Testimony in Opposition to H.608 Before the Joint Committee on Health Care Financing

The Massachusetts Medical Society (MMS) wishes to be recorded in opposition to H.608, “An Act Relative to Health Policy Commission Reviews of Scope of Practice Proposals”.

This bill would allow the Joint Committee on Health Care Financing to refer bills or unfiled proposals related to any “proposal that would change the authority of a health care provider to provide certain health services”, to the Health Policy Commission (HPC) for review, evaluation, and recommendation. The proposed legislation allows the HPC to report whether the “legislature should vote to enact the scope of practice proposal as submitted to it by the committee, or as amended by the commission.” There is no power for the HPC to find any proposal not worthy of consideration. Once recommended by the HPC, the Committee has no discretion whatsoever and the bill automatically is placed on the calendar even if significantly rewritten by the HPC. This process drastically restricts legislative discretion and jurisdiction for virtually all bills affecting the delivery of healthcare throughout the remainder of the legislative process. 

The Medical Society encourages the Committee on Health Care Finance to oppose this bill and to retain the important procedural processes that are stripped away by this bill. Maintaining proper checks and balances, including the right and responsibility to amend bills in committee, and encouraging informed floor debate in both branches are vital components of the democratic process that are particularly important when dealing with scope of practice issues that acutely affect how health care is delivered to patients in Massachusetts. Bills affecting the health and safety of patients should be subject to greater, not lesser scrutiny by the legislature.

The Medical Society welcomes a fair, objective, patient-centered review of scope of practice legislation. We believe that any scope of practice determination by the legislature would be aided by objective data. Physicians strongly value evidence-based practice, and welcome the legislature’s promoting the same in these determinations. 

A data-driven analysis by the HPC is only helpful to the legislature if the data is neutrally evaluated and properly contextualized. The Medical Society believes that the current factors mandated in this bill for the Health Policy Commission to review scope of practice bills and proposals are severely flawed. The factors that the HPC is required to consider will lead to biased reports and recommendations that could lead to legislative actions that affect the quality of care provided in the Commonwealth. For example, cost effectiveness as the first factor listed, whereas “value”, or quality divided by cost would be a more thoughtful directive. Other factors related to patient protection remain absent, such as the quality and depth of education and training, as well as considerations of patient protections such as board oversight (i.e., rigor of licensing and investigatory infrastructure) or long-term quality metrics.

For these reasons, we urge you to oppose H.608 as written.

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