Amendment #609 to H3600

Cost Containment

Mr. Straus of Mattapoisett moves to amend the bill by adding the following sections:

"SECTION XX. Section 8 of chapter 6D of the General Laws, as appearing in the 2014 Official Edition, is hereby amended by striking subsection (d) and inserting in its place thereof the following:-

(d) The commission shall identify as witnesses for the public hearing a representative sample of providers, provider organizations, pharmaceutical organizations, payers and others, including: (i) at least 3 academic medical centers, including the 2 acute hospitals with the highest level of net patient service revenue; (ii) at least 3 disproportionate share hospitals, including the 2 hospitals whose largest per cent of gross patient service revenue is attributable to Title XVIII and XIX of the federal Social Security Act or other governmental payers; (iii) community hospitals from at least 3 separate regions of the commonwealth; (iv) freestanding ambulatory surgical centers from at least 3 separate regions of the commonwealth; (v) community health centers from at least 3 separate regions of the commonwealth; (vi) at least 3 pharmaceutical companies with at least one being representative of and doing business in specialty pharmacy and at least one being representative of and doing business in generic pharmacy; (vii) the 5 private health care payers with the highest enrollments in the commonwealth; (viii) any managed care organization that provides health benefits under Title XIX; (ix) the group insurance commission; (x) at least 3 municipalities that have adopted chapter 32B; (xi) at least 4 provider organizations, at least 2 of which shall be certified as accountable care organizations, 1 of which has been certified as a model ACO, which shall be from diverse geographic regions of the commonwealth; and (xii) any witness identified by the attorney general or the center.

SECTION XX. Said chapter 6D, as so appearing, is hereby further amended by inserting after section 10 the following section:-

Section 10A. The center shall promulgate regulations necessary to require that pharmaceutical companies report data it deems necessary to analyze annual rate of growth and whether that rate exceeds the rate of growth in projected economic growth benchmark established under section 7H1/2 of chapter 29. The center shall also collect and analyze such data as it considers necessary in order to better protect the public’s interest in monitoring pharmaceutical costs and spending. The center may specify in regulations uniform reporting standards and reporting thresholds as it determines necessary.

SECTION XX. Said chapter 6D, as so appearing, is hereby further amended by striking section 11 in its entirety and replacing it with the following section:-

Section 11. The center shall ensure the timely reporting of information required under sections 8, 9, 10 and 10A. The center shall notify payers, providers, provider organizations, and pharmaceutical companies of any applicable reporting deadlines. The center shall notify, in writing, a private health care payer, provider, provider organization or pharmaceutical company which has failed to meet a reporting deadline and that failure to respond within 2 weeks of the receipt of the notice may result in penalties. The center may assess a penalty against a private payer, provider, provider organization or pharmaceutical company that fails, without just cause, to provide the requested information within 2 weeks following receipt of the written notice required under this paragraph, of up to $1,000 per week for each week of delay after the 2 week period following the private payer's, provider's, provider organization's or pharmaceutical company’s receipt of the written notice; provided, however, that the maximum annual penalty against a private payer, provider, provider organization or pharmaceutical company under this section shall be $50,000. Amounts collected under this section shall be deposited in the Healthcare Payment Reform Fund, established under section 100 of 194 of the acts of 2011.

SECTION XX. Subsection (a) of section 1 of said chapter 6D, as so appearing, is hereby further amended by striking the first sentence and inserting in place thereof the following:-

The center shall publish an annual report based on the information submitted under sections 8, 9, 10 and 10A concerning health care provider, provider organization, pharmaceutical company and private and public health care payer costs and cost trends, section 13 of chapter 6D relative to market power reviews and section 15 relative to quality data.

SECTION XX. Subsection (a) of section 16 of chapter 12C of the General Laws, as appearing in the 2014 Official Edition, is hereby amended by striking the words “and (11) the impact of health care payment and delivery reform on the quality of care delivered in the commonwealth” and inserting in place thereof the following:-

(11) the impact of health care payment and delivery reform on the quality of care delivered in the commonwealth; and (12) the impact of pharmaceutical pricing and spending on health care costs.

SECTION XX. Notwithstanding any general or special law to the contrary, the Health Policy Commission shall annually conduct an analysis and issue a report on the impact of specialty drug costs on Massachusetts’ cost containment benchmark with said first report to be publicly issued by July 1, 2016 and annually thereafter on each July 1 and convene a discussion of this report and its implications at its annual cost containment hearings held pursuant to section 8 of chapter 6D of the general laws."

Additional co-sponsor(s) added to Amendment #609 to H3600

Cost Containment