Debate on the State Senate’s sweeping healthcare bill -- An Act Furthering Health Empowerment and Affordability by Leveraging Transformative Health Care (S.219) – begins on Wednesday, Nov. 8 and 9.
The Senate has set 5 p.m. on Monday as the deadline for amendments. Senate President Stan Rosenberg was quoted in the State House News Service as saying on Thursday, “This area is so big that there's room for a lot of other ideas and we hope others will put other ideas on the table.”
MHA has taken a fine-toothed comb through the 100-page bill and has found much to support, including steps to advance patient access to care – such as telemedicine - and a number of pieces that would enhance care coordination. But MHA has also found many items of concern.
For example the Senate bill proposes a reimbursement floor for all hospitals – which is something MHA has endorsed. The thinking is that commercial payment variation between the lowest-paid hospitals and other hospitals is tied to a historical base, and due to a lack of bargaining power, many of the lowest-paid hospitals have been unable to negotiate higher levels of payment. MHA’s Board of Trustees has publicly opined that, under appropriate Division of Insurance oversight, commercial payment rates to the lowest paid hospitals should be increased and that there should be a reasonable floor on these payments with the goal to reduce unwarranted disparity in payments.
But hand in hand with the Senate’s establishment of a payment floor is another proposal that sets a commercial hospital spending growth target that is tied to national marketbasket increases. This new hospital target is separate, distinct, and lower than the growth rate target the state sets each year under the innovative Chapter 224 reform bill. “Adding another layer of complexity by setting commercial hospital spending growth limits –in isolation from all other market participants – at a lower level than the statewide benchmark and tying the cap to the Medicare inpatient marketbasket will subject hospitals to a greater degree of downward cost pressure than the rest of the healthcare system at a time of great uncertainty about the stability of the Medicare and Medicaid programs,” MHA recently wrote to the Senate.
And if the new hospital spending growth targets are not met? The Senate bill proposes assessing fines against “the top 3 hospitals” by virtue of their size alone.
Other areas of concern cited in MHA’s comments focused on sweeping prohibitions on fees for outpatient services that reach far beyond related reductions imposed by Medicare, and a punitive approach to readmission reductions focused solely on hospitals.
MHA pledged to work with the Senate on collaboratively advancing the shared goals of enhancing access to high-quality patient care and minimizing costs.