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Legislative Updates

  • July 21, 2022 7:48 AM | Katy Monaco (Administrator)

    Supreme Court Strikes Down 340B Cuts

    On July 15, 2022, the Centers for Medicare & Medicaid Services (CMS) released its proposed rule for the 2023 Medicare Hospital Outpatient Prospective Payment System (OPPS).

    In June 2022, the Supreme Court ruled that the Department of Health and Human Services (HHS) may not vary reimbursement rates for drugs and biologicals among groups of hospitals without conducting a survey of hospital acquisition costs. Given the timing of the Supreme Court decision, CMS was unable to adjust its proposed payment rates and budget neutrality calculations to account for the decision before issuing its proposal.

    As a result, while CMS is proposing a reimbursement rate of average sales price (ASP) minus 22.5% for drugs and biologicals acquired through the 340B drug pricing program, the agency anticipates finalizing a reimbursement rate of ASP plus 6% for such drugs and biologicals in the 2023 final rule.

    While changes to the OPPS payment rates and the conversion factor that reflect the Supreme Court decision are anticipated to be reflected in the language of the final rule, in the interim, CMS will make relevant impact tables and other supporting data associated with the alternative policy available.

    Prior Authorization: CMS is continuing to advance its Prior Authorization program in Medicare; however, new additions to the list of items or services requiring prior authorization are not directly related to cancer care. Specifically, CMS is proposing to add facet joint interventions as a category of services to the prior authorization process for hospital outpatient departments beginning March 1, 2023.

  • July 08, 2022 7:23 AM | Katy Monaco (Administrator)

    As expected, the House today took up the pandemic policy extension bill passed by the Senate on Tuesday. In its version of the bill, the House removed from the 2020 law on notice and disclosure the section requiring DPH to implement the law including the provision that would impose fines of up to $2,500 on providers for each violation of the notice and disclosure provisions of the law. The Senate had only delayed implementation of the law and penalties until 2025.

    The House and Senate will now need to reconcile their versions of the bill. There are other provisions of the overall bill that will need to be reconciled as well. For health care providers, the likelihood that the state’s implementation along with penalties will be either delayed 2.5 years or not enforced at all is likely.

  • June 29, 2022 8:47 AM | Katy Monaco (Administrator)
    Legislative Report
    provided by Edward J. Brennan, Jr., Esq.
    1. Legislative Update: As the state legislature enters its final month of formal session which ends July 31, there are several major health care initiatives in play. 
      • Prescription Drug Costs: Senate has passed and sent to the House a bill (S.2695) providing State oversight of prescription drug costs.
      • Regulatory Barriers to Expansion of Large Health Care Systems: The House has passed and sent to the Senate a bill designed to help struggling community hospitals. 
      • Behavioral Health: Both the House and Senate have passed similar bills addressing behavioral health which are now before a conference committee to reconcile the differences. 
      • Gov. Baker filed health care reform bill. 
    2. Cancer related legislation MSCO is monitoring:
      • Step Therapy: It goes to the Senate which is expected to pass it before the July 31 end of the formal legislative session.
      • Prescription Co-Pay Assistance
      • Co-Pay Accumulators
      • Fertility Preservation
    3. Telehealth: MSCO continues to monitor the Massachusetts Division of Insurance (DOI) which released draft regulations to implement the telehealth provisions passed by the legislature in early 2021, including parity in reimbursement (equal to face to face services) for chronic disease management through the year 2022. 
     
    Read Full Report & Details

  • March 16, 2022 8:23 AM | Katy Monaco (Administrator)

    Governor Baker released his long awaited health care bill. This closely mirrors the bill he filed last session. The Governor’s office has said the bill is divided up into three major parts...

    1. Prioritizing Primary Care and Behavioral Health
    2. Managing Health Care Cost Drivers
    3. Improving Access to High-Quality Coordinated Care

    Attached is the office summary of the bill. 

  • March 11, 2022 2:34 PM | Katy Monaco (Administrator)

    Last night, after months of delays, Congress passed a budget bill that includes an increase in funding for cancer research.

    The bill significantly increases funding for the National Cancer Institute (NCI) to help advance our nation’s work towards combating, and ultimately curing, cancer. The bill provides $6.9 billion for the NCI – an increase of $353 million over FY2021 – including full funding for the Cancer Moonshot. Congress also provided $45 billion for the National Institutes of Health (NIH) – an increase of $2.25 billion over FY2021 – including a boost of $50 million specifically for health disparities research.

    We know this funding is long overdue and desperately needed. We need scientists in their labs continuing their lifesaving research to find new cancer treatments and new cures. This is a big step, and we are thankful that Congress has voted to make it happen. But we also know there is more Congress can do. 

    We’ll have another chance to convince Congress to maintain this momentum and vote for another increase in funding when they start negotiating this year’s budget bill. So stay tuned.

  • February 14, 2022 2:35 PM | Katy Monaco (Administrator)

    On Saturday, Gov. Baker approved much of the COVID-19 spending bill including:

    • The provision that reinstates liability immunity protections for health care providers and entities where a patient’s care has been impacted by COVID-19 and its variants from Nov. 22, 2021 to February 28, 2022; and
    • Delay's implementation of the state’s notice and disclosure law that was issued as a DPH bulletin “Health Care Provider Obligations”, which outlines the patient notification provisions of Chapter 260. Implementation is delayed until July 31, 2022.
  • February 10, 2022 1:23 PM | Katy Monaco (Administrator)

    The Division of Insurance (DOI) has been slow in promulgating regulations and is now asking DOI to put forward draft regulations and hold a hearing. Massachusetts Telemedicine Coalition (tMED) is sending a letter to DOI requesting action and MSCO has signed this letter to support. View Letter

  • February 03, 2022 12:11 PM | Katy Monaco (Administrator)

    Increased use of utilization management tools like prior authorization can undermine patient access to medically necessary care. Prior authorization practices have a disproportionately negative impact on cancer patients due to their need for timely access to care. H.R. 3173 / S. 3018, the Improving Seniors' Timely Access to Care Act, would help streamline and create an electronic prior authorization system within the Medicare Advantage program, streamline the process for routinely approved items and services, and provide much-needed transparency, thereby protecting patients from unnecessary delays.

    Use the ACT Network to ask your lawmakers to support the Improving Seniors’ Timely Access to Care Act.

  • February 03, 2022 7:54 AM | Katy Monaco (Administrator)

    We have some great news to share! Today, S.644 & H.1053, was given a favorable report and the bills were voted out of the committee! 

    This copay assistance programs help patients afford med but insures don't always count those towards a patient's deductible. Thank you! #mapoli for advancing H1053 & S644 to help patients by ensuring #copayassistance counts toward their deductible! 

  • January 04, 2022 8:54 AM | Katy Monaco (Administrator)

    Bulletin released by the Department of Public Health yesterday. This Bulletin implements Chapter 260 of the Acts of 2020 Notice and Disclosure Requirements for Health Care Providers.

    https://www.mass.gov/news/pricing-transparency-provisions-of-an-act-promoting-a-resilient-health-care-system-that-puts-patients-first-patients-first

    Specifically, the Bulletin details new requirements for health care providers and health care facilities to notify patients about charges and payments for proposed admissions, procedures, services, and referrals that are specific to the patient’s insurance carrier. These requirements take effect on January 1, 2022, and also authorize the Department of Public Health, consistent with its authority to regulate health care providers, to penalize providers who fail to comply with a penalty up to $2,500 for each instance of non-compliance. These penalties will take effect July 1.

    Documentation:

    ·       PROVIDERS: Healthcare Provider Disclosure Obligations related to Scheduling Admissions, Procedures or Services, or Making Referrals to Another Provider.

    ·      PATIENTS: Learn More About “Patients First” – a new law which requires your health care provider to give you more information about charges for hospital stays, medical procedures, healthcare services, or referrals.


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