Amendment #1338 to H5500

MassHealth Sustainability and Reform Commission

Representatives Jones of North Reading, Ferguson of Holden, Frost of Auburn, Muradian of Grafton, Vieira of Falmouth and Smola of Warren move to amend the bill by adding the following section:-

SECTION XX. There shall be a MassHealth Sustainability and Reform Commission, which shall evaluate cost drivers and potential reforms to maintain comprehensive coverage for residents, while containing program costs and ensuring the long-term fiscal sustainability of the program.

The commission shall study and report on:

(i) the number of program enrollees and enrollment trends across eligibility categories;

(ii) the types and volume of services provided under the program;

(iii) total expenditures, including payments to managed care organizations, providers, and contractors;

(iv) federal reimbursement rates, waiver funding, and state revenue sources used to finance the program;

(v) recent spending growth across fiscal years, the program’s share of the state budget, and projected future expenditures if current growth trends continue;

(vi) eligibility standards, enrollment pathways, and renewal processes;

(vii) administrative costs and program structure compared to other states;

(viii) eligibility verification procedures, including income verification, residency verification, asset verification where applicable, and redetermination processes; and

(ix) the incidence of fraud within the program, including an analysis of fiscal impacts and recommendations to strengthen program integrity and oversight.

The commission shall develop recommendations to reform program eligibility standards, improve administrative efficiency, strengthen eligibility verification and program integrity processes, and identify strategies to control MassHealth spending growth while maintaining coverage for vulnerable populations. The commission shall propose legislative or regulatory changes necessary to implement its recommendations.

The commission shall consist of designees selected by: the secretary of health and human services; the Medicaid director; the secretary of administration and finance; the executive director of the health policy commission; the Massachusetts Health & Hospital Association; the Massachusetts Association of Health Plans; the Massachusetts Provider Association; Health Care For All; Associated Industries of Massachusetts; the speaker of the house of representatives; the house minority leader; the senate president; and the senate minority leader.