Volume 17, No. 1, Winter 2009
By Senate President Therese Murray
Building on the success of healthcare reform, Massachusetts has continued to move forward to ensure that residents have access to the most complete healthcare possible.
In 2008, we passed the next phase of the Commonwealth’s two-year-old landmark healthcare reform. This legislative package will work toward bringing down escalating costs by holding hospitals and insurers accountable. To increase access to healthcare providers, the package provides incentives to encourage doctors to pursue primary care and allows nurse practitioners to be primary care providers.
It also works to reduce waste and inefficiencies and improve quality care by focusing on the modernization of the healthcare system through the adoption of electronic medical records and uniform billing among providers and insurance companies. Combined, this could save Massachusetts hundreds of millions of dollars.
While we have had great success with healthcare reform, with a reported 97 percent of our residents covered, the Senate has also focused on improving mental healthcare for the Commonwealth’s residents.
By expanding the scope of the existing mental health parity law, the Legislature assured coverage for additional mental health-related conditions. The new law updates the current list of nine biologically-based conditions covered by the Parity Law to include four more conditions: eating disorders, post-traumatic stress disorders, substance abuse and autism.
Language in the law also gives the Commissioner of Mental Health unilateral authority to require coverage for any additional disorder contained in the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is the medical standard recognized by the insurance and healthcare industries. Disorders not included in the DSM and not authorized by the Commissioner of Mental Health, still would qualify for 60 inpatient days and 24 outpatient visits for non-biologically based illnesses under existing law.
We also specifically focused on children‘s mental health by passing legislation that improves the early identification of children with mental illnesses by reaching them in familiar settings, such as pediatrician offices, early education programs and schools. The law increases pediatric screenings for mental illnesses and requires the Department of Early Education and Care to provide behavioral health consultations.
In addition, consultation services in schools will be promoted to help teachers and administrators better identify mental health issues. By identifying and treating these problems early on, children will be better equipped to reach their full potential.
For Massachusetts residents to lead happy, healthy, productive lives, the Commonwealth must provide access to a complete, quality healthcare system that includes mental and physical health. Preventive care from the earliest stages throughout life is the key to a healthy state, and that is what we are working to achieve.
(Senator Murray, D-Plymouth/Upper Cape, is the first female President of the Senate in Massachusetts history.)
By Representative Cleon H. Turner
In November, Massachusetts voters passed Question 2 on the ballot, which decriminalizes certain amounts of marijuana use and possession. While this is still illegal, the new law changes the penalty to a citation and the nature of the offense from criminal to a civil violation. It also opens the door for consideration of the legalization of medical use of marijuana.
Thirteen states in the Union—including three in New England—have passed laws allowing for the use of marijuana for seriously ill patients.
The types of patients usually prescribed marijuana are the terminally ill and those suffering from AIDS, cancer, glaucoma and multiple sclerosis. Marijuana relieves chronic pain, as well as vomiting and nausea caused by chemotherapy and other drugs.
A 1999 poll showed that 81percent of Massachusetts residents supported the legalization of medical marijuana. The recent passage of Question 2 with nearly 63 percent support, leads many to believe the voters would be amiable to passage of a bill legalizing medical marijuana.
In 1996, a bill was passed by the Legislature requiring the Department of Public Health to establish guidelines for research into medical marijuana’s effectiveness. Those guidelines were developed in 1997 with the support of then-Governor William Weld.
Around this time, the states of Arizona and California started the trend of approving physician prescriptions for medical marijuana. The response from the Clinton Administration was to prosecute those physicians and patients.
After studying the medical applications, the National Institutes of Health reported the drug had “potential” and recommended an active role for the federal government in facilitating clinical evaluations.
Medical opinions of the effectiveness and safety of medical marijuana vary. The American College of Physicians recently issued a position paper calling for less stringent regulations surrounding the research of the medicinal uses of marijuana and other THC products. The American Public Health Association also supports legalization for medical purposes, as does former Surgeon General Joycelyn Elders.
The American Medical Association, however, has called for further study before legalization laws are enacted. Unfortunately, federal laws have restricted such studies despite the long history of the drug’s medicinal use. (Roman and Greek physicians are known to have prescribed cannabis to patients.)
Many peer-reviewed studies have negated arguments that marijuana is addictive and leads to other drug use, especially compared with prescription drugs already on the market. The studies in the United States that have taken place are too few to definitively answer all of the questions, which is why the federal government should invest in such explorations. Until we’ve fully investigated the issue, no one can know for sure either way if medical marijuana is an avenue we should pursue in Massachusetts.
(Representative Turner, D-Dennis, is a member of the Legislature’s Joint Public Health Committee.)By Senator Rob O’Leary
In response to projected shortfalls in state revenues and the shrinking pool of funds available to the Commonwealth, Governor Deval Patrick was granted use of his 9C authority to cut the executive agency budgets, which provide funding to many important programs throughout the state.
The Governor was forced to make difficult decisions and I know it pained him to cut funding to programs targeted at some of the state’s neediest citizens. Although a number of deserving programs on Cape Cod experienced a recent loss in state funding I am going to take this opportunity to highlight just one of those that I present for priority consideration–CHIP’s House.
The Cape Head and Injured Persons’ Housing and Education Group, also known as CHIP’s House, is a private non-profit founded in 1992 by Cape Codders to provide support and assistance for our head-injured residents. These injuries can dramatically change one’s life and ability to be independent, and often require a lifetime of personal care. CHIP’s House is committed to providing long-term, community-based housing that is safe, affordable, and dignified, and allows individuals to maximize their functional potential and achieve their highest level of independence within the community.
CHIP’s House provides an essential service to one of the neediest groups in our community, and for the past three budget cycles it has been awarded $100,000 in state funding. Unfortunately, this year half of that state funding was eliminated by Governor Patrick through 9C cuts.
The state is not the only source of CHIP’s House funding, yet a 50 percent cut will certainly hamper its level of programming.
Residents of CHIP’s House cover the cost of their care through the utilization of federal and state entitlement programs, such as SSI, veteran’s benefits, the Mass Health Personal Care Attendant Program, housing certificates, private insurance and personal resources. However, after all sources of payment are utilized, there’s still an annual shortfall of $132,000.
Through use of his 9C authority Governor Patrick already has eliminated $1billion in state spending. However, as the economy continues its downward spiral and barring a dramatic increase in federal funding dispersed to the states, it is likely that another, deeper, round of cuts will be necessary to keep the Commonwealth solvent.
As we prepare for the next round of budget cuts, we realistically must expect that funding to a number of programs that provide essential services to the residents of Cape Cod and the Islands will be hit. Services to the blind, the Department of Mental Health, AIDS programming, dental care, and rabies prevention are just a few of those already affected by the first round of 9C cuts.
I know that we have all felt the effect of the tightening economy, but now it is more important than ever for communities to band together to take care of their neediest residents.
Those on the edge of poverty are in ever more danger of becoming homeless, going without heat or food for their families, and forgoing necessary medical care to stay afloat. Please consider donating whatever you can spare to a local charity that provides essential services – such as shelter, healthcare or food. As your state senator I will continue to fight for services provided on Cape Cod and the Islands, but I urge you to do what you can to help your neighbors through the rough months ahead.
(Senator O’Leary, D-Cummaquid, represents the Mid and Lower Cape and Islands and is a member of the Legislature’s Joint Public Health Committee.)
By: Michael T. Smith
A recent meeting at the Executive Office of Health and Human Services that I attended in Boston along with other MassHealth Personal Emergency Response System (PERS) providers, discussed the plan that the MassHealth Office of Long Term Care is suggesting to implement emergency cuts related to our industry. The cuts are a result of Governor Deval Patrick’s reductions. The total proposed reduction of $1.4 billion includes $293 million from MassHealth.
In addition to these home-based medical alarm system providers, attendees included Lois Aldrich, Director of Community Services, MassHealth Office of Long Term Care, as moderator; Rachel Richards, Assistant Secretary of Elder Affairs and Director of the MassHealth Office of Long Term Care; Lynda Scully, DME Program Manager; and Lucinda Brandt, Division of Health Care and Finance Policy.
Possible savings they proposed for discussion included: no payment for installation; reducing the monthly fee paid by MassHealth to the PERS providers; changes in policies that concern maintenance, prior authorization procedures; and changes in doctors’ prescription and the renewal process.
A state auditor suggested fee reductions based on comparative information found on the Internet. However, one of the providers questioned the validity of this data because the quality of equipment and service had not been taken into consideration in making the comparison of cost.
The present service model includes free installation; service calls, such as for replacement of missing transmitter button; reinstalling a console, even if it was moved by the client;, and test calls.
While retaining the present service model, PERS provider representatives suggested some of these alternative measure to reimbursement costs: signing longer minimum contracts for each unit, better suspension arrangements for when a client is in a rehabilitation hospital, an annual review for changes, instead of every two years; applying reimbursement cuts for new clients only, not existing ones; and charging clients for lost or damaged equipment.
The providers left the one-hour discussion hopeful that cuts would be minimized to cause the least impact to clients.
(Mr. Smith is the owner of Medical Alarms USA, LLC in Dennisport, 508-398-7723 or info@medicalalarmsusa.com.)