Notwithstanding any general or special law to the contrary, the Massachusetts Health Policy Commission, shall conduct an analysis of children with medical complexity in Massachusetts. The goal of the analysis shall be to capture and represent children with medical complexity in Massachusetts, understand the health insurance coverage, access to services, medical resources utilized and current costs of serving these children.
The Executive Office of Health and Human Services, Department of Public Health and the Center for Health Information Analysis’ All Payors Claim Database shall make all necessary and relevant data available to the Health Policy commission no later than three months after the signing of this bill. The Health Policy Commission may also consult and draw from additional data sets or external consultants as necessary. The Health Policy Commission shall produce a report of its findings to the Executive Office of Health and Human Services, the Division of Insurance, the Joint Committee on Health Care Financing, the House and Senate Committees on Ways and Means and the House and Senate clerks, for public availability, no later than one year after the signing of this bill.
Such report shall include the following:
1. Population: The analysis shall include data on the population children with medical complexity under the age of twenty one in Massachusetts, including their health insurance coverage type, primary diagnosis (disaggregated by single system and multisystem presentations), including mental health diagnoses, this data to fullest extent possible should be disaggregated by geographic region, age, gender, race and/or other available clinical profile characteristics.
a. This analysis shall include children with medical complexity who are currently enrolled in the University of Massachusetts, Commonwealth Medicine Community Case Management program.
b. This analysis shall include children in the care and custody of the Massachusetts Department of Children and Families, including but not limited to those children enrolled in the Special Kids, Special Care Program and any children with medical complexity in the custody of the Massachusetts Department of Youth Services.
c. This is also to include an estimate of the number of children with medical complexity who transition from pediatric to adult care annually in the Commonwealth.
2. Medical Expenditures: The annual medical expenditures to the overall health care system in Massachusetts for children with medical complexity, disaggregated by payor type (MassHealth, including Accountable Care Organizations, the Children’s Medical Security Plan, Connector, Commercial Insurance and Group Insurance Commission). This is to be disaggregation is to include:
a. Data on overall hospital utilization, disaggregated by hospital, including utilization of emergency departments, length of stay, 30 day readmissions and overall cost for the population of children with medical complexity in Massachusetts, including out of pocket costs.
b. Durable medical equipment costs, including out of pocket costs.
c. Pharmaceuticals costs including out of pocket costs.
3. An analysis of the availability of specialty care for children with medical complexity including a comprehensive assessment on network adequacy across payor types in the Commonwealth.
4. An analysis of care models and financial arrangements used for children with medical complexity in other states.
5. To the fullest extent possible, the report shall include the social and demographic conditions of population of children with medical complexity.
6. Recommendations of ongoing data collection and reporting of measures related to this population.
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