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Tuesday, March 15, 2022

麻州長查理貝克提新法案 擴大改良醫療護理

             (Boston Orange 編譯) 麻州州長查理貝克 (Charlie Baker) (15) 日到柯德文廣場健康中心 (Codman Square Health Center) 宣佈,提出「投資於人民未來健康的法案 (An Act Investing in the Future of Our Health) 」,要求醫療護理機構及保險商在一般醫療及精神和行為健康開支上,3年增加30%,並鼓勵更良好的協調護理。

            麻州政府照醫療護理機構及保險商的去年開銷估計,在3年增加30%的一般醫療及精神和行為健康開支,需資約14億元。

在麻州一般醫療及精神健康加起來在醫療護理費用中僅佔15%。醫院服務及處方藥在醫療護理開銷中佔得比率最大。

            查理貝克指出,新冠病毒大流行彰顯了一般醫療,以及精神健康醫療的重要。新法案有3大重點,包括把一般醫療和行為健康放在優先位置,管理增加家庭開銷的因素,以及改善獲得高品質醫療護理途徑。

             在新冠病毒大流行期間,因為醫院關閉或恐懼感染新冠病毒等因素,許多人無法像平日那樣去看病,以至於拖到病情更嚴重,需要更多醫院級的醫療護理。許多人的精神健康,也因此瀕危,每天都有數以百計的病人卡在麻州各醫院。

             查理貝克提出的新法案,並不會指示醫療系統或保險商在一般醫療及精神健康方面,如何增加支出,但他們可藉由增加給醫療供應商的付款比率,延長門診時間,或增加遠距醫療服務等來符合這些要求。

在協助家庭管理醫療費用開銷上,查理貝克的法案要求醫療服務供應商及保險商必須設立默認支付申報率,以有效地免於因為某些未預見的網絡外醫療服務費用帳單,和病人起爭議;藉用於高成本支付者和供應商的類似措施,追究高成本藥品製造商的責任,對藥價過度上漲的製藥商處以罰款,成立新的藥店福利經理監管機構。實施小組費率審查改革,以合併市場顧問委員會報告的建議來推廣採用及獲取高品質,低費用的醫療計畫。

            2020年這受新冠病毒大流行影響的年份中,麻州醫療護理開支和之前一年相比,下降了2.4%,總額約626億元。但是當更多人們開始上醫院時,醫療開銷估計會再度攀升。

            為針對醫療護理的不平等,查理貝克所提法案還包括撥款給為麻州政府照顧貧窮及低收入居民所設「麻州健康 (MassHealth)」計畫提供一般醫療及精神健康服務的供應商。

            在解決藥品費用問題上,查理貝克希望加強監管那些成本增長比麻州基礎標準,目前為3.1%,更快速的製藥公司,並對藥價上漲過度的公司處以罰款。

            在改善人們取得高品質,有協調的醫療護理上,查理貝克的新法案還包括把牌照,執業範圍標準等要求現代化,讓合格醫師更快速取得多州執業執照,指示醫療資訊分心中心(CHIA)研究麻州醫療護理人力相關議題,掃除採納遠距醫療的障礙,促使醫療護理數據的標準,資訊的交換更為現代化。

            法案還包括更多條款,監管為保險公司協商藥價的藥店福利經理,新建稱為牙齒治療師的新牙齒醫療供應商,還要求緊急醫療中心接受「麻州健康」病人。

            查理貝克提出的這新法案和他在2019年末提出,但在麻州議會未通過的法案很相似。


Baker-Polito Administration Files Health Care Legislation Aimed at Expanding Access to Care

 

BOSTON — The Baker-Polito Administration today filed comprehensive health care legislation to strengthen the Commonwealth’s health care system by increasing access to care and controlling costs for Massachusetts families. The bill would increase investments in behavioral health and primary care through a new spending target for health care providers and payers. It would also control health care costs for residents and families by addressing systemic factors that drive increased spending. The legislation also takes several steps to improve access to high-quality care.

 

An Act Investing in the Future of Our Health” includes several components initially filed by the Administration in 2019 and incorporates lessons learned from the COVID-19 pandemic. Governor Charlie Baker announced the filing of the bill today at a visit to Codman Square Health Center alongside officials from Codman and Boston Medical Center. The Administration’s visit to Codman highlighted the legislation’s focus on increasing access to behavioral health services, especially given the impacts of the pandemic.

 

“Over the past two years, the Commonwealth’s health care workers stepped up to the plate and demonstrated the strengths of our health care system. But the pandemic also shed light on structural, underlying challenges, many of which we proposed addressing with our 2019 legislation,” said Governor Charlie Baker. “The bill we are filing today would increase access to behavioral care and other services that keep people healthier in the long-term by increasing investment in these areas. It would also control the factors that increase costs for residents and families, and improve access to high-quality, coordinated care. We know our partners in the Legislature agree on the need to address these challenges and look forward to working with them to enact these meaningful reforms.”

 

“We are pleased to file this bill which would make comprehensive changes that improve access to care and control costs for residents and small businesses,” said Lieutenant Governor Karyn Polito. “Our legislation would provide our small business owners with more affordable coverage options for their employees. It will ensure that high-value, affordable plans are easily accessible to small employers and their employees as well as for individuals and families.”

 

“The delay in preventative and behavioral health services resulting from the COVID-19 pandemic, coupled with the significant workforce challenges within our healthcare systems, require deliberate action to meet the needs of our residents,” said Health and Human Services Secretary Marylou Sudders. “For far too long, primary and behavioral health care have not been at the forefront of our health care system. This legislation is patient-focused, with proposed policies that prioritize the physical and mental health care of all of our residents for years to come.”

 

The bill includes reforms across three major areas: 

 

  • Prioritizing Primary Care and Behavioral Health 
  • Managing Factors that Increase Costs for Families
  • Improving Access to High-Quality Care

 

Prioritizing Investments in Primary Care and Behavioral Health 

This legislation increases investment in primary care and behavioral health care through setting a statewide target to address historic underinvestment in these services, particularly for individuals who have been historically underserved.  The proposal sets a system-wide primary care and behavioral health spending target, requiring health care providers and payers to increase expenditures on primary care and behavioral health by 30% over 3 years, with the initial performance period ending in calendar year 2024. This will result in a substantial rebalancing of funds equal to a system-wide investment of approximately $1.4 billion into primary care and behavioral health, and improve front door access to services.

 

  • Calendar year 2019 serves as the baseline year that calendar year 2024 spending will be measured against.
  • Providers and payers must achieve the target while remaining under the health care cost growth benchmark.
  • Recognizing systems have varying baselines and tools to achieve the target, the legislation does not prescribe how payers and providers achieve the target. Payers and providers can achieve the target through strategies such as increased rates to primary care (PC) and behavioral health (BH) providers, expanding PC/BH networks, increasing access to PC/BH through extended hours and additional telehealth services.

 

In addition to increasing behavioral health and primary care investments, this legislation reinforces behavioral health coverage parity requirements, supports workforce development and sustainability, and promotes timely access to emergency behavioral health care.

 

The legislation builds on recent investments in community health centers and establishes a Primary Care and Behavioral Health Equity Trust Fund to provide enhanced funding to primary care and behavioral health providers serving Medicaid members. Approximately 20% of the funds will be earmarked for grants to high public-payer providers in target equity communities. This fund will help increase access to these critical services and level the inequities in our health care system.

 

Managing Factors that Increase Costs for Families

The legislation addresses health care costs through a multi-faceted approach that targets systemic cost drivers and increases affordability for individuals and small businesses.

 

  • Surprise billing protections for certain Out of Network (OON) services: This bill establishes a default payment rate of reimbursement that carriers must pay to out-of-network providers for unforeseen OON services, effectively removing the patient from the payment dispute.  
  • Increased accountability for drug manufacturers: To address year-over-year increases in pharmacy cost and spending growth, this proposal will: 1) hold high-cost drug manufacturers accountable through similar measures used for high-cost payers and providers; 2) impose penalties on excessive drug price increases; and 3) establish new oversight authority for pharmacy benefit managers (PBMs).
  • Merged Market Reforms: To ensure individuals and small business owners have access to more affordable insurance coverage options, this legislation implements small group rate review reforms, as well as recommendations from the Merged Market Advisory Council Report to promote adoption and access to high-value, lower-cost health plans.

 

Improved Access to High-Quality, Coordinated Care

This legislation modernizes licensure and scope of practice standards and promotes access to high-quality, coordinated care.

 

  • Scope of Practice and licensure standards: Improvements to scope of practice standards and other licensure requirements will strengthen the health care workforce and expand capacity through measures that allow providers to practice at the top of their license and remove barriers to licensure.
  • Multistate licensure compact: This legislation authorizes Massachusetts entry into the Interstate Medical Licensure Compact (ICLM). The ICLM is an agreement among participating U.S. states to work together to significantly streamline the licensing process for physicians who want to practice in multiple states. It offers a voluntary, expedited pathway to licensure for physicians who qualify.
  • Health Care workforce: This bill directs the Center for Health Information Analysis (CHIA) to study the health care workforce in the Commonwealth, including how it is changing over time, the supply of and demand for workers, demographic characteristics of the workforce including race, ethnicity, language, and age, geographic variations, job satisfaction, retention, and turnover, and other issues affecting the Commonwealth’s healthcare workforce.
  • Urgent Care: This legislation defines “urgent care services” and requires entities providing urgent care services to be licensed as a clinic and accept MassHealth members.
  • Telehealth: To reduce barriers and advance adoption of telehealth, this bill provides increased flexibility for providers delivering telehealth services.  Specifically, this legislation clarifies BORIM policy authorizing providers to render telehealth services without limitation to location or setting, so long as the provider is compliant with federal and state licensing requirements of the state in which the patient is physically located.
  • Modernizing data standards and health information exchange: Proposals within this legislation will improve the ability for providers and the health care delivery system more broadly to exchange necessary information to improve patient access and care coordination. 

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