Rep. Howitt supports legislation to expand primary care access and affordability

BOSTON – State Representative Steven S. Howitt (R-Seekonk) recently supported legislation designed to expand primary care access and make health care more affordable for Massachusetts residents.

House Bill 5618, An Act strengthening primary care and advancing health care affordability, was engrossed by the House of Representatives on July 30 by a vote of 158-0. The Senate previously passed its own version of the bill – Senate Bill 3141, An Act relative to primary care for you – on June 18 by a vote of 35-4. A conference committee is expected to be appointed to try to resolve the differences between the two bills and produce a compromise proposal that can be sent to Governor Maura Healey for her review and signature.

Representative Howitt said House Bill 5618 sets targets for investments in primary care services and expands workforce recruitment and training efforts to help address existing shortages within the state’s health care system. Under the House proposal, 9% of all health care spending in the state would be directed to primary care by 2030. That percentage would increase to 12% by 2033 and to 15% of all health care spending by 2036 and beyond.

House Bill 5618 also establishes a Health Care Workforce Transformation Fund. This fund will be used to help meet the aggregate primary care expenditure targets outlined in the bill. In addition, the fund will support expanded education, training and career pathways for health care workers, while also being used to recruit and retain workers and improve equitable access to high-quality health care services.

According to Representative Howitt, House Bill 5618 authorizes an expedited, 60-day Determination of Need process for qualifying community hospital projects that would expand primary care, behavioral health, maternal health, and other critical services in underserved communities. The bill also establishes the Community Hospital Capital Access Fund to support these efforts.

To control costs, the Health Policy Commission would be required to work with health care entities that exceed the health care cost growth benchmark to help them improve efficiency and increase their investments in primary care. Representative Howitt noted that in some instances, the Commission could require the health care entity to file a performance improvement plan to address these concerns.

House Bill 5618 also calls for the development of advanced primary care payment models to support value-based, patient-centered primary care. The Commissioner of Insurance will oversee this program, which they will develop and administer with input from a newly created primary care payment collaborative. This collaborative will consist of the executive director of the Health Policy Commission or their designee, the executive director of the Center for Health Information and Analysis or their designee, and additional members representing carriers, primary care providers, provider organizations, employers, consumer organizations and other appropriate entities appointed by the Commissioner of Insurance.

Representative Howitt said the House proposal requires insurance carriers to disclose their use of automated utilization review tools to health care providers and to the public. He said the bill explicitly prohibits carriers from issuing adverse determinations for coverage based solely on the use of an automated utilization review tool. In addition, insurance carriers would be required to reimburse federally qualified health center services at a rate no lower than the applicable rate they would have received from MassHealth.

The bill additionally requires carriers, pharmacy benefit managers and affiliated entities to make at least 80% of estimated drug rebates available to insureds by reducing their cost-sharing at the point of sale. A carrier that fails to come into compliance after being notified of a violation could face a fine of up to $5,000 per day.

During floor debate, the bill was amended to include language:
• eliminating the statute of limitations for civil claims filed by survivors of child sexual abuse;
• requiring the state’s pharmacy board to be notified at least 60 days before the closing of a pharmacy so it can hold a public hearing to determine if the closure would create a pharmacy desert for area residents and identify alternative pharmacy sources;
• requiring the Group Insurance Commission, MassHealth, and commercial health insurers to provide coverage for biomarker testing; and
• restructuring the Vaccine Program Advisory Council, revising how the childhood immunization surcharge is calculated and capped, directing the Commissioner of Public Health to set annual funding needs for the Vaccine Purchase Trust Fund, and allowing for the provider immunization brand choice.