Guide to Mass Payment Reform Amendments: Sex Ed, Podiatry, and Acupuncture

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For those following at home, the House will debate their version of payment reform today and tomorrow. You can watch here starting at 1 pm and read the redraft of the bill here.

275 amendments have been filed, and legislators appear to be more focused on social policy, labor policy, and special-interest carve outs than health delivery and payment reform. Some of the more colorful amendments consist of:

• Social Policy: Studying sex ed in charter schools.(#30) 4 amendments dealing with family planning (#32, 139, 264, 265), removing ultrasound diagnostic imaging from the definition of an advanced diagnostic imaging service (#179), and health care equity (#217).
• Labor Appointments: There are 5 amendments giving appointments to the Massachusetts Nurses Association (#11, 42, 63, 86, 91), and 6 for AFL-CIO (#44, 137, 242, 244, 245, 246).
• Special Interests: Too many to mention, but examples such as podiatry (#64), numerous groups added to loan repayment program including: nurses, those providing rehabilitative services such as physical therapy, occupational therapy and prosthetics and orthotics,  rural primary care sites, community based behavioral health organizations. Amendment #71 would allow ACOs to be exempt from a major surcharge.
• 4 New Mandates: Annual cytologic screenings (#162), acupuncture (#175), hearing aids for kids of state employees in GIC, or all individual policies plus all related services(#243),  amino acid-based elemental formulas (#248)
• Soda Tax, (#267)
• Unpopular Section 66: 6 amendments to change section 66 of the bill, which includes provisions to force providers to have a  firewall between hospitals when negotiating with insurers.

Chairman Walsh has numerous technical corrections, but also some more substantial changes.

Amendment #1– Reducing the surcharge on hospitals down to ~$68 million instead of the initial $138 million. This will leaves an equal surcharge levied on both insurers and hospitals.

It appears my fears of an equal destruction “compromise” may be coming true.

Amendment #191– Strikes language that prohibited supplemental insurance from covering co-payments, deductibles, co-insurance, or other patient payment responsibilities for services.

Amendment #102- In a technical amendment otherwise, Walsh removes the penalty on hospitals for not having alternative payment methods by 2015.

Amendment #127– Allows cities with more than 150,000 residents to contract directly with an ACO. Will the state follow suit?

Amendments of Note

While I have some questions about implementation with a couple of these, there are a few amendments that would add value to the bill.

Amendment # 8– Calls for alternative payment methods to contain a provision for shared savings that a percentage would be returned to plan participants.

Amendment #77– The state Medicaid office is hereby authorized to establish a pilot program with an external service provider to determine the effectiveness of various fraud management tools to identify potential fraud at claims submission and validation in order to reduce Medicaid fraud prior to payment.

The Republicans have a few amendments worth serious consideration (145, 146, 148,149, 151, 152,154, and 171), one has significant bipartisan support:

Amendment 168 “In calculating the fair share assessment, employees who have qualifying health insurance coverage from a spouse, parent, veteran’s plan, Medicare, Medicaid or a plan or plans due to a disability or retirement shall not be included in the numerator or denominator for purposes of determining whether an employer is a contributing employer.” This will help many small businesses.

Amendment #199 – Bi-partisan amendment to help companies with seasonal workers.

Amendment # 273– A move in the right direction on HSAs.“The executive office of health and human services shall conduct a study commission to investigate the implementation of a pilot program to increase the adoption of health savings accounts and consumer-driven health plans in the marketplace, including state employees and persons receiving subsidized health care”

Amendment #212– Attempts to remove government regulation from business benefit design. “(g) Notwithstanding any general or special law to the contrary, the commissioner shall prohibit carriers that offer health benefit plans to small businesses and eligible individuals from limiting insurance policies to exclude plans that reimburse more than 50 per cent of the plan deductible.”

There are a few different amendments thinking ahead on medicine:

Amendment #90- “physicians licensed in a state other than Massachusetts shall not be prohibited from providing medical advice, diagnoses, treatments and prescriptions when they communicate with patients through internet-based video conferences when the physicians are located in the state where they are licensed and the patient is located in Massachusetts at the time of the advice, diagnosis, treatment or prescription. Any such internet-based technology shall include visual and audio notice to patients that the physicians are not licensed in Massachusetts.”

There are of course many more amendments, but I am hearing that very few will be adopted over the next two days of debate, but hopefully the conversation will be informative as they debate this bill as the savings estimates are still unclear.