionals authorized to prescribe and dispense prescription drugs.
(3) Consideration of alternative pricing mechanisms including consideration of using maximum allowable cost pricing for generic and other prescription drugs.
(4) Consideration of alternative coverage terms, including consideration of providing coverage of over-the-counter drugs where cost-effective in comparison to prescription drugs, and authorizing coverage of dosages capable of permitting the consumer to split each pill if cost-effective and medically appropriate for the consumer.
(5) Development of a simple, uniform prescription form, designed to implement the preferred drug list, and to enable prescribers and consumers to request an exception to the preferred drug list choice with a minimum of cost and time to prescribers, pharmacists and consumers.
Section 5. Consumer Protection Rules(a) The program shall authorize pharmacy benefit coverage when a patient’s health care provider prescribes a prescription drug not on the preferred drug list, if a patient’s health care provider certifies that:
(i) the drug is medically necessary; and
(ii) in the case of a prescription drug that is not the preferred choice in a therapeutic category on the preferred drug list,
(A) the preferred choice has not been effective, or with reasonable certainty is not expected to be effective in treating the patient’s condition; or
(B) the preferred choice causes or is reasonably expected to cause adverse or harmful reactions in the patient.
(b) The prescriber’s certification concerning whether a particular drug has been ineffective, is expected to be ineffective in treating the patient, or is expected to cause an adverse or harmful reaction shall be final.
(c) The program shall authorize coverage notwithstanding any prior authorization requirement if the patient agrees to pay any additional cost in excess of the benefits provided by the patient’s health benefit plan. The provisions of this paragraph shall not apply in circumstances in which their application is inconsistent with federal Medicaid laws and regulations. The provisions of this paragraph shall not affect implementation by a participating health benefit plan of tiered co-payments or other similar cost sharing systems.
(d) The program or any participating health benefit plan shall provide information on how prescribers, pharmacists, beneficiaries, and other interested parties can obtain a copy of the preferred drug list, whether any change has been made to the preferred drug list since it was last issued, and the process by which exceptions to the preferred list may be made.
(e)(1) The program’s prior authorization process shall be designed to minimize administrative burdens on prescribers, pharmacists, and consumers.
(2) The prior authorization process shall ensure real-time receipt of requests, by telephone, voice mail, facsimile, electronic transmission, or mail on a 24-hour basis, seven days a week.
(3) The prior authorization process shall provide an in-person response to emergency requests by a prescriber with telephone answering queues that do not exceed 10 minutes.
(4) Any request for authorization or approval of a drug that the prescriber indicates, including the clinical reasons for the request, is for an emergency or urgent condition shall be responded to in no more than 4 hours from the time the program or participating health benefit plan receives the request.
(5) In emergency circumstances, or if the response to a request for prior authorization is not provided within the time period established in subdivision (4) of this subsection, a 72-hour supply of the drug prescribed shall be deemed to be authorized by the program or the participating health benefit plan, provided it is a prescription drug approved by the United States Food and Drug Administration, and provided, for drugs dispensed to a Medicaid beneficiary, it is subject to a rebate agreement with the Centers for Medicare and Medicaid Services.
(6) The program or participating plan shall provide to participating providers a prior authorization request form designed to permit the prescriber to make prior authorization requests in advance of the need to fill the prescription, and designed to be completed without unnecessary delay. The form shall be capable of being stamped with information relating to the participating provider and, if feasible, at least one form capable of being copied shall contain known patient information.
(f) The program’s prior authorization process shall require that the prescriber, not the pharmacy, request a prior authorization exception to the requirements of this section. The program may exempt a prescriber from the need to secure prior authorization for a specific drug category if the program determines that the prescriber has written a minimum number of scripts in that category, and the prescriber prescribes prescription drugs on the preferred drug list at or above the minimum threshold for that category.
(g) If the patient is denied authorization of coverage, the denial shall be subject to an administrative fair hearing and to all rights under section 14 of chapter 30A of the general laws.
Section 6. Discount Card Program.(a) The commissioner of health and human services or another commissioner of a participating state agency designated by program participants shall implement a pharmacy discount plan, to be known as the Healthy Massachusetts Discount Card Plan, for residents without adequate coverage for prescription drugs. As used in 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. Such plan shall establish a system through which residents without adequate coverage are able to take advantage of discounted prices for prescription drugs negotiated pursuant to this chapter. Such commissioner shall implement the pharmacy discount program authorized by this section without any financial contribution by the state, and may establish an enrollment fee in such amount as is necessary to support the administrative costs of the plan. The plan shall be designed to work cooperatively with other state prescription drug assistance programs, including any program created pursuant to a discount program waiver granted by the Centers for Medicare and Medicaid Services to the division of medical assistance. Such commissioner may contract with a nonprofit corporation or other entity to administer the program. Such corporation or entity shall agree to assist individuals eligible for the program to access other free or discount prescription drug programs offered by private entities, including pharmaceutical manufacturers.
Section 7. Reporting and Legislative Oversight(a) The commissioner of health and human services or another commissioner of a participating state agency designated by program participants shall report quarterly to the joint committee on health care and the house and senate committees on ways and means on progress of the program in implementing a single state purchasing unit for prescription drugs pursuant to section 2. The report shall provide a status report on the formation of or operation of the contract negotiated pursuant to section 2, and shall identify any barriers to full implementation of section 2 and recommend any changes to the program or other legislative changes advisable to eliminate such barriers. The report shall also report on the program’s progress in securing the participation of other health benefit plans with the commonwealth by means of joint purchasing agreements to enhance the commonwealth’s purchasing power.
(b) Each year for the duration of the pharmacy benefit manager contract pursuant to section 3, the commissioner of health and human services or another commissioner of a participating state agency designated by program participants shall provide a status report on the contract and the operations of the pharmacy benefit manager to the joint committee on health care and the house and senate committees on ways and means. The report shall include:
(1) a description of the activities of the pharmacy benefit manager;
(2) an analysis of the success of the pharmacy benefit manager in achieving each of the department’s public policy goals, together with the pharmacy benefit manager’s report of its activities and achievements;
(3) an assessment, based upon information learned in contracting with the pharmacy benefits manager, of administrative costs relating to prescription drug benefits in the Medicaid program and the Prescription Advantage program established pursuant to section 39 of chapter 19A, including any recommendations for increasing the administrative efficiency of such programs;
(4) any recommendations for enhancing the benefits of or minimizing inefficiencies of the pharmacy benefit manager contract or advancing the commonwealth’s public policy goals relating to pharmaceutical costs, quality and access;
(5) a fiscal report on the costs and savings to the commonwealth of the pharmacy benefit manager contract, including the information disclosed pursuant to paragraph (b) of section 3, in a manner that preserves the confidentiality of any proprietary information; and
(6) if the pharmacy benefit manager engages in any of the activities described in paragraph (c) of section 3, an explanation of the reasons for finding that such agreement or practice furthers the financial interests of the commonwealth, and does not adversely affect the financial or medical interests of beneficiaries.
(c) The commissioner of health and human services or another commissioner of a participating state agency designated by program participants shall report quarterly to the joint committee on health care and the house and senate committees on ways and means concerning the cost containment aspects of the program undertaken pursuant to section 4. Such report shall include:
(1) a copy of the preferred drug list, an explanation of the list, a summary of the operation of the prior authorization process or any other cost savings measures instituted as a part of the list, and an estimate of expected cost savings as a result of the preferred drug list;
(2) a description of the efforts undertaken to educate consumers and health care providers about the preferred drug list and the program’s utilization review procedures;
(3) a description of the efforts undertaken to establish programs to educate health care providers about the costs of prescribing patterns, including counterdetailing programs;
(4) a report of other cost containment strategies undertaken, including, but not limited to, alternative pricing mechanisms and alternative coverage terms, the expected savings from such strategies, and the effect of such strategies on access to prescription drugs for consumers; and
(5) a status report on the development of a uniform prescription form and any barriers to such development.
(d) The joint committee on health care shall closely monitor implementation of the program, including the preferred drug list and utilization review procedures, to ensure that the consumer protection standards are not diminished as a result of implementing the preferred drug list and the utilization review procedures, including any unnecessary delay in access to appropriate medications. Such joint committee shall, by means of an oversight hearing or otherwise, ensure that all affected interests, including consumers, health care providers, pharmacists and others with pharmaceutical expertise have an opportunity to comment on the operation of the program, the preferred drug list, and other procedural aspects of the program.
SECTION 3. The General Laws are hereby amended by adding after chapter 268B the following chapter.
Chapter 268C. Physician and Pharmaceutical Manufacturer Conduct
Section 1. As used in this chapter, the following words shall have the following meanings:-
"Gift", a payment, entertainment, subscription, advance, services or anything of value, unless consideration of equal or greater value is received. “Gift" shall not include a commercially reasonable loan made in the ordinary course of business, anything of value received by inheritance, a gift received from a member of the reporting person's immediate family or from a relative within the third degree of consanguinity of the reporting person or of the reporting person's spouse or from the spouse of any such relative, or prescription drugs provided to a physician solely and exclusively for use by the physician’s patients.
"Immediate family", a spouse and any dependent children residing in the reporting person's household.
“Medical device”, an instrument, apparatus, implement, machine, contrivance, implant, in vitro reagent, or other similar or related article, including any component, part, or accessory, which is:
(1) recognized in the official National Formulary, or the United States Pharmacopeia, or any supplement to them,
(2) intended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease, in man or other animals, or
(3) intended to affect the structure or any function of the body of man or other animals, and which does not achieve its primary intended purposes through chemical action within or on the body of man or other animals and which is not dependent upon being metabolized for the achievement of its primary intended purposes.
"Person", a business, individual, corporation, union, association, firm, partnership, committee, or other organization or group of persons.
“Pharmaceutical marketer”, a person who, while employed by or under contract to represent a pharmaceutical manufacturing company, engages in pharmaceutical detailing, promotional activities, or other marketing of prescription drugs in this state to any physician, hospital, nursing home, pharmacist, health benefit plan administrator, or any other person authorized to prescribe, dispense, or purchase prescription drugs. The term does not include a wholesale drug distributor licensed under section 36A, a representative of such a distributor who promotes or otherwise markets the services of the wholesale drug distributor in connection with a prescription drug, or a retail pharmacist registered under section 37 if such person is not engaging in such practices under contract with a manufacturing company.
“Pharmaceutical manufacturing company”, any entity which is engaged in the production, preparation, propagation, compounding, conversion, or processing of prescription drugs, either directly or indirectly by extraction from substances of natural origin, or independently by means of chemical synthesis, or by a combination of extraction and chemical synthesis, or any entity engaged in the packaging, repackaging, labeling, relabeling, or distribution of prescription drugs. The term does not include a wholesale drug distributor licensed under section 36A or a retail pharmacist registered under section 37.
“Pharmaceutical manufacturer agent”, a pharmaceutical marketer or any other person who for compensation or reward does any act to promote, oppose or influence the prescribing of a particular prescription drug or medical device or category of prescription drugs or medical devices. The term shall not include a licensed pharmacist, licensed physician or any other licensed health care professional with authority to prescribe prescription drugs who is acting within the ordinary scope of the practice for which he is licensed.
“Physician”, a person licensed to practice medicine by the board of medicine pursuant to section 2 of chapter 112 .
“Prescription drugs”, any and all drugs upon which the manufacturer or distributor has placed or must, in compliance with federal law and regulations, place the following or a comparable warning: “Caution federal law prohibits dispensing without prescription.”
Section 2. No pharmaceutical manufacturer agent shall knowingly and willfully offer or give to a physician or a member of a physician’s immediate family, and no physician shall knowingly and willfully solicit or accept from any pharmaceutical manufacturer, gifts of any value at any time.
Section 3. A person who violates this section shall be punished by a fine of not more than $5,000 or by imprisonment for not more than 2 years, or both.
SECTION 4. The commissioner of the division of medical assistance, the secretary of the executive office of elder affairs, the commissioner of the group insurance commission and the commissioners of state agencies participating in the Massachusetts prescription drug fair pricing program established by chapter 118H of the general laws shall take all steps necessary to enable the commonwealth to participate in joint prescription drug purchasing agreements with other states and other health benefit plans. Such steps shall include:
(1) Active collaboration with the National Legislative Association on Prescription Drug Prices in the Association’s efforts;
(2) Active collaboration with the Pharmacy RFP Issuing States Initiative, so-called, organized by the West Virginia Public Employees Insurance Agency; and
(3) The execution of any joint purchasing agreements or other contracts with any health benefit plan or organization within or outside the state which such commissioners determines will lower the cost of prescription drugs for the commonwealth and its citizens while maintaining high quality in prescription drug therapies.
SECTION 5. (a) The General Court finds that the National Legislative Association on Prescription Drug Prices is a nonprofit organization of legislators formed for the purpose of making prescription drugs more affordable and accessible to citizens of the member states, including the commonwealth. The General Court further finds that the activities of the Association provide a public benefit to the people of the commonwealth.
(b) Three members of the senate, including one member of the minority party, shall be appointed directors of the Association by the senate president, and three members of the house of representatives, including one member of the minority party, shall be appointed directors of the Association by the speaker of the house. Directors so appointed shall serve until new members are appointed.
(c) The directors of the Association shall report to the house and senate committees on ways and means and the joint committees on health care and insurance on or before January 1 of each year with a summary of the activities of the Association, and any findings and recommendations for making prescription drugs more affordable and accessible to citizens of the commonwealth.
Floor Number: 482 Clerk Number: 638
ORAL HEALTH PREVENTION PROGRAM FOR UNDERSERVED CHILDREN
Ms. Wilkerson, Messrs. McGee and O'Leary and Ms. Tucker moved that the bill be amended, after Section 109, the following new Section 110:
"SECTION 110. Notwithstanding any general or special law to the contrary, through fiscal year 2006, the division of health care finance and policy shall allocate $750,000 for the Forsyth Institute's Center for Children's Oral Health to fund a school based demonstration project to offer preventive oral health care to children in high need areas including Boston, Lynn and Hyannis under subsection (d) of section 18 of chapter 118G of the General Laws; provided, however, that such demonstration project otherwise meets the requirements of said subsection (d)."
Floor Number: 483 Clerk Number: 662
RELATIVE TO THE REIMBURSEMENT OF DRUGS TO TREAT MENTAL ILLNESS
Mr. Tolman moved that the bill be amended by inserting, after Section___, the following new Section: -
"SECTION ___. Section 17 of Chapter 118E of the General Laws, as appearing in the 2002 Official Edition, is hereby amended by adding the following paragraph: Notwithstanding the first paragraph no requirements for prior authorization or other restrictions on medications used to treat mental illness such as schizophrenia, depression or bipolar disorder may be imposed on Medicaid recipients. Medications that will be available under the state Medicaid plan without restriction for persons with mental illnesses shall include atypical antipsychotic medications, conventional antipsychotic medications, antidepressant medications, anticonvulsant medications, and any other medications used for the treatment of mental illnesses."
REDRAFT
Floor Number: 484 Clerk Number: 700
TRANSITION SUPPLY OF PRESCRIPTION DRUGS FOR MEDICAID RECIPIENTS
Mr. Montigny moved that the bill be amended by inserting, after Section , the following new Section:-
"SECTION . Notwithstanding any general or special law to the contrary, the secretary of health and human services, in consultation with the director of the Office of Medicaid shall authorize MassHealth payment for early refills or up to a 90 day supply of prescriptions between November 15, 2005 and December 31, 2005 for beneficiaries under chapter 118E who will also be eligible for the Medicare Prescription Drug benefit on January 1, 2006, so-called "dual eligibles." This section shall not be interpreted to permit the dispensing of more than a 30 day supply of narcotic pain killers and other controlled drugs in violation of state or federal law. The secretary and the director shall authorize payment for a 30 day supply of those drugs to be provided to dual eligibles who present a valid prescription in January 2006 and whose Medicare prescription drug plan will not cover the prescribed medication at the time the prescription is presented. Pursuant to regulations of the Center for Medicare and Medicaid Services, the secretary shall seek federal financial participation for all prescriptions provided pursuant to this section. The secretary and the director shall supply all pharmacists in the Commonwealth with clear, concise and consumer friendly information in at least 2 languages about the impact of the Medicare Prescription Drug Benefit on MassHealth members. This information shall include a warning that the customer's drugs may no longer be covered by MassHealth after January 1, 2006 and shall include appropriate toll free numbers to call for more information. The secretary and the director shall direct all pharmacists to include this information with any prescription filled between October 15, 2005 and February 15, 2006 for a MassHealth recipient who is known or is likely to be eligible for the Medicare prescription drug benefit. The secretary and the director are authorized to promulgate regulations consistent with this section."
Floor Number: 485 Clerk Number: 127
DIVISION OF HEALTH CARE FINANCE AND POLICY OPERATIONAL ASSESSMENT
Mr. Moore moved that the bill be amended, in Section 2, in item 4100-0060 the words "provided, that notwithstanding any general or special law to the contrary, the assessment to acute hospitals shall be calculated as provided in section 5 of said chapter 118G; provided further, that the assessed amount shall be not less than 65 per cent of the division's expenses as specified in this item" and replacing with the following:- "provided, that notwithstanding any general or special law to the contrary, the assessment to acute hospitals authorized pursuant to section 5 of chapter 118G of the General Laws for fiscal year 2006 shall be equal to the amount specifically appropriated in this item less amounts projected to be collected by the division in fiscal year 2006 from (1) filing fees; (2) fees and charges generated by the division's publication or dissemination of reports and information; and (3) federal financial participation received as reimbursement for the division's administrative cost; provided further that any amendments to this item through subsequent budget enactments will not be applied to the assessment and will not be accounted for in any adjustments to the assessment in this item as so amended; provided that the amount of such assessment shall be no greater than 65 percent of the amount appropriated in this line item; provided further, that the provisions of this item shall supercede the applicable provisions of said section 5;"
Floor Number: 486 Clerk Number: 214
CONTRACT TRANSFER
Mr. Rosenberg moved that the bill be amended, in Section 2, in item 4100-0060, by adding the following words:-"; provided further, that the division shall transfer its existing contract with Hampshire Community Action Commission for the demonstration project Hampshire Health Access to Hampshire HealthConnect, a program of Cooley Dickinson Hospital, effective May 1, 2005".
Floor Number: 487 Clerk Number: 639
ORAL HEALTH PREVENTION PROGRAM FOR UNDERSERVED CHILDREN
Ms. Wilkerson, Messrs. McGee and O'Leary and Ms. Tucker moved that the bill be amended, in Section 2, in item 4100-0060 by adding the following: "provided further, that notwithstanding any general or special law to the contrary, the division of health care finance and policy shall allocate $750,000 for the Forsyth Institute's Center for Children's Oral Health to fund a school based demonstration project to offer preventive oral health care to children in high need areas including Boston, Lynn and Hyannis under subsection (d) of section 18 of chapter 118G of the General Laws; provided, however, that such demonstration project otherwise meets the requirements of said subsection (d)."
Floor Number: 488 Clerk Number: 364
COMMUNITY HEALTH CENTER CAMPAIGN FOR EXCELLENCE
Ms. Chandler and Mr. Moore moved that the bill be amended in Section 2, by inserting after item 4100-0060 the following item:-
"4100-0080 For continued funding of the qualified community health center based health maintenance organization campaign for excellence community health center initiative.............................................................................................................$6,000,000".
Floor Number: 489 Clerk Number: 426
DMR SERVICE COORDINATORS
Ms. Spilka, Ms. Fargo, Messrs. Tisei and McGee moved that the bill be amended, in Section 2, in item 5920-1000, by striking out the figure "$53,490,519" and inserting in place thereof the following figure:- "$54,853,237".
Floor Number: 490 Clerk Number: 431
NORWELL FRIENDSHIP HOME
Mr. Hedlund moved that the bill be amended, in Section 2, in item 5920-3000, by adding at the end thereof the following : - "; and provided further that not more than $50,000 be expended for the Friendship Home project in the town of Norwell."
Floor Number: 491 Clerk Number: 201
ICF/MR FACILITIES
Ms. Fargo moved that the bill be amended, in Section 2, in item 5930-1000, by striking out the words "October, 2005" and inserting in place thereof the following words: - "October, 2006".
Floor Number: 492 Clerk Number: 178
BROWN- TIA'S RESCUE HAVEN
Mr. Brown moved that the bill be amended by inserting after Section ____, the following new Section:-
"SECTION ___. Notwithstanding any general of special law to the contrary, the department of mental retardation may lease two acres of land located on the grounds of the Wrentham Developmental Center to Tia's Rescue Haven for the purpose of constructing and maintaining a regional animal shelter.
Floor Number: 493 Clerk Number: 183
CENTER FOR FAMILY CONNECTIONS
Mr. Barrios moved that the bill be amended, in Section 2, in item 4800-0015 after the phrase "foster parents" to include:-provided further, no less than $575,000 shall be expended for Center For Family Connections to provide therapeutic and rehabilitative mental health services, targeted research on well being outcomes and permanency planning for older hard to place youth and those aging out of the system;
Floor Number: 494 Clerk Number: 623
ROCA, INC - DSS TRANSITIONAL EMPLOYMENT PARTNERSHIP
Mr. Barrios moved that the bill be amended, in Section 2, by inserting after item 4800-0015 the following item:-
4800-0016 The department of social services is hereby authorized to expend for the operation of the department of social services transitional employment program an amount not to exceed $2,000,000 from revenues collected from various state, county, and/or municipal government entities, as well as state authorities, for the costs related to the provision of services by the participants and the overhead costs and expenses incurred by the not for profit managing agent selected by the commissioner for administering the program. Notwithstanding any other provision of law to the contrary, the commissioner of social services is authorized to enter into a contract with Roca, Inc., a not for profit community based agency, to manage the transitional employment program and to provide services to participants from the ageing out population, parolees, probationers, youth service releasees, and/or other community residents deemed to have employment needs.
Floor Number: 495 Clerk Number: 79
Withdrawn
Floor Number: 496 Clerk Number: 109
LITTLETON GROUP HOME
Ms. Resor moved that the bill be amended, in Section 2, item 4800-0038, by inserting after the word "parents," in line 18 the following:- "provided further, that not less than $150,400 shall be expended to the Town of Littleton for administrative and educational costs accrued to the Town of Littleton for services provided to Department of Social Services clients associated with a group home located in said town;"
Floor Number: 497 Clerk Number: 245
CSAPP
Mr. Hart moved that the bill be amended, in Section 2, in item 4800-0038 by striking out the following language: "provided further, that not less than $140,000 shall be expended for the Comprehensive School Age Parenting Program, Inc. for expansion of a year-round school-based program in Boston high schools and middle schools for pregnant teens, young mothers and fathers and other youth at high-risk for school dropout" And inserting in place thereof the following: "provided further that not less than $280,000 shall be expended for the Comprehensive School Age Parenting Program, Inc. for expansion of year-round school based programs in Boston high schools, middle schools, the South Boston Educational Complex and the Hyde Park Educational Complex for pregnant teens, young mothers and fathers and other youth at high risk for school drop out"
Floor Number: 498 Clerk Number: 295
NEON
Mr. Buoniconti moved that the bill be amended, in Section 2, in item 4800-0038 by inserting the following language:- "; provided further not less than $200,000 shall be expended for the North End Outreach Network (NEON) of Springfield."
Floor Number: 499 Clerk Number: 300
Withdrawn
Floor Number: 500 Clerk Number: 326
THE SOUTH END COMMUNITY CENTER IN SPRINGFIELD
Mr. Buoniconti moved that the bill be amended, in Section 2, in item 4800-0038, by adding the following words;- "; provided further that not less than $100,000 shall be expend for the South End Community Center in Springfield."