Mass. Legislature to vote on long-term care, prescription drug bills on last day of formals

House lawmakers are expected to vote on legislation overhauling the long-term care industry Wednesday while the Senate will take up a bill that looks to address the increasing costs of prescription drugs.

The two votes on major health care proposals cap off formal law making for the year. Legislators on Beacon Hill will head into the holiday break Thursday with only informal sessions — where a single lawmaker can object to a bill — scheduled until the new year.

The two votes come as the House and Senate are also working out a separate multi-billion proposal that closes out the books on fiscal year 2023 and shuttles $250 million to shelters in Massachusetts housing migrant and homeless families with children as well as pregnant people.

Both health care bills are priorities of House Speaker Ronald Mariano and Senate President Karen Spilka. Mariano said the nursing home sector has “long faced” workforce and financial challenges that were made worse by the pandemic.

“Addressing persistent challenges within this important sector will not only improve the quality of care that residents receive, it will increase capacity and help acute care hospitals more efficiently discharge patients to the appropriate post-acute care settings,” Mariano said in a statement.

The House and Senate both gaveled into session at 11 a.m. but quickly moved into extended recesses, with the House scheduled to come back at 1 p.m. The Senate did not have an exact time of return.

The long-term care bill up for debate in the House looks to establish small house nursing homes, mandate infection outbreak response plans and “anti-social isolation” policies, and provide new training and education programs, according to a summary of the bill from Mariano’s office.

House Democrats also want to raise civil penalties levied by the attorney general for underperforming nursing homes in instances of “abuse or neglect” and boost fines from the Department of Public Health if a facility is operating without a valid license, the summary said.

Expanded financial reporting would give the Department of Public Health, lawmakers, and the public “a better understanding of the complicated ownership arrangements of nursing homes and allow stakeholders to gain a real-time understanding of the state of the nursing home sector in the commonwealth,” the summary said.

The bill launches a two-year pilot program that requires insurance carriers to respond to a prior authorization request for admission to post-acute care facilities by the next business day or to waive prior authorization altogether if a patient can be admitted into a facility over the weekend, the summary said.

Spilka said Massachusetts residents cannot wait for prescription drug relief, “especially when lives are at stake.”

“This is a bill that will take major steps towards addressing affordability for all our residents, along with increasing access to important life-saving medications,” the Ashland Democrat said in a statement.

Senate Democrats pitched their prescription drug cost bill as a way to reduce prices for patients and lower health care prices overall, as well as provide a no-cost sharing option for certain prescription drugs used to treat chronic illnesses that disproportionately affect communities of color and residents with lower income.

The bill limits out-of-pocket spending on certain drugs used to treat diabetes, asthma, and heart conditions.

For each chronic condition identified, the legislation requires insurers to eliminate deductibles and cost-sharing requirements for one generic drug and to cap co-payments on one brand-name drug at $25 per 30-day supply, according to Spilka’s office.

Senators also want to bring more oversight to pharmacy benefit managers, the third-party administrator of prescription drug programs for commercial health plans.

Spilka’s office argued the managers “operate with little oversight, making it unclear if they act in the best interest of consumers or health plans when they negotiate the price of drugs with pharmaceutical manufacturers.”

The legislation directs the state’s Division of Insurance to provide “much-needed” oversight by licensing and regulating pharmacy benefit managers and establishing sanctions if they fail to meet certain standards, Spilka’s office said.

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