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April 2nd Legislative Update

By Catherine Carver, MS, ANP, CDE, Vice President, Advocacy and Planning


Relative to diabetes, issues are relatively quiet right now. There have been some recent studies that might indicate that costs for consumers could increase in October when the ACA act is fully implemented but a lot of this will depend upon the various categories and where a person falls. Additionally, some states and the Department of Health and Human Services continue to hash out specifics of the responsibilities of each party as everyone gets ready for Medicaid expansion.

President Obama and Congressional Republicans have quietly raised the idea of broad systemic changes to Medicare that could produce significant savings and end the polarizing debate over Republicans to privatize the insurance program for older Americans. Both sides show possible common ground on curbing the costs of Medicare suggesting a lingering chance for a budget bargain.

Several changes are likely to appear in the President’s annual budget which will be released on April 10. The president has told House Republicans that he is open to combining Medicare’s coverage for hospitals and doctor services, a proposal that Representative Eric Cantor has previously suggested.

Commonwealth of Massachusetts

The Health Policy Commission continues to discuss and develop rules and regulations related to the implementation of Chapter 224, the 2012 health care cost containment legislation. Issues such as what is an appropriate definition of a provider organization, who bears the risk (a contracting entity or the docs), how are revenues aggregated and recognized, and what are “material changes” that will require approval or notification to the state by a provider organization.

The Health Policy commission recognizes that no changes of any sort can continue until it issues interim guidance and even forms that entities will be required to submit under the procedures. It is expected that the interim guidance will be issued this month.

The first meeting of the HPC Advisory council was held where there was a discussion of the definition of total cost trends data and what should be included. This is a major element of the Commission’s work to control health care costs. Gene Lindsey from Atrius made the point that how health cares is utilized and its output should be included in the definition.

Additionally, a number of Advisory Council members suggested concentrating on chronic conditions, e.g., diabetes, asthma, as “drill-down” areas to analyze health care cost data. HPC also is seeking comments on the Innovation Investment program included in the statute that includes the development of Innovation Investment Programs and what new payment and delivery of care models, e.g., chronic conditions, might be developed.

Catherine Carver, MS, ANP, CDE
Vice President, Advocacy and Planning

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Page last updated: April 22, 2019