Contact: Richard Gulla
781-434-7101
rgulla@mms.org
Waltham/Boston -- July 30 -- The Massachusetts Medical Society (MMS) today testified in opposition to five bills before the Joint Committee on Health Care Financing, saying that each of the bills “advance the business interests of managed care companies over the interests of patients and providers.” It also offered testimony in support of three additional bills that would expand patient protections for MassHealth participants and add efficiency to the state’s Medicaid system.
The statewide physicians’ association opposed companion bills Senate 544 and House 1018, An Act Improving Access to Coverage for Medicaid Beneficiaries, companion bills Senate 547 and House 1020, An Act Relating to Equitable Provider Reimbursement, and House 1019, An Act Making Greater Use of Managed Care in Medicaid.
It issued strong support for companion bills House 1014 and Senate 552, Acts Relative to Extending Patient Protections to Recipients of MassHealth, and House 1034, An Act Relative to Administering National Standards to Medicaid Medical Necessity Reviews.
MMS Testimony Opposing Senate 544 and House 1018
The Medical Society argued that Senate 544 and H 1018, while claiming to improve access to care by closing the primary care clinician plan and fee-for-service models of care in the state, “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,” MMS said.
In presenting its position, MMS cited the findings of the Massachusetts Medicaid Delivery Model Advisory Committee in its comparison of Managed Care Organizations (MCO) and Primary Care Clinicians (PCC) as models of care, which said that both models “are well-established parts of the health care landscape in Massachusetts, that each has widely recognized positive features, and that many stakeholders see value in having both programs continue.”
Among many of the Advisory Committee’s findings, MMS noted that the state’s MCOs are among the highest-ranking Medicaid managed care plans in the country by the National Committee for Quality Assurance and that the PCC program has a proven track record of caring for complex populations of patients. “Thus it is clear,” MMS said, “that Senate 544 and House 1018 do not reflect the current evidence regarding providing care to MassHealth recipients and should not be advanced.”
MMS Testimony Opposing Senate 547 and House 1020
MMS said these bills “represent more legislation in which the name and the contents seem to conflict” and “would provide a windfall to managed care companies with no benefit to the Commonwealth.”
MMS argued that the 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, that managed care companies would benefit from limits on their costs with no corresponding limit on the fees they charge the state, and that managed care companies would have little incentive to contract for emergency services that hospitals are required to provide regardless of ability to pay.
MMS Testimony Opposing House 1019
MMS said House 1019 would effectively erase Section 261 of Chapter 224, an important section of the health care cost containment bill that mandates a transition in MassHealth toward alternative payment methods and specifies the process and the issues for consideration in moving quickly to those new payment methods.
MMS said House 1019 proposes that the state consult with a limited group of existing providers to find ways to use those providers to “the greatest extent possible” in creating innovative alternative approaches to providing care. MMS testified that “the legislature got it right the first time and that no amendment to Section 261 of Chapter 224 is necessary.”
MMS Testimony Supporting House 1014, Senate 552, and House 1034
The Medical Society also testified before the Joint Committee on Health Care Financing in strong support of companion bills House 1014 and Senate 552, Acts Relative to Extending Patient Protections to Recipients of MassHealth, legislation the Society believes “would expand patient protections for MassHealth recipients and require MassHealth to adopt administrative reforms that would encourage physicians and other health care providers to participate in the program.”
MMS also registered its support of House 1034, An Act Relative to Administering National Standards to Medicaid Medical Necessity Reviews, a bill that would ensure that MassHealth utilizes an appropriate clinical peer reviewer, provides clear and timely notification to the recipient of appeals policy and procedures, and utilizes national evidence based medical standards and criteria for review determinations.
The complete testimony of the Massachusetts Medical Society is available at www.massmed.org/testimony
The Massachusetts Medical Society, with more than 24,000 physicians and student members, is dedicated to educating and advocating for the patients and physicians of Massachusetts. The Society, under the auspices of NEJM Group, publishes the New England Journal of Medicine, a leading global medical journal and web site, and NEJM Journal Watch alerts and publications covering 13 specialties. The Society is also a leader in continuing medical education for health care professionals throughout Massachusetts, conducting a variety of medical education programs for physicians and health care professionals. Founded in 1781, MMS is the oldest continuously operating medical society in the country.
