After watching the pandemic exacerbate the need for improved access to behavioral health care, Gov. Charlie Baker doubled down Tuesday on a plan to force providers and insurers to inject up to $1.4 billion into the system over the next three years to remove barriers to care and reach people before they end up in emergency rooms.
The governor’s proposal would require providers and insurers to boost spending on primary and behavioral health care by 30 percent by 2025, penalize drug companies for “excessive” drug price increases, and target funding to primary and behavioral health providers that serve large volumes of patients on Medicaid.
“As we emerge from this pandemic we all know too many people, young and old, are struggling with feelings of isolation, depression and despair and too often it’s difficult and complicated to access services that can help them,” Baker said, visiting Codman Square Health Center in Dorchester to announce his proposal.
The bill Baker said he was filing arrives with just four months left on the legislating calendar and mirrors the approach he took in 2019 when he filed similar legislation that got derailed by the arrival of COVID-19. While the pandemic led to the widespread adoption of telehealth services and other improvements, Baker said there remains a lot of room for improvement that can only be solved by investing more in core health services.
“The pandemic has only underscored the need to treat behavioral health care services the same way we treat other health care services,” Baker said, echoing a viewpoint shared this session by the Senate but which so far had not taken hold in the House.
Baker said he expects his bill to get a “pretty solid and significant” look from lawmakers over the next four months as they pursue their own strategies to address concerns about access and cost in the health care system.
Describing a “a lot of back and forth” between his administration and top Democrats on the issues addressed in his bill, Baker said he believes there is agreement that something needs to be done to improve behavioral health and he’s hopeful something will reach his desk before the end of the formal sessions on July 31.
The legislation, like the governor’s 2019 bill, requires providers and health insurers to boost spending on behavioral health and primary care services by 30 percent over three years, while keeping within the state’s 3.1 percent cost growth benchmark. This would likely require the industry to cut spending in other areas.
“It’s the only way I know of to put enough resources into the system so that people do get served in the community, they do get access to treatment and they don’t end up in your ER,” Baker said.
Baker said the bill gives providers and insurers flexibility to decide how they meet the target, which could lead to increased rates paid to primary care and behavioral health providers, expanded networks, increased hours or additional telehealth services.
“If you don’t spend the money, you’re not going to get the participation,” Baker said, explaining how Medicare reimbursement rates used as a baseline in the industry currently provide an incentive for medical school graduates to pursue careers in high-end specialties where they can earn more money and lead to shortages in other fields.
By boosting spending in the areas of mental health and primary care, Baker said Massachusetts can realign its health care industry to better serve patients before they seek care in emergency rooms for more acute health issues.
The governor’s bill would also make reforms to the small group insurance market to make more affordable plans available to employers and their workers, eliminate the risk to patients of getting slapped with high bills for out-of-network services in unforeseen cases, and expand the scope of practice for some providers, which Baker did by executive order during the pandemic and is now looking to cement into law.
The concepts in Baker’s bill may be familiar to lawmakers, but top House and Senate Democrats have so far pursued their own agendas when it comes to health care this session.
The Senate has already passed a mental health parity bill that would improve insurance coverage for behavioral health service and eliminated disparities between the rates paid for mental and physical health care. That branch has also passed separate legislation targeting the high cost of prescription drugs.
The House, meanwhile, passed a bill prioritized by Speaker Ron Mariano to strengthen oversight of hospital expansions with an eye toward controlling cost in the system and protecting smaller community hospitals with less market clout.
The last time the two Democrat-controlled branches attempted to pass a major health care reform bill to shore up the finances of community hospitals, talks collapsed at the eleventh hour at the end of the session in 2018.
While Baker’s bill will serve to elevate the policy debate on Beacon Hill, behind the scenes the governor’s administration is in the midst of negotiations with the Biden administration over a new Medicaid waiver that will govern the allocation of $40 billion in resources over the next five years.
The governor’s fiscal year 2023 budget proposal also includes a new assessment on health insurers to help pay for a behavioral health helpline that would be staffed around the clock to connect residents, regardless of their insurance, with providers and crisis intervention services.
Secretary of Health and Human Services Marylou Sudders recently told the Joint Committee on Ways and Means that the waiver application was submitted in December, and talks are ongoing with the current waiver set to expire at the end of June.
Among the reforms sought in the waiver is a new “subcapitated payment model” for primary care providers to further shift away from fee-for-service toward “value-based care,” Sudders testified last week.
Assistant Secretary for MassHealth Amanda Cassel Kraft also told lawmakers that the waiver and Baker’s fiscal 2023 budget proposal would extend an assessment on acute care hospitals to make more than $600 million available annually for hospitals to promote health equity.
Kate Walsh, the CEO of Boston Medical Center, joined Baker at his afternoon press conference to offer her support for the bill and outline ways BMC has reformed its care system to integrate behavioral health services.
Walsh said the requirement that more money be spent on primary and mental health in Baker’s bill would “significantly help improve access to those services.”
Lora Pellegrini, CEO of the Massachusetts Association of Health Plans, said insurers were “strong supporters” of the protections in Baker’s bill against surprise billing that would create a default payment rate for out-of-network services in emergency cases, and supports the governor’s proposed prescription drug cost controls.
Describing primary and behavioral health care as the “backbone of health care delivery system,” Pellegrini also said it would be important that any new spending be done within the framework of the state’s cost control benchmark overseen by the Health Policy Commission.
Health Care for All Executive Director Amy Rosenthal also said Baker’s bill would take “important steps” toward addressing barriers to accessing affordable behavioral health care.
“We have long known that promoting overall health must include behavioral health care and, too often, we hear from people on our HelpLine who struggle to find a primary care physician or mental health provider who takes their insurance,” Rosenthal said in a statement. “Access to these vital services could help them stay healthy and avoid higher-cost treatments such as hospitalizations.”
PhRMA, which represents drug companies in Massachusetts, said it welcomed the more strict oversight proposed by Baker of pharmacy benefit mangers, who negotiate drug prices for insurance companies, but said the bill’s “dangerous price controls” would threaten access to medicines and stifle the development of new therapies.
“It’s good to see Gov. Baker calling out ‘middlemen’ like pharmacy benefit managers for not always sharing the rebates and discounts they negotiate with patients at the pharmacy counter. Unfortunately, Governor Baker has again decided to come after the same industry that directly supports more than 90,000 jobs in Massachusetts and supports the Commonwealth’s role as a global leader in biopharmaceutical innovation,” the trade group said in a statement.
(Copyright (c) 2022 State House News Service.