SENATE DOCKET, NO. 1547        FILED ON: 2/17/2021

SENATE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 1403

The Commonwealth of Massachusetts

_________________

PRESENTED BY:

Julian Cyr

_________________

To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
Court assembled:

The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:

An Act relative to establishing and implementing a Food and Health Pilot Program.

_______________

PETITION OF:

SENATE DOCKET, NO. 1547        FILED ON: 2/17/2021

SENATE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 1403

[SIMILAR MATTER FILED IN PREVIOUS SESSION
SEE SENATE, NO. 2772 OF 2019-2020.]

The Commonwealth of Massachusetts

_______________

In the One Hundred and Ninety-Second General Court
(2021-2022)

_______________

An Act relative to establishing and implementing a Food and Health Pilot Program.

Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:
 

SECTION 1. (a) The office of Medicaid shall, within one year of the effective date of this act, establish and implement a Food and Health Pilot Program to demonstrate the impact on health outcomes and cost effectiveness of medically tailored nutrition services for MassHealth enrollees diagnosed with health conditions that may be improved through medically tailored nutrition services. The medically tailored nutrition services shall include:

(1) medically tailored meals tailored to an individual’s medical condition by a Registered Dietitian Nutritionist or other qualified nutrition professional as determined by the office of Medicaid. A medically tailored meal service shall consist of between 5 and 21 meals per week;  

(2) medically tailored food consisting of partially prepared or non-prepared food items, or both, selected by a Registered Dietitian Nutritionist, or other qualified nutrition professional as determined by the office of Medicaid as part of a treatment plan for an individual with a defined medical diagnosis. A medically tailored food service shall consist of partially prepared or non-prepared food items, or a combination of these, sufficient to prepare at least 14 meals per week; and 

(3) a nutritious food voucher, equivalent to at least $20 per week, for free or discounted nutrient-dense food.

(b) The director of the office of Medicaid shall establish a Food and Health Pilot Research Commission, that shall consist of experts in medically tailored nutrition services as defined in (a)(1)-(a)(3). The director shall design and implement the pilot in consultation with the commission.

(c) The commission shall consist of the director of the office of Medicaid, or their designee, who shall serve as chair; the commissioner of the department of public health, or their designee; the executive director of the health policy commission, or their designee; the secretary of elder affairs, or their designee; the commissioner of the department of agricultural resources, or their designee; 14 members appointed by the director of the office of Medicaid, 3 of whom shall be academic researchers who have previously or are currently conducting research on the impact of nutrition interventions on health outcomes or utilization, 1 of whom shall represent the Massachusetts Food is Medicine State Plan, 1 of whom shall represent an organization experienced in providing medically tailored meal services, 1 of whom shall represent an organization experienced in providing medically tailored food services, 1 of whom shall represent an organization experienced in providing nutritious food referrals, 1 of whom shall represent a state-designated Aging Service Access Point organization that coordinates a regional Elder Nutrition or Meals on Wheels Program, 1 of whom shall represent an organization experienced in providing medically-tailored nutrition services to rural areas or gateway cities, 2 of whom shall be MassHealth members who have received medically-tailored nutrition services, 2 of whom shall represent health care organizations with experience in delivering or partnering to deliver a medically-tailored nutrition intervention, and 2 of whom shall represent organizations, agencies, or health-focused coalitions that have experience or expertise in nutrition and health,  a member of the house of representatives, appointed by the speaker; and a member of the senate, appointed by the senate president.

Members of the commission shall represent diverse regions of the commonwealth and shall, to the extent possible, represent diversity in personal aspects including gender, race, and economic status.

(d) Participants of the pilot shall include individuals with one or more of the following health conditions: 

(1) congestive heart failure;

(2) type 2 diabetes;

(3) chronic obstructive pulmonary disease;

(4) renal disease;

(5) pre-diabetes; 

(6) obesity; 

(7) overweight;

(8) underweight; or

(9) hypertension.

(e) The pilot shall screen participants for food insecurity and need for medically tailored nutrition services based on illness profile. Qualifying participants shall be directed to the appropriate level of service.

(f) Qualifying participants shall receive one of the medically tailored nutrition services, as defined in (a)(1)-(a)(3) and appropriate nutrition counseling services, which may include Medical Nutrition Therapy, for the duration of at least 16 weeks.

(g) The office of Medicaid shall determine the number of eligible participants and providers in the pilot, may establish additional eligibility requirements, and may extend services to members of the participants’ households such as caregivers, spouses, or dependents.

(h) MassHealth Accountable Care Organizations may include pilot services in their flexible services protocols.

(i) At the conclusion of the pilot, the office of Medicaid shall use data on the pilot participants to evaluate the pilot’s impact as compared to a control group of similar MassHealth beneficiaries not receiving nutrition services, on factors including: 

(1) total health care costs; 

(2) emergency department utilization; 

(3) hospital admissions and readmissions; 

(4) pharmacy costs; and

(5) clinical and non-clinical outcomes selected by the director of the office of Medicaid in consultation with the commission, such as blood pressure, cholesterol, hemoglobin A1c, depression and other mental health indicators, food insecurity, nutrition status, and quality of life.

(j) Not later than 12 months after the conclusion of the pilot, the commission and the office of Medicaid shall file a report that includes an evaluation of the pilot and an assessment of how medically tailored nutrition services provided through the health care system could impact access to nutritious foods with the clerks of the house and senate, the joint committee on public health, the joint committee on health care financing, and the house and senate committees on ways and means.

(k) The office of Medicaid shall develop a methodology for reimbursing contractors, or other entities as applicable, for services or activities provided pursuant to this section based on, and not to exceed, the aggregate amount of funds allocated per year for purposes of the pilot. Up to 20 percent of the funds appropriated each year of pilot operation may be used to support its administration and evaluation.

(l) The office of Medicaid shall seek any federal approvals necessary to implement this section, including any waivers it deems necessary to obtain federal financial participation for the pilot, and shall claim federal financial participation to the full extent permitted by law. In the event federal financial participation is not available, the executive office shall implement the program, subject to appropriation.