The Health Policy Commission met on Tuesday, March 12. The Commission began diving into the substance, approving regulations and guidance documents on several fronts.
Meeting materials available here (pdf), and our complete report is after the break.
The meeting started with a report from the chairs of the four HPC committees. First David Cutler gave an update on the Cost Trends and Market Performance Committee. The committee has been working on interim guidance on the issue of notice of material change (which is discussed in greater detail later). Nikhil Sahni gave an update of the Annual Cost Trends Report on total health expenditures (see meeting materials slides 3-5 for details)
Next Marylou Sudders gave an update on the activities of the Quality Improvement and Patient Protection Committee. The committee held a special listening session on Feb. 22 in Worcester to discuss and solicit comments on the provision of Chapter 224 related to mandatory overtime for hospital nurses. Section 103 of the law prohibits a hospital from requiring a nurse to work mandatory overtime except in the case of an emergency situation. HPC is charged with developing guidelines and procedures to determine what constitutes an emergency situation for the purposes of allowing mandatory overtime. More than 100 people attended the hearing.
She also briefly mentioned the transfer of Office of Patient Protection (OPP) to the HPC, to be discussed in greater detail later. Jenifer Bosco, currently an attorney at Health Law Advocates, will be the new Director of OPP. At the next committee meeting they will be discussing mental health parity and the integration of physical and behavioral health. The committee will be looking at how to define a behavioral health medical home and the definition of integration, with help from Commissioner of DMH.
Carole Trust gave an update on the Care Delivery and Payment System Reform Committee. While the most important responsibilities of the committee are to define PCMHs and ACOs, they have been focusing on the most immediate task, the development of the registered provider organization rules. In conjunction with DOI, they will be holding three listening sessions on the registration of provider organizations and the certification of risk-bearing provider organizations at the DOI (Room 1-E) on Friday, March 15 at 9am, Monday, March 25 at 1pm and Monday, April 1 at 1pm.
Paul Hattis gave an update on the Community Health Care Investment and Consumer Involvement Committee, which met twice in February. The committee held a hearing on the one-time assessment regulation in late February. Three individuals testified and others submitted written comments (see below for the vote on final regulation).
The report regarding flexible spending accounts, health reimbursement arrangements, health savings accounts and similar tax-favored health plans is in progress and will be released by the April deadline.
Next on the agenda was the adoption of Regulation 958 CMR 2.00 (Relative to the One Time Assessment). David Seltz went over the one-time assessment distribution and emphasized that the assessment cannot be passed on to consumers in the form of higher premiums or rates. Counsel Lois Johnson walked through key components of the regulation. The Medicaid managed care organizations (MMCOs) submitted comments objecting to their inclusion in the definition of surcharge payers. HPC staff agreed that there are sound policy reasons to exclude the MMCOs and therefore they recommend approval of the regulation with one amendment to exclude the MMCOs from the definition of surcharge payors. The exclusion does not apply to commercial insurers. They are not taking up the issue of waivers/mitigation applications today but once they receive applications they will review them individually and make a recommendation. In response to question about Children’s Hospital, Johnson explained that they are waiting for clarification from the legislature, but they are legally required to respond to an application when they receive it. The regulation as amended was unanimously approved.
The next agenda item was the adoption of Emergency Regulations 958 CMR 3.00, 4.00, relative to the Office of Patient Protection (OPP). Johnson explained that the two proposed emergency regulations are identical to the existing DPH regulations. The transfer of the OPP to the HPC will be effective as of April 20. She provided background on the OPP and the purpose of the two regs (see materials). The goal is to have continuity in regulatory scheme and no disruption of consumer access/health plan interaction. The HPC will hold a hearing within 90 days of the effective date, but they don’t anticipate substantive changes. Everett asked why Chapter 224 moved OPP to HPC. Seltz replied that while DPH did outstanding job, they faced limited financial resources. He sees the transfer as an opportunity to reinvigorate the OPP and expand the office to new roles such as extending the external review process with regards to medical necessity determinations made by ACOs, so that consumers have access to similar appeals processes as ACOs begin to function more like health plans. He looks forward to working with Jenifer Bosco in this process. He also sees the OPP as a feedback loop to inform the Commission when consumers face barriers. Both regulations passed with unanimous approval.
Next Nikhil Sahni gave an update on the report on Consumer-Driven Health Plans pursuant to Sec. 263 of Ch. 224. He went over the current status of the report (see materials slide 11). Altman emphasized interim nature of the report, and acknowledging that the issue has political implications. Cutler also acknowledged the controversial nature of the topic and suggested that limited and tiered network plans be part of the discussion as well.
The next item was the Interim Guidance Relative to Notice of Material Change. David Seltz and Lois Johnson reviewed the purpose and content of the interim guidance (see materials slides p. 12-15). The guidance is narrower in scope than an emergency or full regulation. Seltz understands the interest in expanding the definition beyond the statute and expects and welcomes full debate in the development of the full regulation. Veronica Turner and Marylou Sudders advocated that closures should be part of the definition of material change. Altman was in agreement but concerned about delays in implementing the guidance. Seltz mentioned that parallel structures at DPH are in place for the closure of services. Seltz said that the Commission is trying to strike a balance, and assured the board that the guidance is only interim and does not bind the Commission as regulations are developed. The Guidance passed unanimously.
Seltz ended with an Executive Director’s report. He reported that they are in the process of developing a 2013 strategic operating plan and calendar 2013 implementation timeline (see slides 17-19). Both plan and timeline will be final for next HPC meeting on April 24, and both will be posted on HPC website to hold HPC accountable to its goals. He also announced that the HPC Advisory Council has been selected (slide 20), which will hold its first meeting on March 26 at 9 am at the UMass Boston Campus Center. On staffing, he said that Coleen Elstermeyer, Chief of Staff and External Affairs, and Kim Haberlin, Communications have joined the Commission, and they will be hiring four additional staff in the next few weeks, who will be introduced at the next meeting.