Last week, ML Strategies released an Advisory providing a comprehensive review of the sweeping health care legislation recently released by the Massachusetts Senate. The Advisory summarizes the notable provisions contained in the bill, including, among other things, how to handle the rising cost of prescription drugs, hospital reimbursement rates, changes to MassHealth (the Massachusetts Medicaid agency), and commercial insurance market tiering. The bill represents the latest in a series of proposals lawmakers and the Baker administration have made this year aimed at lowering health care costs and improving quality of care. Given the uncertain future of health care at the national level, all eyes will be on Massachusetts as it grapples with these important issues.

Our colleagues on the Employment Matters blog have been following Massachusetts’ efforts to make up a funding shortfall in the Commonwealth’s Medicaid program and its Children’s Health Insurance Program (CHIP). Back in May, they blogged on the two options introduced by the Senate to offset these rising costs: (1) a “play-or-pay” option that would impose a per employee assessment on companies that do not offer their workers’ health plans, or (2) an across the board increase in the Employer Medical Assistance Contribution (or “EMAC”).

Last week, they provided an update on the Commonwealth’s effort. On August 1, Massachusetts Governor Charlie Baker signed into law H. 3822, “An Act Further Regulating Employer Contributions to Health Care” (the “Act”). This Act (i) increases the Employer Medical Assistance Contribution (“EMAC”) from an annual maximum fee of $51 per employee to $77 per employee; and (ii) imposes a penalty on employers of up to $750 for each non-disabled worker who receives health insurance coverage through MassHealth or the Massachusetts Health Connector (i.e., the Commonwealth’s Affordable Care Act marketplace).

Read their full update here.

Our colleagues on the Employment Matters blog recently analyzed a budget proposal by the Massachusetts Senate that would authorize the Governor to collect additional funds from employers to offset increasing MassHealth costs.  MassHealth, Massachusetts’s Medicaid program, offers low-cost, benefit rich coverage to low-income individuals.   Eligible individuals sometimes forgo employer coverage in lieu of MassHealth coverage, a trend that is unsustainable for the Commonwealth.

In Governor Baker’s fiscal year 2018 budget, he called on Massachusetts employers to help pay for the increasing Medicaid costs.  To support this initiative, the Senate recently introduced a proposal that would allow the Governor to select from two options to offset these rising costs: (1) a “play-or-pay” option that would impose a per employee assessment on companies that do not offer their workers health plans, or (2) an across the board increase in the Employer Medical Assistance Contribution (or “EMAC”).  The Employment Matters post analyzes how the increase in the EMAC may be more administratively feasible for the Commonwealth, while the “pay-or-play” option is potentially preempted by the Employee Retirement Income Security Act of 1974 (ERISA).

Check out their full analysis here.

Written By: Kimberly Gold and Stephanie D. Willis

Last week, the Massachusetts’ Secretary of Health and Human Services, John Polanowicz, announced the launch of a new $5 million program designed to detect and prevent provider fraud, waste, and abuse in MassHealth, the Commonwealth’s Medicaid program.  Under the MassHealth anti-fraud program, the Medicaid agency will freeze payments to health care providers with suspicious Medicaid claims pending further investigation by state agencies.  This state-based program mirrors the Centers for Medicare & Medicaid Services’ use of payment suspensions at the federal level under the authority of Section 6402(h) of the Patient Protection and Affordable Care Act (“ACA”).  In fact, the federal government is providing a majority of the funding for the MassHealth anti-fraud program. Continue Reading Massachusetts Launches New Program to Combat Provider Fraud