Testimony In Opposition to S.544/H.1018, An Act Improving Access to Coverage for Medicaid Beneficiaries, S.547/H.1020, An Act Relating to Equitable Provider Reimbursement and H.1019, An Act Making Greater Use of Managed Care in Medicaid
Before the Joint Committee on Health Care Financing
The MMS wishes to be recorded in opposition to these three bills filed by Representative Paul Donato and the identical Senate versions of two of the bills, filed by Senator Michael Moore. Some of this legislation was filed in the last session and did not pass. While having different provisions, each of these bills advance the business interests of managed care companies over the interests of patients and providers.
Senate 544 and H 1018 purport to improve access by closing the primary care clinician plan and fee for service models in Massachusetts. This would give patients no access to care except through managed care companies that contract with MassHealth and would give MassHealth no competitive model for care. This would particularly impact patients in areas without patient concentrations which are attractive to managed care.
The Massachusetts Medicaid Delivery Model Advisory Committee has been meeting frequently over the past year to look at ways to deliver high quality efficient care. The Committee commissioned a report from Navigant on delivery models. The report was delivered last month. One of its missions was to compare MCO’s and the PCC model. Here are some of its findings:
- “Both the MCO and PCC models are well-established parts of the health care landscape in Massachusetts, and each has widely recognized positive features:
- The Massachusetts MCOs are among the highest ranking Medicaid managed care plans in the country, based on ratings by the National Committee for Quality Assurance (NCQA).
- The MCOs have diverse coverage models and provider payment policies.
- The MCOs are making meaningful progress toward the use of alternative provider payment methods.
- The PCC program has a proven track record of caring for complex populations of patients.
- The PCC program has enhanced its contract with its behavioral health vendor to incorporate care coordination capabilities for all types of services.
- The PCC program is also beginning to make meaningful progress toward the use of alternative provider payments methods.
- Many stakeholders see value in having both programs continue.
- There are risks and uncertainties associated with significantly or totally supplanting one or the other.
- High-level comparisons of the cost performance of the MCO and PCC programs by population group do not themselves provide a clear indication that there would be a financial benefit to MassHealth from transitioning fully from one care delivery model to another."
Thus it is clear H 1018 and S 544 do not reflect the current evidence regarding providing care to MassHealth recipients and should not be advanced.
S.547/H.1020, An Act Relating to Equitable Provider Reimbursement is another piece of legislation in which the name and the contents seem to conflict. This legislation would legalize a fee limit for managed care companies that contract with MassHealth to pay hospitals, physicians and other providers with whom they don’t have a contract. They would only pay for services that they had authorized but they would not be required to pay market rates but would pay only the state approved fee for service schedule. Managed care companies would benefit from limits on their costs with no corresponding limit on the fees they charge the state. Managed care companies would have little incentive to contract for emergency services which hospitals are required to provide regardless of ability to pay. This legislation would provide a windfall to managed care companies with no benefit to the Commonwealth.
H 1019 An Act Making Greater Use of Managed Care in Medicaid guts Section 261 of Chapter 224. This important section mandates a transition in MassHealth towards alternative payment methodologies. It also specifies the process and the issues for consideration in moving quickly towards adoption of new payment methodologies. H 1019 simplifies the process in the following manner: “In developing such a program, the office of Medicaid shall consult with and the Medicaid managed care organizations, Senior Care Options plans, PACE plans, and Medicaid Medicare Integrated Plans under contract with the commonwealth to provide services to beneficiaries, and to the greatest extent possible utilize said Medicaid managed care organizations, Senior Care Options plans, PACE plans, and Medicaid Medicare Integrated Plans in implementing the requirements of this section.”
H 1019 proposes that the state consult with a limited group of existing providers to find ways to use those specific providers to the “greatest extent possible” in creating an innovative alternative approach to providing care. The MMS feels that the legislature got it right the first time and that no amendment to Section 261 of Chapter 224 is necessary.
The MMS appreciates the work of the Committee on Health Care Financing and urges an ought not to pass recommendation on all of the above bills.
