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MONDAY REPORT

Senate Ways & Means Releases Proposed Budget

The Senate Committee on Ways & Means (SWM), chaired by Senator Michael Rodrigues (D–Westport), last Tuesday released its $49.68 billion FY2023 state spending proposal. The budget plan includes $15 million for local and regional boards of health, more than $200 million for substance use treatment, and $15 million for Department of Mental Health (DMH) initiatives aimed at alleviating psychiatric boarding in acute care hospitals. It also directs $75 million in various targeted investments to address acute nursing home workforce shortages exacerbated by the pandemic.

The SWM budget provides $108.4 million more in the MassHealth program budget compared to the House proposal, with additional funding for nursing facilities and dental coverage benefits. Of note, the legislation calls for a transfer of no more than $7.5 million from the prescription advantage program and the Health Safety Net Trust Fund to support the expanded Medicare savings programs. The House proposal authorized a transfer of no more than $17 million. The SWM budget carries similar language from the governor and House versions that transfers $40 million from the MassHealth Delivery System Reform Trust Fund to the General Fund. Spending in this MassHealth trust fund is financed by the current hospital assessment and federal revenue.

The Senate Ways and Means budget makes several investments in behavioral healthcare across the Departments of Mental Health and Public Health. In reaction to the leaked Supreme Court draft opinion on overturning Roe v. Wade, the Senate proposal establishes a new line item to support access, infrastructure, and security for reproductive health services. These initiatives are funded at $2 million.

The budget funds the operational budget of DMH at $32 million, with an additional $274.8 million for its hospital facilities and community-based mental health services, including a $5 million contract for an additional 30 DMH continuing care beds at a third-party facility that was not included in the House budget. The Senate also maintained funding of $112 million for its child and adolescent mental health services, including $3.9 million for Massachusetts Child Psychiatric Access Program (MCPAP) services. Notably, the child and adolescent services line item includes the costs of psychiatric and related services provided to children and adolescents determined to be medically ready for discharge from acute hospital units or mental health facilities and who are experiencing unnecessary delays in being discharged due to the lack of more appropriate settings.

The overall Bureau of Substance Addiction Services line item is funded at $209 million. The Senate Ways and Means proposal includes an increase to the House’s previously earmarked $3.5 million for five new recovery centers to instead include $7 million for 10 new recovery centers, to enhance geographic access to services.

In line with the House budget, the Senate also included $1 million to the Mass. Nursing and Allied Health Workforce Development Trust Fund towards supporting nursing and allied health workforce development, recruitment, retention, and training.

The SWM draft recommends a 10% increase to benefit levels in both the Transitional Aid to Families with Dependent Children (TAFDC) and Emergency Aid to the Elderly, Disabled and Children programs. It also would increase the TAFDC annual clothing allowance by $50, to $400 per child annually. The bill’s outside Section 55 amends the statutory charge of the Special Legislative Commission on Poverty established by Chapter 74 of the Acts of 2021 to require an analysis of the potential financial disincentives that occur when an individual or family receiving public assistance increases their income and becomes ineligible for assistance programs, or “the cliff effect.”

Amendments to the budget were due last Friday and debate is expected to begin on the proposal next Tuesday.

DOI Posts ACCESS Law Q & As

The state’s Division of insurance (DOI) last week posted a Frequently Asked Questions document to help explain the state’s ACCESS Law (Chapter 120 of the Acts of 2017), which requires health insurance companies to cover, without cost sharing, at least one of the federally approved contraceptive drugs, devices, and other products listed in the federal Birth Control Guide. Insurers must allow for a 12-month supply of an approved prescription contraceptive drug, must cover patient education and counseling on contraception, and must cover FDA-approved, over-the-counter emergency contraception when acquired with a prescription or pursuant to a standing order.

DOI’s FAQ page covers such issue as the limits of the prohibition against cost sharing, access to emergency “Plan-B-type” contraceptives, and the requirement that individuals seeking a 12-month supply of a contraceptive must first use the contraceptive during a trial period. The document also outlines the appeal process individuals can use if they attempt to acquire a 12-month supply and are told by their insurer or pharmacist that they cannot receive one.

Massachusetts to Providers Regarding Paxlovid: “We Need Your Help”

State physicians sent a letter to all providers last week to drive home the availability of the COVID-19-fighting drug Paxlovid, and the need for physicians to make it available to patients, who are in the early stages of having the virus.

“We need your help to ensure that Paxlovid and other COVID-19 treatments are offered to all patients eligible to receive them,” reads the letter from the state’s Bureau of Infectious Disease and Laboratory Sciences. “Any patient 12 years or older who tests positive for COVID-19 should be evaluated and prescribed Paxlovid or other treatment, as appropriate.”

Paxlovid is in ample supply and widely available in Massachusetts and is 90% effective in preventing severe disease when given to people within five days of them testing positive for COVID-19. A PCR test is not required before beginning treatment; a positive antigen tests, even one administered at home, is sufficient to prove infection and prescribe treatment.

This Paxlovid Treatment Guide from the state instructs providers on the proper dosing. Individuals who have tested positive and want to get Paxlovid – at no cost – to prevent COVID-19 from escalating into serious illness, can contact this free telehealth service the state offers, which will link them quickly to a clinician for consultation. The telehealth service is available to any Massachusetts resident 18 and over.

HRSA Says Merck Violated 340B Statute

The U.S. Health Resources and Services Administration (HRSA) sent a letter to pharmaceutical giant Merck last week informing the company that it is in violation of the 340B statute, and that its actions have resulted in overcharges.

HRSA received complaints that Merck was placing restrictions on 340B pricing for certain covered entities dispensing medications through pharmacies, unless the covered entities provide claims data to a third-party platform. In its letter to Merck, HRSA wrote, “Nothing in the 340B statute grants a manufacturer the right to place conditions on its fulfillment of its statutory obligation to offer 340B pricing on covered outpatient drugs purchased by covered entities.” Entities do not have to provide claims data, HRSA added.

“Merck must immediately begin offering its covered outpatient drugs at the 340B ceiling price to covered entities through their contract pharmacy arrangements, regardless of whether they purchase through an in-house pharmacy,” HRSA wrote. “…Merck must work with all of its distribution/wholesale partners to ensure all impacted covered entities are contacted and efforts are made to pursue mutually agreed upon refund arrangements.” HRSA set a May 20 deadline for compliance with its order.

John LoDico, Editor