Consolidated Amendment #F to H.3400

Consolidated Amendment "F" to H3400

Public Health

Fiscal Note: $7,327,000

Amendment 936 has been re-categorized from Mental Health, and Disabilities

Amendment 363 has been re-categorized from Labor and Economic Development

Amendment 693 has been re-categorized as Legislation, Non-Budget

Amendments from Public Health: 6, 17, 25, 31, 37, 47, 49, 52, 69, 75, 81, 115, 121, 125, 140, 144, 147, 175, 252, 257, 274, 291, 297, 300, 303, 320, 336, 344, 363, 379, 389, 400, 414, 437, 443, 444, 449, 454, 474, 488, 504, 521, 524, 541, 558, 623, 643, 649, 651, 657, 658, 660, 679, 680, 686, 708, 716, 726, 734, 756, 757, 770, 773, 779, 782, 789, 790, 791, 797, 802, 812, 821, 823, 827, 839, 842, 846, 862, 912, 936, 956, 963, 967, 982, 990, 1002, 1013, 1016, 1027, 1046, 1048, 1056, 1057, 1066, 1074, 1076, 1095

Mr. Dempsey of Haverhill and others move to amend H.3400 in section 2, in item 1599-1450, by inserting after the words “social work” the following words:- , early intervention providers,;

And further amend said section 2, in item 4510-0110, by inserting after the words “254c(f)(1)” the following:- ; provided further, that not less than $100,000 shall be expended for the operation and implementation of the South Boston Community Health Center and its Youth Ambassador Program and South Boston Leadership Initiative; and provided further, that not less than $50,000 shall be expended for the Mattapan Integrative Care Partnership Pilot program among the Mattapan Community Health Center, Mattahunt Community Center, Mattahunt Elementary School, and the Wheelock College Social Work Department for a behavioral health practice at the Mattapan Community Health Center and support a full time licensed social worker to bring mental health care to the community’s youth and to improve the coordination of care;

And further amend said item by striking out the figure “$1,045,993” and inserting in place thereof the following figure:- $1,195,993;

And further amend said section 2, by inserting after item 4510-0110 the following item:-

4510-0112 For the department of public health to conduct a postpartum depression pilot program at community health centers in Holyoke, Jamaica Plain, Lynn and Worcester………..$200,000;

And further amend said section 2, in item 4510-0790, by striking out the figure “$731,959” and inserting in place thereof the following figure:- $831,959

And further amend said section 2, in item 4510-0810, by striking out the figure “$3,857,869” and inserting in place thereof the following figure:- $4,357,869

And further amend section 2, in item 4512-0103, by inserting after the words “HIV/AIDS and associated conditions;” the following words:- provided further, that not less than $120,000 shall be expended to conduct a hepatitis C pilot program at the North Shore Health Project;

And further amend said item by striking out the figure “$31,923,620” and inserting in place thereof the following figure:- $32,193,620;

And further amend section 2, by striking out item 4512-0200 and inserting in place thereof the following item:-

4512-0200 For the bureau of substance abuse services, including a program to reimburse driver alcohol education programs for services provided for court adjudicated indigent clients; provided, that programs in substantial regulatory and contractual compliance shall receive the same percentage level of funding in fiscal year 2016 as received in fiscal year 2015; provided, that not less than $250,000 shall be expended for a pilot program for young adults aged 17 to 25 to address substance abuse issues for this age group; provided further, that not less than the amount appropriated in item 4512-0200 of section 2 of chapter 165 of the acts of 2014 shall be expended for the Gavin Foundation; provided further, that not less than $100,000 shall be expended for a statewide program to improve the care and training for newborns with neonatal abstinence syndrome at hospital-based facilities that care for mothers and newborns, including the ten level III neonatal intensive care units in the commonwealth; provided further, that the program shall encourage collaboration between medical providers, community organizations and public health agencies to educate and increase the standardization of practices while developing a robust statewide database to allow for measured improvements in care and outcomes for newborns with neonatal abstinence syndrome, including reductions in length of stay and pharmacologic treatment; provided further, that not less than $100,000 shall be expended to the Berkshire County Youth Development Project for youth intervention services; provided further, that not less than $25,000 shall be expended for the Merrimack Valley Prevention and Substance Abuse Project toward resources and community outreach; provided further, that not less than $75,000 shall be expended for development and administration of a program to prevent and treat addiction to opioid and related substances and that the program shall be administered by a community health center agency that has a 24/7 emergency department licensed as a satellite emergency facility under 105 CMR 130; provided further, that not less than $50,000 shall be expended for the purpose of hiring a substance abuse coalition coordinator in the town of Stoneham; provided further, that not less than $100,000 shall be expended for the New Beginnings program that targets youth at risk and in recovery in collaboration with school districts; provided further, that not less than $100,000 shall be expended for Project RIGHT’s substance abuse and trauma prevention initiative in the Grove Hall area of Boston; provided further, that not less than $150,000 shall be expended for Self-Esteem Boston’s direct services programs for women in the Boston region and provider training programs; provided further, that not less than $300,000 shall be expended for integrated treatment and stabilization services for individuals and families with co-occurring substance abuse and mental health disorders; provided further, that not less than $150,000 shall be expended for the operation of the Behavioral Health and Outpatient Substance Abuse Services to provide counseling and treatment for individuals suffering from behavioral health challenges or substance abuse at the Dimock Community Center; provided further, that not less than $500,000 shall be expended for a voluntary training and accreditation program for owners and operators of alcohol and drug free housing pursuant to section 18A of chapter 17 of the General Laws; provided further, that no less than $2,500,000 shall be expended for the extended release naltrexone pilot program described in section 70 of this act; provided further, that no less than $250,000 shall be expended for a public awareness campaign relative to Narcan and section 34A of chapter 94C of the General Laws; provided further, that funds shall be expended on increasing the number of licensed residential recovery beds by 75; provided further, that no less than $1,500,000 shall be expended to expand and support municipalities utilizing grant funds from the Massachusetts Opioid Abuse Prevention Collaborative (MOAPC) grant program; provided further, that in order to support and strengthen public access to substance abuse services in the commonwealth, funds shall be expended to maintain programming, including but not limited to, the following: (a) central intake capacity, as defined in section 18 of said chapter 17; (b) the number and type of facilities that provide treatment; (c) detoxification and clinical stabilization service beds in the public system and (d) the placement of addiction specialists in selected courts, which shall include, but not be limited to, Brockton, Quincy and Plymouth district courts……………………….….$98,475,501;

And further amend said section 2, by striking out item 4512-0500 and inserting in place thereof the following item:-

4512-0500 For dental health services; provided, that not less than the amount appropriated in item 4512-0500 of section 2 of chapter 165 of the acts of 2014 shall be expended for the Forsyth Institute Health’s Center for Children’s Oral Health to expand its ForsythKids programming focused on children or adolescents and to explore the emerging association between oral health status and academic performance; provided further, that not less than $1,495,525 shall be expended for the commonwealth’s comprehensive dental program for adults with developmental disabilities; and provided further, that not less than $100,000 shall be expended for the promotion of services to all dental providers in the commonwealth and to increase after-hour, weekend, and holiday coverage with on-call response and if necessary actual clinical evaluation……………………………………………………………………….……$2,036,188;

And further amend said section 2, in item 4513-1020, by striking out the figure “$26,600,167” and inserting in place thereof the following figure:- $27,600,167;

And further amend said section 2, in item 4513-1026, by inserting after the words “elder affairs;” the following:- provided further, that not less than $100,000 shall be expended for suicide data collection in accordance with section 13 of chapter 284 of the acts of 2014; provided further, that not less than $250,000 shall be expended for the Good Samaritans;

And further amend said item by striking out the figure “$4,000,000” and inserting in place thereof the following figure:- $4,350,000;

And further amend said section 2, in item 4513-1098, by inserting after the words “impacted by violence” the following:- ; and provided further, that not less than $50,000 shall be expended for Women Survivors of Homicide Movement of Roslindale;

And further amend said item, by striking out the figure “$150,000” and inserting in place thereof the following figure:- $200,000

And further amend said section 2, by striking out item 4513-1111 and inserting in place thereof the following item:-

4513-1111 For the promotion of health and disease prevention including, but not limited to, the following programs: breast cancer prevention; diabetes screening and outreach; ovarian cancer screening; a statewide STOP stroke program and ongoing stroke prevention and education; hepatitis C prevention and management; multiple sclerosis screening, information, education and treatment programs and the Multiple Sclerosis Home Living Independently Navigating Key Services program administered by the Greater New England Chapter of the National Multiple Sclerosis Society; colorectal cancer prevention; prostate cancer screening, education and treatment with a particular focus on African American males; osteoporosis education; and maintenance of the statewide lupus database; provided, that funds may be expended for the operation of the Betsy Lehman Center for patient safety; provided further, that not less than $50,000 shall be expended for education and support of patients diagnosed with PKU or related disorders and their families through a grant to the New England Connection for PKU and Allied Disorders, Inc.; provided further, that not less than $35,000 shall be expended for the New North Citizens’ Council, Inc.; and provided further, that not less than $50,000 shall be expended for the Haitian American Public Health Initiative to provide vital healthcare and education services to families and children in the Haitian community in the city of Boston and town of Milton……..$3,267,464;

And further amend said section 2, in item 4513-1130, by inserting after the words “hotline;” the following:- provided further, that not less than $75,000 shall be expended for the Katie Brown Educational Program for a pilot instructional initiative, the Train the Trainer program, to train educators and increase the number of Southeastern Massachusetts students who acquire invaluable knowledge about the prevention of relationship violence;

And further amend said item by striking out the figure “$5,860,068” and inserting in place thereof the following figure:- $6,482,068;

And further amend said section 2, by inserting after item 4513-1130 the following item:-

4513-1131 For a competitive grant program in public schools from grades 5 through 12 that will promote healthy relationships and address teen dating violence; provided, that the department of elementary and secondary education shall develop a 3 year grant program for 10 schools on anti-teen dating violence programming for implementation for the school year beginning in 2016; provided further, that the grant program shall be for schools in which the majority of students are eligible for free or reduced lunch; and provided further, that at least 1 grantee shall be a school located in a municipality with a population of 25,000 or less………………………….$150,000

And further amend said section 2, in item 4590-0250, by inserting after the words “ school-based health center programs;” the following:- provided further, that not less than $50,000 shall be expended for the Massachusetts Model of Community Coalitions;

And further amend said item by striking out the figure “$12,257,055” and inserting in place thereof the following figure:- $12,307,055;

And further amend said section 2, in item 4590-0915, by inserting after the words “section 2B;” the following:- provided further, that Tewksbury State Hospital shall maintain the same number of beds in fiscal year 2016 as was maintained in fiscal year 2015; provided further, that not less than $100,000 shall be expended for the Massachusetts Hospital School Summer Program; provided further, that the Massachusetts Hospital School shall maintain not less than 120 beds for clients in its inpatient setting to the extent feasible within the appropriation;

And further amend said item by striking out the figure “$158,036,217” and inserting in place thereof the following figure:- $158,136,217;

And further amend said section 2, in item 4590-0925, by inserting after the words “shall grant” the following:- not less than eighty-five percent of the;

And further amend said item by inserting after the words “other state-funded” the following:- non-profit;

And further amend said section 2, in item 4590-1507, by inserting after the words “those organizations” the following:- ; provided further, that not less than $50,000 shall be expended for the Center for Teen Empowerment, Inc.; provided further, that not less than $900,000 shall be expended for the Alliance of Massachusetts YMCAs, which shall be distributed between the recipient’s member organizations; provided further, that not less than $1,000,000 shall be expended for the Massachusetts Alliance of Boys and Girls Clubs, which shall be distributed equally between said recipient’s member organizations; and provided further, that not less than $50,000 shall be expended for programs and services at the Milford Youth Center;

And further amend said item by striking out the figure “$1,800,000” and inserting in place thereof the following figure:- $3,800,000;

And further amend the bill by striking section out section 35;

And further amend the bill by inserting after section 38 the following sections:-

SECTION 38A: The General Laws are hereby amended by inserting after chapter 111N the following chapter:

Chapter 111O. Mobile Integrated Health Care.

Section 1. As used in this chapter, the following words shall have the following meanings, unless the context or subject matter clearly requires otherwise:-

“Advisory council”, the group of advisors established pursuant to section 3.

“Commissioner”, the commissioner of public health.

“Department”, the department of public health.

“Community paramedic provider”, a person who (1) is certified as a paramedic in accordance with the provisions of chapter 111C and department regulations; and (2) has successfully completed an education program for mobile integrated health care, in accordance with department regulations.

“Health care facility”, a licensed institution providing health care services or a health care setting, including, but not limited to, hospitals, and other inpatient centers, ambulatory surgical or treatment centers, behavioral health centers, skilled nursing centers, residential treatment centers, diagnostic, laboratory and imaging centers, and rehabilitation and other therapeutic health centers.

“Health care entity”, a provider or provider organization, including, but not limited to, ambulance services licensed under chapter 111C, visiting nurse associations, accountable care organizations, and home health agencies.

“Health care provider”, a provider of medical, behavioral or health services or any other person or organization that furnishes bills or is paid for health care services delivery in the normal course of business.

“Mobile integrated health care” or “MIH”, a health care program that utilizes mobile resources to deliver care and services to patients in an out-of-hospital environment in coordination with health care facilities or other health care providers. Such medical care and services include, but are not limited to, community paramedic provider services, chronic disease management, behavioral health, preventative care, post-discharge follow-up visits, or transport or referral to facilities other than hospital emergency departments.

“Medical control”, the clinical oversight provided by a qualified physician or existing primary care provider to all components of the MIH program, including, without limitation, medical direction, training, scope of practice and authorization to practice of a community paramedic provider, continuous quality assurance and improvement, and clinical protocols established under this chapter by the department in regulation.

“Medical direction”, the authorization for treatment provided by a qualified physician or existing primary care provider in accordance with clinical protocols, established under this chapter by the department in regulation whether on-line, through direct communication or telecommunication, or off-line through standing orders.

“Patient”, an individual identified by a healthcare facility, entity or provider as requiring MIH services in accordance with department regulations.

“Person”, an individual, an entity or an agency or political subdivision of the commonwealth.

“Physician”, a medical or osteopathic doctor licensed to practice medicine in the commonwealth.

“Scope of practice”, the clinical skills or functions (1) as defined by the Statewide Treatment Protocols governing the delivery of emergency medical services under chapter 111C; (2) clinical protocols established under this chapter by the department in regulation; and (3) any other requirements established by department regulations.

Section 2. Subject to appropriation, the department shall establish a program of mobile integrated health care within its bureau of health care safety and quality. With respect to the program, the department shall have the following powers and duties:

(a) to plan, guide, assist, coordinate and regulate the development of a unified MIH program;

(b) to establish minimum standards and criteria for all elements of the program, taking into consideration relevant standards and criteria developed or adopted by nationally recognized agencies or organizations, and the recommendations of interested stakeholders, including, without limitation, the statewide mobile integrated health advisory council, established in section 3;

(c) to develop and implement a state mobile integrated health care plan, in consultation with the advisory board, which shall be updated at least once every three years and which shall address the distribution of all elements of mobile integrated health care in the state, so that quality services shall be reasonably available to all residents of the commonwealth at the lowest aggregate reasonable cost;

(d) to ensure that health care providers operating MIH programs collect and maintain data, including statistics on mortality and morbidity of consumers of mobile integrated health services, including but not limited to, information needed to review access, availability, quality, cost and third party reimbursement for such services, and coordinate and perform such data collection in conjunction with other data collection activities;

(e) to establish minimum criteria for MIH to be followed by health care facilities, health care entities and health care providers, to ensure that MIH programs meet the following criteria:

(1) provide pre-hospital and post-hospital services as a coordinated continuum of care that fully supports the patient’s medical needs in the community;

(2) address gaps in service delivery and prevent unnecessary hospitalizations, or other harmful and wasteful resource delivery;

(3) focus on partnerships, through contracts or otherwise, between health care providers and health care entities that promote coordination and utilization of existing personnel and resources without duplication of services;

(4) adhere to clinical standards and protocols, established under this chapter by the department in regulation, with the guidance of the advisory council, to ensure that MIH community paramedic providers or other providers employed by a health care entity provide health care services or treatment within their scope of practice;

(5) dispatch only those community paramedic providers or other providers employed by a health care entity who have received appropriate training and demonstrate competency in the MIH clinical protocols;

(6) meet appropriate standards related to capacity, location, personnel and equipment;

(7) ensure that every MIH program shall have access to qualified medical control and medical direction;

(8) provide a secure and effective medical communication subsystem linkage for on-line medical direction;

(9) ensure activation of the 911 system in the event that a patient of an MIH program experiences a medical emergency, as determined through medical direction, in the course of an MIH visit provided such activation is in the best interest of patient safety; and

(10) ensure compliance with all state and federal privacy requirements with regard to patient medical records and other individually identified patient health information.

(f) to issue rules, regulations, guidelines and orders, and delegate authority to its divisions, employees and agents, and to the advisory board, as may be necessary or appropriate to carry out the provisions of this chapter, provided that such regulations shall take into account how MIH programs effect EMS first response services, and provided further that the department shall examine how 911 triage trees may be incorporated into MIH; and

(g) to take any other action consistent with its role as state lead agency for mobile integrated health services.

Section 3. (a) There shall be established a mobile integrated health advisory board, which shall assist and support the department in carrying out the provisions of this chapter and in developing and implementing the state mobile integrated health plan, by planning, guiding and coordinating the components of mobile integrated health services.

(b) The advisory council shall consist of the director of the bureau of health care safety and quality, or a designee, who shall serve as a non-voting chair, and 17 members who shall be appointed by the commissioner and who shall reflect a broad distribution of diverse perspectives on mobile integrated health care, including appointees or their designees from the following groups: the division of medical assistance, Massachusetts Hospital Association; Massachusetts Council of Community Hospitals; a for-profit hospital system that is not a member of another hospital advocacy group; Massachusetts Senior Care Association; Massachusetts Medical Society; Massachusetts Chapter of the American College of Emergency Physicians; Massachusetts Nurses Association; Home Care Alliance of Massachusetts; Professional Fire Fighters of Massachusetts; Fire Chiefs Association of Massachusetts; International Association of EMTs and Paramedics; Massachusetts Ambulance Association; Hospice and Palliative Care Association of Massachusetts; 2 members representing private payors; and the Massachusetts Association of Hospital-Based Paramedic Services.

SECTION 38B. Clause (3) of section 19 of Chapter 111C, as appearing in the 2012 Official Edition, is hereby amended by striking the words “approved under this chapter;” and inserting in place thereof the following words:-- approved under this chapter or chapter 111O

And moves to further amend the bill by inserting after section 73 the following sections:-

SECTION 73A: Notwithstanding any general or special law to the contrary, the department of public health shall study the feasibility of establishing a system for the bulk purchasing and distribution of naloxone to all cities and towns in the Commonwealth. The department shall file a report with the clerks of the senate and house of representatives and the senate and house committees on ways and means on or before Jan 1, 2016. The report shall include, but not be limited to: (i) the process or processes by which the state could make bulk purchases of naloxone with a significant public health benefit, (ii) the process or processes by which other governmental or nongovernmental entities might participate in a collaborative approach to bulk purchasing of naloxone, (iii) whether, and by what process or processes, other states engage in bulk purchasing of naloxone; (iv) the process or processes by which the state could efficiently and economically distribute said bulk purchases; (v) the sources of funding available to implement said bulk purchases; (vi) the effect of anticipated cost savings or losses bulk purchasing of naloxone would have on the state; and (vii) recommendations for how a bulk purchasing model could effectively be utilized by the commonwealth to reduce costs for the state, other governmental or nongovernmental entities, and consumers.

SECTION 73B: Notwithstanding any special or general law to the contrary, the department of public health shall implement a two-year institutional pharmacy discharge medication pilot program for the purposes of ensuring patient medication adherence; provided that the department shall define institutional pharmacies as retail pharmacies for the purposes of implementing the program. Such a program shall: (1) allow institutional pharmacies to be treated like retail pharmacies for the purposes of providing medication to a patient at the time of discharge; and (2) allow hospitals licensed pursuant to section 51 of Chapter 111 of the General Laws and hospital pharmacists that hold a current license to practice pharmacy in the commonwealth to provide a 14-day supply of medication to a patient at the time of discharge and to perform medication review, reconciliation and counseling. Within 90 days of the conclusion of the pilot program, the commission shall file a report with the clerks of the senate and house of representatives and the senate and house committees on ways and means. Said report shall include information relative to whether the pilot program improved medication adherence and outline any regulatory barriers that prohibit such a program from expanding.

SECTION 73C: Section 40 of chapter 258 of the Acts of 2014 is hereby amended by adding at the end thereof the following words:- ;provided, that until said first draft is published, any drug product approved by the federal food and drug administration for abuse-deterrent labeling shall be deemed an interchangeable abuse deterrent drug product for the purposes of this act.