This afternoon the Senate begins its debate on comprehensive health payment and delivery system reform. Over the weekend, we blogged on a dozen amendments supported by Health Care For All and the Campaign For Better Care. There’s lots of other interesting amendments among the 265 filed to the bill.
Here are some we picked out, roughly in order of amendment number.
- Employer Fair Share Assessment: a large number of amendments make various changes to the Employer Fair Share Assessment, the payment made by employers with 11 or more workers who do not provide fair and reasonable coverage to their employees. Among these are amendments 15 (M. Moore) and Tarr amendments 175, 176 and 185. The Fair Share system will need to be changed with the coming of ACA implementation in 2014, and the administration plans to convene a broad stakeholder process, including employers, to find a consensus on systemic updates to the statute. The Senate should allow this process to go forward, and not short circuit it by using payment reform as a vehicle for random changes.
- Count Broker Commissions as Medical Costs: Amendment 17 (M. Moore) would allow insurers to count broker commissions as part of their medical expenses, as part of the requirement that insurers spend a minimum amount of premium dollars for medical care. Broker commissions are a marketing expense, and we don’t see any reason to consider them part of medical care.
- Prevention Strategy: Amendment 52 (Chandler) would require the state to have a comprehensive strategy for promoting prevention. This would help guide coordinated efforts by state and private groups to keep the population healthy. We support this idea.
- Culturally and Linguistically Appropriate Care: The Culturally and Linguistically Appropriate Services (CLAS) standards are principles for better health care services so that everyone in the health care system receives equitable and effective treatment in a culturally and linguistically appropriate manner. We support Amendment 102 (Fargo), which would commit the Commonwealth to living up to these standards. Senator Fargo filed a whole package of amendments sponsored by the Disparities Action Network. These amendments would make sure that disparities reduction is a top goal of health reform.
- Palliative Care and End of Life Options: Senator Richard Moore filed amendment 121 directs caregivers to provide dying patients with information and counseling on palliative care and end-of-life options, including the patient’s legal rights to comprehensive pain and symptom management at the end of life. Similarly, Senator DiDomenico proposed amendment 129 to add hospice and palliative care to ACO benefits, and Senator Jehlen filed amendment 135 to add hospice benefits to two MassHealth plans. These are compassionate, appropriate reforms, that we support.
- Same Rules For Co-ops: Amendment 127 (Welch) would remove a section that gives an unfair advantage to new co-op plans. The section in the bill would fragment the individual and small group market by allowing co-op plans to offer discounts not justified by actuarial factors. The result would be higher premiums for everyone else. We support Senator Welch’s amendment.
- Report Checklist Compliance: The Senate bill includes language supported by HCFA’s Consumer Quality Council to encourage the use checklists during surgery and other procedures, which improve care, save money and reduce errors. But the bill does not let patients learn which hospitals use checklists as part of their procedures. Amendment 137 (Jehlen) would allow the public to learn about hospital compliance with the standard. We support this amendment.
- Paperwork Delays Shouldn’t Delay Enrollment: Senator Tarr’s amendment 170 provides that enrollment in Commonwealth Care not be terminated if requested documentation has been provided by the recipient and received by MassHealth. Paperwork processing delays in MassHealth enrollment centers is leading to many people losing coverage for no good reason, and we support Senator Tarr’s amendment to fix this problem. We also support his amendment 172, which directs the Division of Unemployment Assistance to provide information about termination of unemployment benefits to help Medical Security Program members switch to other health coverage programs.
- Strengthen Mental Health: Senator Keenan has a package of amendments that strengthen the integration of mental health, behavioral health and substance abuse care into our health care system. We support his amendments, including 222, 227, 228, 241, 247 and others.
There’s more we can report on, but this is a good list of key amendments that we’re watching.