2021-07-27 00:00:00 - Joint Committee on Financial Services

2021-07-27 00:00:00 - Joint Committee on Financial Services

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SEN CHANDLER - SB 631 - SB 632 - Thank you very much, Mr. Chairman and your Co Chair as well. Thank you for taking me out of order. I'm here to testify on behalf of two bills; Senate Bill 631 an act relative to increasing patient choice to assignment of benefits and Senate Bill 632, an act relative to medical loss ratio, reporting for general benefits corporations. Both of these bills that are filed in partnership with the Massachusetts General Society and I support them as the Senate sponsor and it's the Senate Chair of the oral health caucus. Assignment of benefit provisions in general benefit plans allow patients who choose to seek treatment from an out of network dentist to direct their insurance carrier to directly pay the provider, permitting the assignment of benefits, enables patients to have fewer, immediate, immediate out of pocket expenses and placed improvised and therefore access to care. Without the ability to sign benefits directly to the provider of their choice, patients are responsible for all costs up front.

They must submit a claim to the carrier after the fact,231 then wait for an undefined amount of time for reimbursement check. Carriers allow for this at least one large carrier does not, and I believe we should empower patients by passing Senate 631. The second piece of legislation also deals with dental insurance carriers. Currently, there is no transparency around medical loss ratios or MLRs for dental insurance. This is important because unlike medical insurers, general260 insurers are not required to hit certain263 cars. As a result, gentleman carriers may spend significantly less on patient care. To ensure policymakers have the best information to make policy decisions on oral health care, MLR should be disclosed to DOI with a vision of insurance, which is what this bill would do.

For all these reasons, I encourage the committee to give a favorable report to Senate bill 631 an act relative to increasing patient choice through assignment of benefits and Senate Bill 632, an act relative to medical loss ratios, reporting for general benefits corporations. I thank you for your time, I would be happy to answering questions and any other suggestions you might have. Thank you.
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REP BALSER - HB 1041 - HB 1039 - Thank you, both Mr. Chairman for taking me out of turn. I'm Representative Balser, State rep from Newton. I'm here today345 to speak in support of two bills, two important mental health bills, one is H 1041 an act relative to mental health parity implementation. The other is H 1039, an act providing continuity of care for mental health treatment. Both of these bills earned the support of this committee last session, and I hope the committee will support them again and move them along, and maybe this year, we'll get them all the way to the Governor's desk. I will start by mentioning because there are lots of new members and because we've all been working remotely, maybe we don't all know each other so well but I'm a clinical psychologist by profession and I've spent the more than 20 years that I've been in the legislature advocating for improved access for mental health services, for the people of Massachusetts, and was involved with the predecessor committee to this, back when it was called the insurance committee when we passed the first mental health parity bill back in 2000 and then the second one in 2008.

I'm414 here today to say, let's keep moving into the next level. In the years, these years, not only has the state asked mental health parity legislation, so, too, has the federal government and there's a fairly complex set of laws now regarding mental health parody to make sure that people with mental health conditions get the same kind of coverage that people with any other kind of health conditions get. What H 1041 would do, an act relative to mental health parity implementation, it would require the health plans to report.453 It's really a transparency piece of legislation, and it would require them to report to the division of insurance that they are complying with465 all federal and state mental health parity laws.

There has been evidence to suggest that there has not been full compliance with all these474 laws and you'll hear later from people from the psychiatric society who will give you more on the ground information about that. But what this bill does is require that the plans report and requires that the Division of insurance enforce all of our mental health parity laws. I should mention that the draft that before you today was worked on by both representatives of the psychiatric society and of the Mass Association of Health Plans, and so the health plans and the providers have, as I understand, it, reached agreement on this language. I ask that you support, I've come to learn that mental health parody is a goal rather than a vital state and we keep having to tweak our laws to make sure that people really get the coverage that they need and deserve.

H 1039, an act providing continuity of care. A Bill I have filed with Representative Tricia Farley Bouvier and Senator Comerford, this is a bill that basically says that if your provider is no longer on the network for your health plan and you're in the middle of a treatment episode, that the health plan should cover that provider on an out of network basis. This bill, which I've been advocating for many years, is particularly important now because of Covid. I don't have to tell anyone on this committee how many people lost their jobs, how many people hopefully are getting new jobs, but what comes with a new job often is a new health insurance plan and what that means is that there may be a different behavioral health network, and what can happen is the treater who a consumer was working with is no longer covered by the new plan.

So this bill would say that the treatment should not be interrupted, that that new598 provider should be covered. So I appreciate very much this committee's commitment to improving mental health access and I ask for your support for both of these pieces of legislation. Thank you.
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CHRISTINE QUIGLEY - CONCERNED CITIZEN - SB 632 - Thank you, Chairman and committee members. I've been working on this legislation and testifying before you for 12 years or so, so, some of you have heard from me before. Forgive me if I talk fast, but I've been obsessively editing what I want to say because I know you have a lot of bills today. Several people on our panel have work obligations or need to see patients so if somebody doesn't answer right away, I hope you would not mind circling back to them. My daughter and I both have dentin genesis imperfecta, one of the craniofacial conditions named in the bill. All of us speaking today parents, patients and the dedicated professionals who are here to support us want better access to treatment and to help others going forward to lead healthy happy lives without crippling financial hardship. I believe that's a major goal of the current administration here in Massachusetts as well and where a state known for leadership in health care.

A few bullet points. The American Academy of Pediatric Dentistry considers these conditions to be disabilities and the lack of treatment is dental neglect. Mass laws mandate coverage for all birth defects, but insurers employ the dental loophole to deny treatment. That loophole was closed in 2012 for cleft palate patients but our rare disorders which require similar reconstruction from a team of experts was not included. The new CHIA study, thank you for ordering it. It shows the cost729 of the bill to insured individuals is only 10 to 28 cents per member per month, obviously negligible to our families, it would make a huge difference. Also from the study, lifetime costs for individual patients, 173 - $514,000, multiplying that by two for families like750 mine and the Mercer's whom you'll hear from and that could be over $1 million.

All of us speaking today have stories of insurance denials, difficulties with treatment, struggles with the condition, financial hardship or if they're starting out, they know and are fearful of what lies ahead. All special needs patients and parents need to be able to focus on managing the775 conditions and getting optimal care without lengthy insurance appeals,779 without foregoing a college education, without mortgaging the house, if they're lucky enough to have one or trying to finance their medical care through relatives or online go fund me campaigns. Health insurance is meant to spread out the risk so individual families aren't hit with catastrophic797 health care costs. But because of the coverage gap, it doesn't work that way for us and we need your help to close the loophole. Thank you for your time, happy to take questions.



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SEN FRIEDMAN - SB 675 - I really appreciate you allowing me to testify on S 675, an act relative to mental health parity implementation.861 We've all been here before, I think we did this last session. I'd like to tell you that things have changed, but870 they haven't. Despite the legislative efforts at both the state and federal level to achieve true parity in insurance coverage between mental health care coverage880 and coverage for physical health care, there still remains a number of widespread barriers and put simply the reality of what people face does not square up with the law. So this Bill continues to seek to create reporting899 and transparency requirements to help us finally enforce parody and achieve the fundamental intent of parody law, which is to create more equitable access to behavioral health care for families and children.

This Bill would achieve913 this in a number of ways; improving enforcement through enhanced carrier self reporting, by addressing barriers created by insurers such as onerous and time consuming approval processes, by applying parity across payers, including the Group Insurance Commission and Mass health, and by ensuring consistent and fair application of medical necessity criteria. We need to hold insurers accountable for mental health parity, we cannot let them continue to treat mental health care differently from physical health care, whether it's through denial of coverage, draconian preauthorization and treatment review950 requirements, higher co pays for patients or unfairly low rates of reimbursement for mental health care providers. We need to shine a bright light on these practices and no longer just accept their assurances that they're treating mental health fairly and on a par with physical health care, they will need to prove it.

Our constituents have waited too long for true mental health parity and we can see what's happening now. The complete lack of providers who are willing to take insurance and provide care for people with insurance is a direct result of mental health parity. It's the direct result of insurers not leveling the playing field, not following the letter of the law and finding ways to make payment for providers a very, very difficult process and even when they do, the rates are so low that people simply can't afford to be in the insurance business. I hope that we can finally take this legislation to the finish line this session and I therefore respectfully requests that you report this bill favorably at your earliest convenience once again, thank you so much.

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SEN COMERFORD - SB 636 - HB 1039 - SB 648 - SB 675 - Thank you so much, Mr. Chair. I am grateful to be able to offer this testimony, Chair Crighton, Chair Murphy and honorable members of the committee. I'm here to offer testimony in support of legislation I introduced alongside Representatives Balser and Representative Farley Bouvier, the legislation is S 636 and H 1039, an act providing continuity of care for mental health treatment. Before I begin about these bills, I want to also note my very strong support of S 648, an act relative to ensuring treatment for genetic craniofacial conditions, a legislation that's led by Senator Cyr and Representative Carrie. I have submitted written testimony on this legislation and I know I have constituents who you'll hear from today who are affected by genetic craniofacial issues, I'm moved by their passion.

This bill will close an insurance coverage loophole for them and many others who need complex restorative care. I also support S 675 an act relative to mental health parity implementation, which Senator Friedman just spoke to. With regard to S 636 and H 1039, this legislation would give patients receiving mental health care the right to continue their care with their provider, even if the provider is removed from the patient's insurance network. It ensures that every mental health patient will be allowed to continue the progress they've built with their current providers uninterrupted. As you know, Chairs and committee, effective mental1138 health care is dependent upon the relationship between patient and provider.

The therapeutic relationship is an intensely personal one, and it's contingent upon a combination of trust, respect and mutual responsibility for progress, all of which can be really difficult to develop in the short term. Research also shows that changes in providers are often perceived by patients as setbacks in treatment, sparking feelings of anxiety, frustration and rejection. Studies also suggest that patients who were able to see the same provider for an extended period felt a sense of stability, respect, and trust and their treatment outcomes, perhaps the most important thing we're after here were positively affected. Under current rules, patients can no longer receive coverage for care with a provider who is moved out of their insurance network. When that happens, patients are forced to start over.1196 State law, I'm suggesting here with this legislation should protect continuity of care by preventing this harmful interruption.

This Bill has become ever more important this session in the context of the unprecedented mental health challenges brought on by the Covid pandemic. Those who already struggled with mental health found themselves in environments that made it difficult to maintain progress, including the transition to remote treatment. Others experienced new mental health challenges and had difficulty finding a provider. As you will hear later, this Bill is endorsed by the Mental Health League advisors Committee, the National Association of Social Workers, Massachusetts Health care for All, Health Law advocates, the Association for behavioral health care, the Massachusetts Association for Mental Health and many other groups concerned about mental health. I strongly and respectfully urge the committee to support S 6361251 and H 1039 to ensure that every patient in the commonwealth can receive quality mental health care that they need. Chairs, please also look favorably on S 648 and S 675. Thank you so much for taking my testimony.

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MEGAN PUGACH-GORDON - FORSYTH INSTITUTE - SB 648 - I'm speaking in support of S 648. So the Bill for the act relative to ensuring treatment for genetic craniofacial conditions. My name is Dr Megan Pugach Gordon and I am an assistant faculty scientists and director of education at the Forsyth Institute which is a nonprofit or a health research institute in Cambridge. For the past 20 years, I've been researching tooth development and genetic tooth abnormalities. More specifically, I studied the genes that cause Amilio genesis imperfecta which affects enamel, the outer surface of the teeth and dense genesis imperfecta which affects dent in the layer under the tooth enamel. These genetic craniofacial diseases are inherited and caused by mutations and genes important in craniofacial development, such as those that cause cleft lip and palate which is currently covered.

Amilio genesis imperfecta or AI is associated with increased pain sensitivity, infection abscess and bone loss. It's a rare dental disability which deteriorates over time and requires continual treatments throughout the patient's lifespan. The varying and heritages patterns of AI means that parents don't necessarily know they are carriers as disease status may be very different in children and parents. Teeth can look gray or brown or yellow are rapidly worn and susceptible to fractures and this is not a result of poor hygiene. Patients and their families experience a reduced quality of life due to extensive treatments and financial hardships. Although our research is progressing and we are dedicated to finding cures to AI and other genetic craniofacial conditions, they do not yet exist, but meanwhile the patients are suffering.

So the available treatments are not cosmetic at all, in fact, they enhance function and aesthetics, which can improve the psychosocial functioning of patients. AI can be mitigated with appropriate care, but such care must be accessible through medical insurance coverage. As both a mother and a health oral health researcher, I'm heartbroken to know that some Children spend their childhoods and pain and embarrassment only then to spend their adult lives enduring repeated painful treatments while their families are financially devastated due to the lack of health insurance. The Forsyth support of oral health research dates back 50 years and we remain committed to oral health and overall health. I commend the broad coalition of stakeholders who have come together and compromise to craft legislation that will provide appropriate medically necessary care covered by medical insurance, to mitigate the hardships caused by genetic craniofacial conditions and I order the committee's full support. Thank you.
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YOSHIYUKI MOCHIDA - BOSTON UNIVERSITY DENTAL SCHOOL - SB 648 - Thank you. My name is Dr Yoshiyuki Mochida, I am a Associate professor at the Boston University School of Dental Medicine. I am a dentist and a PhD1541 scientist whose career has been devoted to academic teaching, research, patient care and service. For the last 12 years, my research laboratory has been focused on genetic craniofacial conditions,1554 researching the dental and facial abnormalities with dental genesis, imperfecta analogies, imperfecta and ectodermal dysplasia. Today, I'd like to briefly explain about these genetic conditions and the reason why I feel this Bill should pass. Our teeth as we know composed of two layers. Top layer is enamel, which is the hardest part of the body at the bottom layer is dented, which is as hard as born.

Enamel and venting layers are strongly connected. If there is a gene mutation in enamel coating self producing cells in enamel porting becomes abnormal, this abnormal condition is called emergency1596 product which is just explained by Dr Pugach. Ectodermal dysplasia is also caused by abnormal enamel plotting. If there is a gene mutation in dent plotting cells, which is the bottom layer lent plotting, becomes abnormal. This abnormal condition is called contingency impact because of these abnormal proteins. All1620 of the teeth become abnormal and often chip away in patients with ectodermal dysplasia. In patients with the1629 intelligence imperfecta, all of their teeth become softer than food. If this condition is left untreated, all of the teeth are worn off.

The patient's teeth become nonfunctional of course, often very painful and the patients loose easily. As our gums and jawbones are holding our teeth, if patients was even one single tooth, they can't really maintain the amount of jaw bones. Consequently the jaw bones become deformed and they often experience abnormal occlusion and sometimes generate temporomandibular disorders, which is a jaw joint disease. To prevent this whole craniofacial problems, it is important to address three points; one, diagnosed at early age, second, start the age appropriate and the disease appropriate dental and craniofacial treatment as applicant has needed and third, maintain the normal chewing function for the quality of their life.

Otherwise the untreated conditioning ultimately increase the treatment cost. Therefore, those three are the most difficult cases for dentists to treat requiring extensive dental treatments. So correction of these defects is vital for copper, oil and the cranial facial functions and these defects are not visible when babies are born but become more obvious when they start chewing food. If so, we should consider these conditions as the same as other birth defects in terms of medical necessity. I thank you for the opportunity to testify and now I'm happy to answer any questions and comments.

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ADAM LOWENSTEIN - TUFTS UNIVERSITY SCHOOL OF DENTAL MEDICINE - HB 1153 - HB 1208 - HB 1214 - SB 648 - Thank you, I appreciate. So I'm1767 a second year pediatric dental1769 resident at Tufts. I'm asking you to consider approving House Bills H 1153, H 1208, H 1214 and S 648 to improve and enhance the access to care for pediatric patients with genetic craniofacial disorders. On behalf of the Tufts University School of Dental Medicine pediatric residents, we issued a survey to the massachusetts Association of Pediatric Dentists about the treatment of patients with craniofacial disorders. There is such a burden placed on the families of patients with craniofacial disorders that dental treatment should not be another obstacle. A significant percentage of the dentist said there are barriers other than costs that impact the family's abilities to receive proper dental care, including finding a properly trained dentist that can treat the children with1814 special needs, that travel to that said dentist and time off from work.

Here's some of the quotes from the MAPD dentists. Many patients might be seen by dentists that are not familiar or can train to treat them. No one outside of boston wants to take on the cases and this is really a long term issue, proper bonding is not always achievable and the restorations, the dental restorations often have to be maintained and redone multiple times. Of the dentist survey, some of the patients families have had to decline treatment. It is overwhelming for these families because they needed interdisciplinary treatment and early intervention. The long term cost of declining and delaying treatment as drastic as baby teeth will impact adult teeth terribly down the road.

Once cavity starts in baby teeth, they can travel fast through those teeth and infection can spread from the1862 baby teeth to the adult teeth. If treatment is unable to be obtained, the patient is not only being placed in danger, but the patient will also have grave psychosocial effects. On behalf of all the pediatric patients with genetic craniofacial disorders and their families, please pass this important legislation to improve and enhance the access to care, we need significant legislative efforts in support of these bills. Thank you for your time and consideration.
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NGUYEN - TUFTS UNIVERSITY SCHOOL OF DENTAL MEDICINE - SB 648 - Good morning everyone. My name is Doctor Adrian Owen, I'm a current second year pediatric dentistry resident at Tufts University School of Dental Medicine and I'm the1912 current chief resident. I'm speaking to you today to show my support for an act relative to ensuring treatment for genetic craniofacial conditions to ensure that my pediatric patients with these conditions can receive the dental treatment they desperately require. As part of a dental academic institution, our clinic receives numerous patient referrals from1932 private offices all over Massachusetts so they can receive comprehensive care from an interdisciplinary team of dental specialists.

I myself have seen two patients, sisters who both have a Amilio genesis imperfecta where their teeth are malformed and are congenitally missing teeth. These siblings have teeth that are missing the protective outer layer of enamel, leaving the teeth very prone to decay and these patients experience extreme dental sensitivity and pain. Their condition requires full coverage crowns and very large composite fillings that cover the entire surface of every tooth present.1968 These restorations would restore form and function for these very young patients. Due to these malformation of their dentition, the bonding of the general restorations we do can sometimes be subpar resulting and failed and broken fillings that need to be repeatedly redone, requiring numerous visits to the first patient, parent and provider.

Both patients1993 I'm seeing are currently receiving dental care from a team of pediatric dentists, orthodontists, oral surgeons and protonic. The extensive treatment completed for these two patients is only the beginning, a small fraction of the dental treatment they will require over the lifespan of their dentition. Most of these extensive treatments rendered is not covered by their dental insurance and the family is paying significant out of pocket costs. On behalf of my patients and their families, I plead with you to take the steps necessary to pass this important legislation. Thank you so much for your time and consideration and thank you for giving me the opportunity to speak today. If you have any questions, otherwise, thank you.
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JONATHAN WILL - CONCERNED CITIZEN - SB 648 - So thank you for allowing us the chance to speak before the2072 committee today about this important piece of legislation. It's an act relative to ensuring treatment for genetic craniofacial conditions. My nine year old daughter Manny was born with a genetic condition um known as ectodermal dysplasia and it affects her hair, her sweat glands, her nails and her teeth. While she has several functional baby teeth, they don't look like typical teeth, they are small and round and conical and some of them are missing, but just as important, X rays revealed that she only doesn't have permanent adult teeth to replace them. So we've worked really hard to create a medical plan for her and to help her understand what it is that makes her different and special.

So we can talk her through feeling sad or confused when a school teacher creates a chart of how many teeth her friends2139 have lost and she's not on it because she doesn't have adult teeth to push out the baby teeth. I can write a letter from the tooth fairy with a little bit of money congratulating her on taking care of the teeth that she has because we need them to last as long as possible but she's going to need specialized medical care throughout her life on her teeth and possibly her jaw and currently that financial burden, which is immense, would fall in our family because insurance companies routinely denies such claims, they label the work cosmetic because it involves teeth.

My daughter's teeth, her health, her nutrition, her speech development, her social development, they're not cosmetic, they are are part of who she is. We're just one example of why this legislation is so important, it would help so many families in the commonwealth who live with genetic craniofacial conditions and who struggle with health care that should be covered by insurance. So I would respectfully urge you to consider the impact of this legislation and I thank you very much for your time.
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JASSIDE CARBALLO - CONCERNED CITIZEN - SB 648 - My name is Jasside Carballo. I am the mother of2234 a 10 year old daughter who has AI and she is struggling a lot2240 in school, she's struggling at birthday parties, she's struggling pretty much everywhere as a kid because she gets bullied. It's really hard sometimes her coming home from school, coming home from birthday parties, other different places that she may be at dealing with this. It takes a while for me to calm her down, to explain exactly what she's going through as well as going to the dentist, each time we visit the dentist, she has to get a crown. Most of these crowns are silver so they go over her teeth and it's kind of the same thing she feels, it's not helping in any way, if anything, it's directing more attention to her teeth. I also received many quote that I have to spread out to help pay for these copays and the treatment, I hope this testimony helps in looping the whole with AI and craniofacial disorders. Thank you very much.
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JOHN MILLS - CONCERNED CITIZEN - SB 648 - Thank you for the opportunity to share our family's story. My wife, Kylie and I have two boys, 2.5 year old William who is right here with me and Leo who is six months. A genetic test last year confirmed that William has XLHDD ectodermal dysplasia that Jonathan spoke about a couple speakers ago. William currently has four2362 teeth and a child2364 of his age 2.5 typically has 20. If I can put up a picture, I guess I might not be able to do that. So his teeth are very pointy, they look like a shark's too and as a result, it2393 makes it very difficult for him to chew, he's prone to choking and and he's also has difficulty pronouncing certain sounds and we certainly anticipate all the things that Jonathan talked about and the other things you've heard about just integrating socially with his friends. So, and like you've heard, we anticipate a lot2420 of dental work in his future. So we just think this legislation is a wonderful opportunity to help a lot of people like William get medical treatment to do these basic things. Thank you very much.
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REP MURPHY - Where is he at today with his treatment? How does it work for your family? Like where is he at in the process for this treatment?

MILLS - William is at the very beginning, at 2.5, there's really not much that can2494 be done and he's almost too young to even get the X rays to determine what adult teeth he may have. We're just now reaching out to places like Tufts to set up appointments so that we can anticipate what work we should do at what time to give him the best chance of doing as well as possible.

MURPHY - Did you have a hard time finding a dentist that2525 would understand that2526 condition in a child? How how difficult was it for you to get treatment?

MILLS - So we're very fortunate to have a very well connected, I should have mentioned, we live in Newton, we used to live in Brookline, his pediatrician's across the street from Children's hospital and through his pediatrician, we found a dentist locally who is familiar2550 with it and has connections at Children's hospital and also places like BU and Tuft. So, you know, we're very fortunate to be in Boston and well connected, and it's still very challenging for us. Hearing a lot of the stories of people that are further along in the process, it makes us want to get started as soon as possible to give them the best chance and the best medical care.

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ANN QUIGLEY - CONCERNED CITIZEN - SB 648 - Thank you, Chairman and committee members. So I have AI genesis imperfecta, one of the conditions named in this bill, and I started treatment for my craniofacial condition when I was two years old. I've seen at least 20 dentists and specialists2636 all over Massachusetts and as far away as North Carolina, and I've had to switch providers, I have experienced difficulty finding experience providers and I've had years of complicated treatments. I also was going to try to do a quick screen share, let's see if it will work. I don't know if you can see that photo. So I just wanted to show you what my adult teeth looked like before treatment. So on the left, those are my teeth at 14, and then this is another example on the right, another Massachusetts DI patients adult teeth before her treatment.

So you can see that our teeth are small, they're discolored and malformed and you may not be able to see but they are soft and they're breakable and prone to infection. So, I had a full mouth reconstruction at2716 16 and since then, I've had complications like infections, teeth breaking, prosthetics breaking, pain and trouble chewing and my treatment costs has been well over $100,000 so far and almost all of that was out of pocket. I'm 33 now and five years ago I found out that I would need to have another full mouth reconstruction but because of the cost being estimated at $95,000, I've waited to get treatment and kept hoping that this Bill would pass.

Right now, my mouth is a mess, I'm missing most of the molars that I need for chewing, I have decay and infection that often causes pain when I try to bite down, I have broken crowns and bridges, I have an exposed natural tooth where a2774 crown is missing. I've got a partial temporary denture that was supposed to only be for a few months that I've had for years where a front tooth is missing and while I'm waiting for treatment, I'm losing bone in my jaw wherever I don't have a natural tooth or an implant. So please help this legislation to pass so patients can concentrate on figuring out and getting through the treatment itself without the addition of this financial nightmare on top of it. So thank you so much.
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REP FERNANDES - HB 1153 - Thank you, Mr. Chairman and good to see you both and honorable committee members. I haven't testified on many pieces of legislation this session, just given the remote nature and the time constraint that we're all under but this one I really wanted to weigh in on because I feel very strongly about it. I2860 think you've already heard just incredibly compelling testimony from constituents that I have, so I am just here to chime in on the Bill that Ann was speaking to H 1153. This is just a really severe disease that can cause extreme physical harm. People are unable to eat, they2882 have chronic pain and in addition to that, there's severe psychological trauma that comes with it as well around social, pain, around anxiety and depression, other issues.

There's a lot of data around limited employment opportunities that come with having something like this. In Massachusetts, there's no coverage and that's a real problem,2910 we have a loophole in our existing Health insurance system that says, you know,2915 if you have something like this in any other part of your body, it's it's covered but dental insurance is severely lacking. As Ann mentioned, out of pocket costs is insane. I mean, $100,000 she's already paid by the age of 16 and then there's going to be probably have to pay more money down the line if we do not close this gap. I'm really, really hopeful2942 that will be able to do that. I don't know if the other speakers have mentioned, but we had CHIA do a renewed study just last year and they came out with it in the spring of 2021 that shows that this will cost the state significantly less than was previously reported, and it cost the state somewhere between $2.5 and $6.6 million dollars a year.

I think that's a really, really small amount given the scale of this problem and how deeply impactful it is on people's lives, and we're a state that prides ourselves on having universal coverage and a state that prides ourselves in saying that no one should have to forego healthcare to stave off bankruptcy and financial strain. So I just want to chime in3000 and3000 add my support. Thank you so much for reporting this out of committee last session and I really appreciate your due diligence and deep look on this. So thank you very much.

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KAREN TENOR - CONCERNED CITIZEN - HB 1153 - SB 648 - Hello members of the committee, thank you for allowing me to testify today. My name is Karen Tenor, I was diagnosed with Amilio genesis imperfecta and have had countless psychological, emotional, functional and financial challenges as a result of this. I am now a practicing primary care physician in the commonwealth and I know firsthand the impact for dentition has on many aspects of my patients health. Early on, my teeth were brown and brittle crumbling. I was lucky, my family sought out consultation from experts across the world and I was diagnosed with AI at age two. As an elementary school child, I still remember the taunts, the questions, don't you brush your teeth and the discomfort and pain with eating that having an analyst teeth came with.

As a teenager, I spent a summer recovering from a bone graft to prepare my mouth for essentially a full set of implants. During my first two years of high school, before this drastic intervention, I was missing two thirds of my adult teeth. I remember hiding my smile ashamed of the gaping holes in my mouth. I am one of the lucky ones, I speak before you today after having almost every single one3104 of my adult teeth removed. I have almost an entire set of implants. While my bone graft3109 was partially covered by my medical insurance, there was essentially no other coverage. Over the course of3115 my childhood, my parents estimate that they have spent over $250,000 on my dental work out of pocket. Even with all these interventions and costs my problems continue today.

In the last three years, I have had three teeth pulled due to AI related complications and implants placed. Now as an adult with excellent dental coverage, the work has still cost me thousands3137 and thousands of dollars out of pocket. This work is not just cosmetic, teeth are essential for speech, sustenance and our ability to function in the world. I'm almost certain that had I not been born into a family that was able to afford this care out of pocket, I would not be the same contributing member of society I am today. As a patient and a physician, I ask for your support in this essential bill to3160 guarantee coverage so that all patients, regardless of their financial status, can get the care they so badly need and deserve in the3167 commonwealth. Thank you for your time.
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COLLEEN MERCER - CONCERNED CITIZEN - HB 1153 - SB 648 - My name is Colleen, I'm going to read my testimony. Growing up, I absolutely hated the color yellow, even hearing the word made my face flushed bread and turned my stomach into knots. I despise the color so much because there was a thing that made me3232 different from everyone else. Every time I looked in the mirror I saw yellow teeth, yellow frail teeth that I resented more than anything in the world. Throughout my childhood, I was bullied for my condition. There were simple questions like why do your teeth look like that? But I didn't mind as much because of course Kids can be curious and they just had3251 to be told that it was something I was born with. However, there were always the main kids.

Remember the most heartbreaking moment in my elementary school years being the boy, I had a crush on making fun of me, that all his friends behind my back, with all his friends joining it and of course. I think that was the moment where I first truly felt like I would never be loved because of the way I looked. I would cover3272 my mouth when I left and smile without my teeth. I had nothing but shame for something that I was nowhere near my fault. Not only was it hard in my self esteem, but having Amilio genesis imperfecta was physically3282 painful as well. Eating cold food, hard food, chewy food, it all hurt, even going outside in the cold winter months brought tears to my eyes, the sensitivity being too much. I do not want any other child to have to go through this pain. The only thing that kept me going was3298 the hope that one day I would have my dental work done.

One day, I would feel pretty. One day, I want to have to worry3304 about mean comments and one day I'll be able to care really smile. That day has come for me and I'll go and although the process of having it all done was tedious and one of the hardest things3313 I would go through it, times over. I am privileged to be able to have my parents find the means to pay for my work, however, it should not be a privilege. Dental care is health care and families should not be required to pay thousands upon thousands upon thousands of dollars so their children are no longer in pain. Now I can say my favorite color is yellow and I can laugh loudly without covering my mouth. I can meet new people without worrying about them, judging me and I want every person with AI to be able to experience the same relief. Thank you.
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JILL MERCER - CONCERNED CITIZEN - HB 1153 - SB 648 - Thank you. So I don't want to get a little emotional because hearing my sister always makes me feel overwhelmed. My name is Jill Mercer, I am a college graduate of Boston College and now a sales professional. I am diagnosed with Amilio genesis in perfect and I want to mirror some of the things that Karen and Colleen all stated growing up with pain and discomfort, teasing all came with, you know the condition that I wear. I can confidently say that without the work that my parents were able to find the means to3410 pay for. I would not be the person that I am today. I can very much say that I would not be able to comfortably speak in front of a crowd even if it's virtually.

Dental care is essential, the mouth is really like the key to the entire body. You eat, you talk, there's so many muscles in the face for you to express emotions. If you are not paying attention to your teeth and not smiling like you really change your whole demeanor, it really impacts how people view you. I would like to cut out my entire freshman year of college. Every Friday, I was at the dentist chair having my teeth, you know, ground down into little circles to have porcelain crowns put on and that's something that I am extremely grateful for. It was pretty traumatic, I didn't get to experience you know college the way normal kid would, but3466 here I am today,3467 I have all my work done, without the support of my parents, I wouldn't have been able to go to college, we would have had to put the money towards, you know, the teeth rather than my education and I'm extremely grateful for my parents to be able to find other means.

I really urge you guys to move this bill forward so that other patients, you know, my sister and everyone else that was here to testify today can have confidence that their kids one day might not have to go through this. I can say on myself3500 if I find out that my kids are going to have this, it would be very hard for me to go through with having a child knowing that I would have to pay out of pocket costs for their dental care. So thank you for your time and happy to answer any questions but didn't cry today, so it's very exciting.
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ANN MERCER - CONCERNED CITIZEN - HB 1153 - SB 648 - Thank you. Thank you for allowing me to speak today. The last time I was before this committee, I spoke about luck, luck, odds, rolls of the dice and fortune. Our family has experienced all. Today, I will speak about shame. The shame that society and individuals put on my daughters from the time they were young girls, children. The shame a3567 parent feels when they cannot provide the care their child requires at all or the shame that we felt as parents when we would try to explain to our girls, small children that they would need3579 to be patient. We would find a way for restorative work, sadly any and all monies had to be saved for that day. We could not think of the now, only the then.

Convincing children to wait patiently for years for teeth. The Quigley's have been working on this legislative solution to close the loophole in coverage since 2009. I became involved in 2018. Chris and I knocked on a lot of doors before the world shut down due to Covid. At one point, we had a meeting with a senior member of the Massachusetts legislative body. It was suggested that this Bill would never pass, it was also suggested that we instead3633 turn our efforts to approaching dental societies and associations in an effort to request free care. Let me be clear, I am not here for charity, I am not seeking a handout and I do not want pity, what I want is for my insurance to pay for the care and treatment that my family's3657 medical condition requires, no more, no less.

It is my greatest frustration that I have been unsuccessful in my efforts to see this legislation move forward in3671 the Massachusetts legislative. I simply cannot make this happen alone but you can. I implore you to vote this Bill out of committee as quickly and with the most favorable recommendation possible. For that, I am willing to beg. Thank you very much for your time.
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THOMAS CLEARY - DENTIST EASTHAMPTON - HB 1216 - HB 322 - Thank you. Good day and thank you for allowing me the opportunity to testify. My name is Dr Thomas Cleary, I'm a practicing3769 dentist in East Hampton, a small town3771 in the Western part of the commonwealth. I'm also the founder of serious dental subscription management platform that allows dentists to offer patients the membership program in their individual offices. I'm here to testify about two bills; the first is House Bill 322, an act to create direct dental care agreements submitted by Representative Carey. You're hearing from other dental providers and interested parties about the concerns with access to care, affordability of care and inefficiencies in the market.

This Bill is crafted after legislation enacted in 29 other states that allow for direct care arrangements and eliminates a significant hurdles an individual small business owner would face and crafting their own program. Basically,3810 this structure is a new payment arrangement that allows dentists to offer known services such as cleanings, exams and X rays for a known budget able monthly payment. It eliminates the fear of the unknown cost of going to the dentist and provides preventive care. They can help to educate patients and eliminate the need for other, more costly services, it's not insurance. If you accept that things could be better. I ask that3832 you consider this legislation. I'm3834 a proponent for dentists and small businesses owned by dentists.

I believe that there is an opportunity for a more efficient market and that in office subscriptions allow for this efficiency. As evidence of this, I suggest that you look at the federal tax insurance for Delta Dental, the largest dental insurer in the commonwealth, that show delta retaining nearly 40% of the program fees by providing a structure for independent small business owners to offer a subscription directly to their patients, you eliminate the inefficiencies, Delta reports on their tax returns and foster innovation. This legislation would have no cost to the3865 commonwealth and represents an opportunity for legislators to tout their support of efficient and affordable dental care as well as innovative small businesses and employers. I'm also here to advocate for House Bill 1216, an act to provide equal and fair access to affordable dental care for all patients, also submitted by Representative Carey.

When dentists signed contracts with insurance companies, many times their terms in the contract that prevent or hinder them from negotiating deals with other unrelated insurance companies or individual patients. The effect being the biggest insurers become more powerful by engaging in anti competitive practices. This Bill eliminates insurance companies ability to3902 dictate the terms of unrelated parties agreements. I'll give you two examples; if I have a patient3907 without dental insurance who faces financial hardship and needs a denture to place missing front teeth for their job, I can decide to lower my fee for the denture, perhaps only charging the patient3916 the lab fee or waiving the fee entirely, but based on contracts the major insurers offer, I have to give all the insurers patients the same deal, something that would be unsustainable, thereby denying the patient possible care.

Similarly, if I have a major employer and want to negotiate directly with them for a new product offering, I have to give the unrelated insurer the opportunity to pick apart the agreement, to choose the terms they find most beneficial. A way to think about this would be going to burger king. I went there for dinner last night and they had3943 an offer where if you bought one product, they'd give you a second for a dollar. If I wanted to purchase just the second product, I couldn't get it for a dollar but based on the insurance contracts as they now stand, I would have provide the insurance company with the $1 offering for all of my services, even though they have nothing to do with burger king.

Getting back to dentistry, if I want to offer a new pricing strategy for bundling services with a local company, an attempt to eliminate the inefficiency of the insurance market, where many insurance companies will retain more than half the3971 patient premiums, insurance company would get to pick and choose3974 what they wanted, something which would be unsustainable for my practice and stifling my ability to innovate. For these reasons, I ask you support these bills. Thank you.

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JILL TANZI - MASSACHUSETTS DENTIST ALLIANCE FOR QUALITY CARE - HB 1171 - SB 714 - Good afternoon, Chairman Murphy, Chairman Crighton and members of the committee. Thank you for hearing our testimony today regarding the assignment of benefits Bills. House Bill 1171 and Senate, Bill 714. My name is Jill Tanzi, president of the Massachusetts Dentist Alliance for Quality Care. I am representing over 350 independent dentist in the state who own their dental offices. We advocate for protecting the doctor patient relationship and maintain that the dentist owned dental practices are crucial for providing quality care to communities. This is the second time that our organization is filing a version of this assignment of benefits Bill with the help of Sean Duhamel and Chris Cohen from CK strategies.

Half of the states in the US have passed some form of this legislation, including four other new England states, Rhode island, New Hampshire Connecticut and Maine. We urge you to seriously consider it this session.4062 Both patients and dentists would like to see this passed. This Bill will require dental plans4068 to pay offices directly when instructed by the patient. Most dental plans do this in our state, whether the dental offices in or out of network, but our largest two plans to not honor assignment of4081 benefits when the patient's instructs them to do so, a whole host of problems ensue for patients and dental offices4088 when dental plans ignore4089 these requests. I would like to introduce Susan Roth, an office manager in a small, privately owned dental office serving Stoughton and surrounding towns. She is here to tell the stories of patients that visit her office.

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SUSAN ROTH - DENTIST OWNER - Thank you for the opportunity to testify on the assignment of benefits bill and how it is in the best interests of patients like you and me and their dentists. I am Susan Roth, I have been the office manager for my husband's small solo dental practice for over 30 years. I'm going to discuss a few unfortunate consequences that I've faced in our office over the last few months because Massachusetts doesn't have an AOB Bill. Our office dedicates a lot of energy towards attempting to ascertain in advance how much a patient's out of pocket expense4143 will be so that they can avoid surprise billing and plan for their copays. Our policy is that if the insurance will pay an amount to our office directly by honoring the AOB Clause, then the patient doesn't have to pay that amount and this has been our policy for 30 years.

I will give you a couple of examples, one of which is happening right now. We have a 64 year old male patient who has 80% coverage for4176 implants in a Delta dental plan that does not honor AOB. For three years, he has planned for his implant using his maximum benefit of about $3000 of this very good plan. First, one year4194 to have his surgical implant paced by a specialist last year and he waited for his new policy year to begin in April 2021 to schedule his implant ground with our office, we arranged that he would pay half of his out of pocket copay at the impression appointment and the remaining half at the delivery appointment. We would send the claim to the insurance company, and after Delta paid, he can bring us that 80% amount at the time of delivery along with his remaining copay instead of paying completely up front.

Today was the date of delivery, he called me yesterday and told me he does not have the money4238 to pay us. He received that cheque, 80% of his implant but he spent it on something else. He turned to me and he said, why didn't you just have the insurance company pay you directly? I explained that today, I would be discussing his situation at this hearing today, that if there was an AOB Bill, that they would have paid us directly. I have a couple of other circumstances; divorced and separated households. A 22 year old female, her parents are divorced, but her father is the subscriber on her out of network Delta dental plan. She pays for her dental services at the time of services with her own money. Her dad gets reimbursed.

Since her dad and mom have disputes about finances, he put her through unreasonable conditions to get reimbursement for him. The stress was too much for her, she had to find another dentist in network so she didn't have to deal with this pressure from her dad. I've got a 54 year old female patient who had been with us for 13 years recently divorced, trying very hard, struggling to make it on her4314 own with her new minimum wage job, she just turned to us and said she just can't handle the stress of having to pay at the time of service and wait to be reimbursed, so she left to go to another office that would be in network. In some, people in general aren't great with money if they get a check in the mail,4334 they have other obligations or desires, they might spend that check or they don't open the envelope or worse, they throw the envelope out without even opening it or one family member deposits and spends the cheque not realizing that those monies were to be used by another family4353 member to pay the dentist. Thank you for the opportunity to bring these situations to you today and I'm available for questions.
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KERI DISCEPOLO - MASSACHUSETTS DENTAL SOCIETY - HB 1181 - HB 1182 - SB 632 - SB 648 - My name is Keri Discepolo. Thank you, Chairman and committee members for allowing me to speak.4401 I am the Representative of the Massachusetts Dental Society and I'm the Chair of the Council on government affairs. My current position, though is as a pediatric dentist at Boston Children's Hospital. I'm here to speak in support of House 1181 an act relative to increasing patient choice through assignment of benefits, H 1182 and S 632 an act relative to medical loss ratio, reporting for dental benefits corporations and finally, Senate Bill 648 an4444 act relative to ensuring treatment for genetic craniofacial conditions. With respect to an act relative to increasing patient choice through assignment of benefits, the Massachusetts Dental Society believes that all massachusetts residents should have access to equal quality oral health care and they should be able to choose their dental provider and especially choose who is4465 best for them.

To preserve patient choice, an act relative to increasing patient choice through assignment of benefits would require all insurance to permit a covered person to direct in writing that reimbursable benefits for covered services be paid directly to the dentist of their choice. The legislative text also includes provisions to ensure that the rate of reimbursement will be the same whether or not the dentist is contracted with the insurance provider. When working with children specifically, and I work typically with children with extensive dental needs, the cost of care can be very burdensome to families. Out of pocket expenses for families with small children and especially if they have multiple children can be quite large and with day to day costs in their own lives, the expense of dental care can be quite a bit.

Imagine that you have a large dental bill that is covered by your dental insurance but because of the lack of assignment of dentist, you will have to pay the bill and wait for reimbursement from your company and4530 you4530 can imagine that that's very difficult for some families. Imagine as well that if you had established a rapport with the dentist and you were unable to go to that provider because of the extensive dental work you need and the fact that there is an assignment of benefits, how that might be challenging for some people to have to move to another provider. By allowing carriers to withhold assignment of benefits, Massachusetts is allowing dental benefit companies to interfere with the patient's ability to choose the provider who best meets their needs.

We would like the legislation passed so that the commonwealth can provide patients with a simple solution that4567 empowers them to have freedom to go to their provider of choice and reduces financial uncertainty associated with accessing care. With respect to H 1182 and S 632, an act relative to medical loss ratio reporting for dental benefits appropriations, the Massachusetts Dental Society seeks to ensure that dental benefit companies are transparent and accountable. An4594 act4594 relative to medical loss ratio reporting for dental benefits corporations requires dental benefits companies to submit medical loss ratios to the department of Insurance. The legislation would4605 also require carriers to file financial reports with the DOI including detailing self funded lines of business.

Medical loss ratio reporting is important to dentists, but equally important to the patients we treat. Patients take great pains to pay premiums and pay for plans, so dental benefits will cover the care provided, just as you saw with respect to some of the other testimony today. We are concerned that some of those dollars are going to padding carriers bottom lines, and people opt out of dental care because coverage doesn't work for patients, which is a negative trickle down effect on personal public health. It can be very detrimental. Our recent policy brief from Health Policy Institute revealed that among the top three reasons people don't get care is because insurance doesn't cover procedures. Understanding the financial practices of insurance companies is important to dentists who contract with those providers and patients who subscribe to their insurance plans as well.

The law would provide clarification with respect to the amount of profit4671 the company gains from doing business, while at the same time allowing consumers to obtain financial understanding about the insurance plans they are purchasing. Dentist contract with insurance plans to provide financial feasibility for their patients. When contracting with an insurance company, there is little room to negotiate fees. The dentist may not be allowed the reimbursement she desires, and insurance companies are allowed to set those premiums and their profit margins are enhanced by controlling their expenditures to providers and maximizing their income by reducing the increasing the insurance premiums and also reducing the coverage benefits.

Dentistry is costly and many times, patients don't feel they understand why there is not more coverage for services as a testament to some of the testimonies today you heard and why they need to pay large amounts out of pocket. As a consumer, I would like them to understand better the insurance plans, their purchasing and how their money is being used. As a provider, I'd like to know more about the insurance companies with whom I've been contracting and what their business practices are. I would like to just state that we're in endorsement of passing this piece of legislation so that we can better understand how the finances are utilized between the company, the dentist and the patient.

With respect to S 648, an act relative to ensuring treatment for genetic cranial facial conditions, the Massachusetts General Society supports this legislation to improve insurance coverage for craniofacial4764 conditions, providing medically necessary coverage for functional repair or restoration of craniofacial disorders to improve function or if to approximate the normal appearance of any normal abnormal structure caused by disease or anomaly the necessary care and treatment for medically diagnosed congenitally disease. Some other metal conditions that also reduce how many teeth, the quality of the dimensional structures and etc that also present with similar challenges and restore stability and effects online.

For instance, regional differences dysplasia, regional displays dental dysplasia, type one and two, AI genesis imperfecta enamel in Denton, a play asia and Kodansha, or hip Kodansha. Those all have4826 similar conditions that would affect the patient similar way. I would also like the Legislature consider wording with respect to children who undergo cancer therapy. They can have similar effects on their developing dentition that also present such similar to things like Amelia genesis imperfecta where the enamel and Denton aren't formed correctly. These conditions are devastating to the primary and permanent addition, affecting the quality of life patients. As you saw through all the very heart wrenching testimonies. You know, all of these patients talked about the cost of care and how much care they needed. I don't think anyone of them talked about how painful these procedures can be.

As a young child with two year old's going in and having to get restorations like silver caps and things like that, it's hard. You know, a lot of times these Children don't have the voice to talk about the pain and suffering that they cause the fact that the aesthetic burden of not having a perfect teeth and values white straight teeth. I have patients describe the wrapping, bring the hands because they were able to cover the security gates and people couldn't make fun of them or ask them questions about their teeth. So I just would like that that's how far some of our patients have to go to deal with these conditions. Passing this legislation will benefit so many children and would provide a better quality of life to them through their adulthood. I4920 strongly urge you to pass that legislation. Thank you for your time.
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ERIC DUPONT - GUARDINA LIFE INSURANCE COMPANY - SB 632 - Thank you, Chairman Crighton, Murphy and members of the committee. I'm Eric Dupont with Guardian Life. The Guardian Life Insurance company employs about 500 people in Massachusetts and is one of the largest potential insurers in the commonwealth and the nation. So4975 my comments today ain't pertain to the assignment of benefits, loss ratio and other dental insurance bills. Guardian takes no position on the craniofacial legislation. Dental insurance is the third most popular employee benefit after major medical and 401 case. It's a voluntary purchase yet 82% of Massachusetts residents have dental insurance because it offers good value for money and it must offer good value, it is a very price sensitive products. 95% of the private dental insurance market in Massachusetts is group insurance. It's purchased by sophisticated buyers, generally, employers.

Experts advise groups, both small and large on the purchase. So there are two layers of review; employer, employee before it purchase. It's a highly5023 competitive marketplace, with dozens of dental insurers competing for business and that keeps prices low and quality high. If one company fails to deliver low prices and high quality, it will certainly lose the business to others who do. As a result, the Massachusetts dental insurance marketplace is highly developed and well functioning, efficiently delivering cost effective dental care to Massachusetts consumers. For the last decade or so, dozens of bills have been filed to tinker with the dental marketplace. Generally, they seek change at the expense of consumers.

This year's bills are no different, several bills require significant new reporting requirements that will add administrative cost5063 with no return to consumers yet will cause premiums to rise. Two, would require reporting of loss ratios. My understanding is the division of insurance eliminated that requirement for dental insurance in 2017, I'm not sure why, but I assume it did so as the information had no use. Other bills attempt to change dental network arrangements. It is not clear what the objective of the Bill is, we Guardian does not object to the way some laws are written in that regard but these clearly we would object to ah as they would pertain to pricing and other factors. Again, dental insurance is a voluntary purchase in a very price sensitive product.

If employers find it is not a good value, they will not purchase it. If consumers find it is not a good value, they will not purchase it, yet 82% of Massachusetts residents freely choose to purchase it. Guardian values its relations with dentists in Massachusetts, we are partners working to deliver superior dental care at affordable prices to the citizens of the commonwealth. To protect the consumers of the commonwealth, the health of the Massachusetts dental marketplace and indeed, the practice of many hardworking dentists in massachusetts, Guardian opposes the dental bills before the committee today. Thank you.
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JENNY ERICKSON - LIFE INSURANCE ASSOCIATION OF MASSACHUSETTS - Good afternoon, Chairman Crighton, Chairman Murphy and the members of the committee, thanks for letting5148 us testify before you today. I'm Jenny Erickson, senior vice President and general counsel at the Life Insurance Association of Massachusetts. LIAM is a trade association that represents 23 of the nation's leading life long term care, disability and dental insurance carriers.5165 Many of our members also offer family and medical leave and retirement plans. I'm here to speak in opposition to the bills regarding dental insurance that are before your committee today. None of these measures will provide meaningful rights or benefits to dental consumers, rather they will unnecessarily increase costs for dental plans, leading to higher premiums and restricted access to care.

According to the American Dental Association, having dental insurance coverage contributes to better dental and overall health, but the5196 more and more adults are experiencing increased financial barriers to care. The ADA research has long shown that financial barriers are the most common reason for5207 delaying dental care, especially for Hispanics and blacks. Their research has also shown that dental care seeking behavior is strongly associated with having dental benefits and that individuals with dental benefits are more likely to have visited the dentist in the last year and go to the dentist5225 for preventive care than those without benefits. It's important to note that, according to the National Association of Dental plans, dental benefits are relied on more heavily by consumers with lower incomes.

In Massachusetts, 44% of consumers covered by dental benefits have an annual household income of less than $50,000. The Bills5248 in your committee contain a number of provisions, including unnecessary reporting requirements and undermining of dental networks that will raise the price of dental insurance. Thus, rather than creating pathways to affordable care, these Bills actually create greater financial barriers to accessing dental care in the commonwealth. This will no doubt be a detrimental to both the dental and the physical health of families and individuals here. I'd like to mention the work5277 of the Special Commission on Dental Insurance and I was a member of that commission because we believe their perspective is still important today.

Because of the potential detrimental effects similar proposals would have had on Massachusetts, consumers and their oral health, the Special Commission on Dental Insurance expressed concern and voted against these similar measures, voted against them5301 several years ago. The law creating the commission charged it with making recommendations5306 to promote access to and delivery5309 of affordable quality dental care in the commonwealth and to file a report with the General Court detailing its work and findings. The commission report was submitted on December 2014. Although not specifically addressed by the Special Commission, there are several aspects of the bills before you today that fly in the face of the commission's goal by making affordable dental care more difficult to access. We believe the commission would likely express concern about them should it still be active today. We will be submitting more detailed written comments to you within the next few days and again, thank you for letting us testify today.

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LEIGH SIMONS YOUMANS - MASSACHUSETTS HEALTH AND HOSPITAL ASSOCIATION - HB 1061 - Good afternoon,5363 Chairs Crighton and Murphy, and the entire committee. My name is Leigh Simons Youmans, I am the senior director of health care policy for the Massachusetts Health and5371 Hospital Association. MHHA serves a the unified voice for Massachusetts hospitals and health systems, representing over 100 hospitals, health systems, position organizations and allied health care providers across the commonwealth. On behalf of our members, thank you for the opportunity to speak today on House 1061, an act to strengthen and expand access to behavioral healthcare filed by Representative Marjorie Decker.

As we all know, our behavioral health system has faced challenges for decades. No one could have expected it to get any worse but the existing emergency department or ED boarding crisis compounded by Covid, has resulted in a pressing behavioral health crisis that has truly been the epidemic within the pandemic. In response to the crisis, MHHA has recently begun to collect weekly psychiatric boarding data from health systems across the Commonwealth. Over the past three weeks, that data has shown more than 500 patients waiting in EDs or on medical surgical units for an inpatient psychiatric placement.

I would note that in the last two5432 months, hospitals have seen a marked reduction in pediatric boarding consistent with the long standing trend of decreased pediatric boarding during the summer, when kids are away from the stresses of school. As a result, we may well see that 500 border number increase as the summer ends and as kids go back to school in the fall. The administration and legislature have been partners to5453 our health care system on all of our challenges during the pandemic, including the issues of emergency department boarding. This has included funding in the Fy 21 budget, an additional substantial investment for Mass health that will bring 300 psychiatric bits online this calendar year. Also Mass health supplemental payments to support psychiatric units.5473

Just last week, the administration announced funds dedicated towards immediate workforce needs to attract and retain staff at inpatient psychiatric units and facilities. These incredible financial commitments by the state will help to address the current acute crisis. Addressing the longstanding systemic challenges of the behavioral health system will take additional steps which we look forward to addressing and continued partnership with the administration and legislature. House 1061 would do so by addressing workforce reimbursement and coverage and other access and administration of the system.5507 I won't go through every provision of the Bill but did want to highlight a few. To address workforce challenges, it would establish a behavioral health investment trust fund to5517 support the expansion of services and increased rates of payment for behavioral health providers.

Importantly, this would include supports for behavioral health pipeline initiatives to expand the behavioral health workforce in the long term and in a culturally competent way. We increasingly hear from hospitals and health systems and other stakeholders that behavioral health workforce shortages are the primary barrier to increasing services. To address reimbursement of coverage, it would create a behavioral health rate task force to, among other charges, evaluate ways to ensure the financial stability of inpatient behavioral health units and facilities, including a cost based method for rate determination and adequate reimbursement for staff and require coverage for all medically necessary mental health services across Mass health, the AGIC and the commercial insurers.

Thank you again for the time to testify this afternoon on this pressing issue. Solving the boarding crisis has been and will continue to need to be a collaborative project between the legislature, the administration providers, payers, advocates and others. MHHA is eager to work together to solve this behavioral health emergency. Thank you.
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JENNIFER WARKENTIN - MASSACHUSETTS PSYCHOLOGICAL ASSOCIATION - SB 636 - HB 1039 - Thank you so much for having me today. I'm Dr Jennifer Warkentin, I'm a licensed psychologist in private practice and up until last month, I also served as the director of professional affairs for the massachusetts psychological Association. I'm here today on behalf of MPA who will also be submitting written testimony to testify in support of S 636 and House 1039, an act providing continuity of care for mental health treatment. This5640 is a Bill that we've been supporting for a very long time and it's an incredibly important Bill. I know that a few people have testified on this earlier, but I really want to highlight the importance of the therapist client relationship. When we're looking at how effective is a particular therapy or treatment, anywhere from 30 to 50% of the kind of contributing factors are5667 the therapist client relationship.

So we're talking about one of the most important features and one of the most important predictors of whether or not therapy is going to be successful. When we're talking about therapeutic alliance and that relationship, we're really talking about, does that client feel comfortable being open with their therapist? Are they able to talk openly about what they're thinking and feeling? As well as you know, as a therapist, are we able to push our clients a little bit without alienating them? And so you really have to have that strong relationship in order to do the very important work of therapy. Unfortunately, with the way that the behavioral health system is set up with carve outs as well as you know if you think about all of the different health plans that have behavioral health benefits, there are wide ranges of reimbursement rates as well as varying levels of unfair business practices, and so there's a lot of very legitimate reasons why a clinician might be contracted with some health plans and not others.

But the unfortunate aspect of that as well is, you know, when people are changing health plans, you know, they might track as my PCP listed in this new plan because that's what people think of, but they don't often think to check whether or not their therapist is still listed. So this becomes a really significant issue, and I've seen this in my practice with clients. It's really difficult to have these conversations with folks. I know sometimes plans have said we'll use5765 out of network benefits, well we're seeing more and more plans that are not offering out of network benefits at all anymore, that is something that is becoming less and less common, and those that are offering out of network benefits have very high deductibles. So I'm talking easily starting at5784 $1600 for deductible.

So out of network benefits are really not the kind of replacement that they used to be, and so essentially what ends up happening is the client is forced to choose between paying out of pocket to continue their treatment or have to go through the process of finding a new therapist, creating a new relationship, and then trying to kind of pick up the pieces at that point and move forward. It's just not feasible, you can't just kind of hand off to another therapist and replicate that relationship. What we're talking about here is basically that the providers would be willing to accept the end network rate for that health plan, so we're not talking about increased prices for the plans, we're really talking about preserving that5836 relationship and making sure that somebody's mental health doesn't deteriorate, making sure that we're not seeing people experiencing an increase in symptoms solely because of a change in jobs or because their employer has decided to try to save money through a different health plan.

As it stands right now, as clinicians we're lucky to get five sessions for a transition before we basically say, you know, we have to stop seeing the person. Again, this is a Bill that we've been working on for a very long time. It was reported favorably from this committee last session and we're really really hoping that you guys will report favorably on this as well. It's really, especially with the pandemic, again, this is a really key piece of helping people manage the emotional impact of5897 the pandemic and not penalizing them because of this kind of whole separate system that's being used for behavioral halt. Thank you so much for your time today and I'm glad to answer any questions if you have any.
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CRIGHTON - Just a quick question in terms of tracking patients that have gone through that transition, is there a way to quantify how many continue? I mean imagine the disruption may lead some to you know, stop treatment altogether or stop the visits altogether.5934 Is there a way to quantify that? Have any studies been done?

WARKENTIN - I can certainly go5940 back and take a look. I don't know that there's been studies that look at kind of the quantity of that happening, there absolutely have been studies that have looked at the negative impact of therapist changes on a person's mental health, but I can certainly take that back and see what we can find for you.

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TIM CLEMENT - AMERICAN PSYCHIATRIC ASSOCIATION - HB 1041 - SB 675 - My name is Tim Clement, I'm director of Legislative Development for the American psychiatric association, and I'm testifying in support of the mental health parity implementation bills H 1041 and S 675, and6017 I'll6017 certainly stay within a three minute limit. As Representative Balser and Senator Friedman mentioned earlier, these pieces of legislation are about requiring insurers to perform comparative analyses demonstrating that they are in fact in compliance6031 with some of the very complex components of the federal mental health parity law, and this is something that is obviously very important with suicide, that's rising overdoses at record levels. I just wanted to point out to the committee two things that have happened that might have gotten lost in the shuffle of6049 the pandemic.

One thing that happened just before the pandemic, another thing that happened at the end of last year that are very relevant to these pieces of legislation. The first is that last February, the Massachusetts Attorney General's office, found that several insurers6064 in Massachusetts were directly6066 violating the federal parity laws related to how they set their reimbursement for behavioral health providers and also how they designed and apply their prior authorization practices. So what this demonstrated, it's quite clear that we have direct evidence that there are still in fact ongoing parody problems in the commonwealth, which, of course, highlights the necessity for this legislation to provide the transparency and accountability on the part of insurers, to make sure that they actually are in fact in compliance with the law but it seems like we have evidence that indicates they might not be.

The second piece of information that is relevant is at the end of last Congress in December, Congress passed and the President signed into6106 law legislation that requires every health insurer in America,6109 including those in Massachusetts, to perform comparative analyses demonstrating that in fact, comply with the complex component of the federal parity law, and these analyses that they have to do now under federal law are almost identical to what is in H 1041 and S 675. So what this means is there really shouldn't be any pushback or opposition from the insurance industry because they already have to do this, This is already required of them under federal law, it's been required of them since February 10th of this year. So this is something they have to be doing right now anyway, however, this legislation is still important H 1041, S 675, because we need to make sure that they actually submit those analyses to the Commonwealth and6146 the Commonwealth review those analyses to make sure there is in fact compliance and follow up, but there isn't, or if they get incomplete analyses.

So, I think the point here is that we know that this legislation is necessary because we have direct evidence of non compliance within the last year and a half in Massachusetts and federal law now already requires insurers to do6166 this work, so there really shouldn't be any objection to actually submitting the analysis to the commonwealth for inspection. So with that, I'll conclude my testimony and thank the committee for allowing me to testify.



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SEN CRONIN - SB 645 - SB 646 - Thank you, Chair Crighton, Murphy and members of the committee for the opportunity to speak to you today, and support two bills. The first, an act for medical necessity fairness, and the second bill, an act for supportive care for serious mental illness. Both these Bills take action to address the lack of mental health parity6249 that exists today in the commonwealth. I have a panel that is assembled here with me today who I'm proud to stand along, they will share both their experience and expertise to articulate the win win that these two bills seek to achieve. The first is dignified treatment, better patient outcomes and lower costs of care, but specifically, both these Bills seek to address insurance gaps that denied patients access to critical care.

The first bill is an act medical necessity fairness and it it seeks to update the law to provide more equitable access to and coverage of behavioral health treatment to all residents and families in the commonwealth. Currently, commercial health insurance carriers develop their own medical necessity guidelines or purchase commercially available guidelines that are not in accord with widely accepted standards used by treatment providers and, in fact run, counter to the medical judgment of providers6305 in determining what care they will cover and what is medically necessary. So the result is that many patients are denied critical treatment because insurance providers don't consider it medically necessary.

So this Bill addresses that coverage gap and requires commercial health insurance carriers to use standardized medical necessity guidelines for treatment, guidelines adopted by national accreditation organizations like the American Society of Addiction Medicine to define what is medically necessary6336 for patients suffering from substance use disorder or with a mental health diagnosis. So I'd appreciate your consideration of that Bill. The second Bill I'd like to speak to is an act for supportive care for serious mental illness. This Bill requires commercial health insurance plans to cover evidence based, coordinated6355 specialty care programs to treat serious mental illness such as schizophrenia or schizo effective disorder.

What's so important about treatment programs is that they provide critical, ongoing, wraparound supportive care to patients after their first serious acute mental health crisis and hospitalization. This model is proven to improve recovery rates and avoid future hospitalizations down the road related to acute mental health episodes. It mitigates clinical deterioration and the need for more intensive treatment to achieve recovery and the results are better outcomes for patients, long term cost savings to our behavioral health care system and most important dignified treatment for patients and their families. So I ask for your consideration and a favorable report of both those bills, and I am also joined by a panel, I'm proud to defer to for their expertise and experience speaking to both of these Bills, but thank you to both chairs and look forward to moving these along. So thank you very much.



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SUZANNE CURRY - HEALTH CARE FOR ALL - SB 675 - SB 645 - Good afternoon, Chair Murphy, Chair Crighton, and members of the committee. I'll be testifying on two bills. So thank you for the opportunity to testify in support of Senate bill 645 an act relative to medical necessity fairness that the Senator has just testified regarding, and S 675 an act relative to mental health parody implementation. My name is Suzanne Curry, I am the behavioral health policy Director at Health care for All and a member of the Children's mental health campaign leadership team. State and federal parity laws require health insurers to cover mental health and substance use disorder treatment under the same terms and conditions as they cover other medical services but despite these laws passed more than a decade ago, problems still persist.

Families report that denials of coverage, burdensome health plan approval processes, inadequate provider networks and other issues continue to block access to timely appropriate care. They're also as the Senator talked about, can be a mismatch between medical necessity criteria insurers use and the generally accepted standards of care providers follow. Given the high and increasing prevalence of behavioral health conditions, especially in the aftermath of a pandemic, it's imperative that we enact systemic policies that underpin access to services. To address these issues, State parody and related health care laws must be updated and enhanced to close loopholes, increased transparency and provide consumers with tools to understand6526 and assert their rights.

As Senator Cronin explained earlier S 645 requires carriers to follow established independent guidelines for determining medical necessity of behavioral health care to account for different treatment approaches for different age groups like kids, to aim to treat underlying conditions, not just the acute symptoms, and to follow generally accepted standards of behavioral health care. S 675, the parody bill will strengthen existing laws around parody to ensure that consumers are not unjustifiably denied behavioral health care services. It does this by strengthening consumer appeal rights and private insurance and Mass health enhancing division of insurance and Mass health parody oversight and enforcement roles, requiring carriers and Mass health managed care plans to complete parody self assessments and analyzing the impact of behavioral health contractors on consumer access.

Both of these Bills will help advance true behavioral health parity and support ongoing reforms to make meaningful difference for individuals and families across the commonwealth. So with that, we ask you to favorably report both Senate Bill 645 and Senate Bill 675 from your committee. Thank you for your time and attention today.

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WELLS WILKINSON - HEALTH LAW ADVOCATES - SB 675 - SB 645 - Good afternoon, Chair Crighton, Chair Murphy, Senator Cronin and members of the committee. I thank you for the opportunity to testify in support of Senate bill 675, the mental parity implementation bill, and also Senate bill 645, the medical necessity legislation. We think these two Bills will give consumers the tools that they need to start accessing behavioral treatment on the fair and equal terms that were intended under both the Massachusetts federal parody law. I'm sure the Massachusetts parody law and the6634 federal parody law that was passed more than a decade ago. My name is Wells Wilkinson, I'm an Attorney with health law advocates and nonprofit law firm that provides free legal services to Massachusetts residents seeking access to needed health care coverage or services.

I would like to share a few6649 of my clients stories that unfortunately illustrate the kinds of barriers to behavioral health treatment that consumers still face in Massachusetts today. One of my clients at age 20 went to the ER after attempting suicide and he revealed for the first time, his secret for your long history of undisclosed depression and anxiety. The ER and ESP team both evaluated him thoroughly and transferred him to a nearby inpatient facility for treatment and this is the one that had the only bed available in Eastern Massachusetts at that time. Despite all of this, his carrier denied coverage because the bed was in an out of network facility. This denial violated two Massachusetts laws and was overturned successfully by our appeal.

Another client at age eight had a complex mental health condition affecting how he interacts socially, including with other children. His carrier denied authorization for a play therapy group that his parents had found saying that play therapy was not medically necessary because the eight year old could participate in traditional talk therapy. This is despite the fact that the child had just completed 16 months of attempting talk therapy with no progress and his own therapist determining the talk therapy was not appropriate for his age and condition, this denial was also overturned by our appeal.

A 19 year old client of ours with autism received a denial or in the form of a reduction of therapy hours regularly every six months for nearly five years from his carrier and behavioral health carve out and this is true, even though along the way, all but one of those denials or reductions were overturned successfully by appeal. This shameful and inappropriate and quite honestly erroneous series of denials only stopped by the carrier and their behavioral carve out after it was addressed by the Massachusetts Attorney General's office in a parody investigation and settlement that Dr Tim Clement mentioned earlier. Lastly, you got one last client, he was 24 year old with depression and substance use disorder who had been in treatment for years and he had three recent suicide attempts.

He was denied coverage for about half of the length of the stay for his residential treatment and for two weeks of subsequent step down therapy at a partial hospitalization program. Now, we successfully overturned the6791 first denial, but we lost the second one because the appeal reviewer applied an overly restrictive medical necessity criteria, basically saying he was no longer at risk of suicide, and this is an inappropriate criteria for a step down program. It might have been appropriate for an inpatient level of care, right? And due to stigma and the families fear of the disclosure of his name, behavioral condition becoming public, the family chose not to pursue this denial through further legal challenge. So I thank you for your consideration in support of Senate 675 and 645 and hopefully hope that you report those Bills out. Thank you.

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MONICA LUKE - NAMI MASS - SB 646 - HB 1062 - Thank you, Senator Crighton, Representative Murphy and other members of the committee for hearing my testimony. My name is Monica Luke, chair of the advocacy committee at NAMI Mass, which is a grassroots organization and our members and individuals with mental health conditions, their family members, caregivers, we are often the people on the front lines of dealing with our mental health system and all too often we find that evidence based practices for individuals with serious mental illness are not covered by commercial insurance. My son, age 40 has schizophrenia. I'm testifying today on S 646, H 1062, an act for supportive care for serious mental illness. Psychosis typically on sets between age 16 and 22, when young people experience a psychotic episode, they're often hospitalist in an acute crisis and given6911 large doses of medication to be stabilized.

Once discharged, individuals and their families must6916 navigate their illness and try to find a path to recovery. But without a treatment team or care plan in place, many individuals cycle in and out of the hospital from crisis to crisis. Our NAMI family members are often left to watch helplessly as their loved one suffers without adequate care losing ground with each episode of illness.6934 I've personally experienced that with my own son. Our medical system does not operate in this way for serious physical illnesses such as cancer,6943 diabetes or6944 a heart attack. All these illnesses provide follow up care, supportive care to ensure individual has the best possible outcome. Would we find it acceptable if an insurer covered surgical treatment for children with cancer but not chemotherapy or radiation?

The ACA requires health insurers to cover dependence until age 26, yet, despite mental health parity laws and we've heard something about that earlier today from Wells and Tim, some of the most effective parts of care for psychosis are simply not covered. When young people6976 can't get access is dependent on their parents health insurance, they end up getting treatment in taxpayer funded programs, but usually asked after a significant delay and significantly worse illness. As they live with untreated psychosis, they may lose their community, friends job and eventually experience interactions6994 with law enforcement, incarceration, homelessness, and increased use of social services. Again, this all comes at a cost to taxpayers and a huge cost to the individual.

The CSC act programs when achieving fidelity to standards as required by this legislation, have years of research demonstrating their success and you'll hear about that shortly, and beyond having a much better outcome for the individual, these programs reduce7019 the overall cost burden on insurers, we shall hear about shortly from Eric Barons and yet insurers currently are passing the cost of treating psychosis to the taxpayer and much, much worse, they're delaying appropriate care for these young people. As NAMI Massachusetts, we're all too familiar with the trauma of ineffective treatment and unnecessary barriers7039 to recovery. Massachusetts has the opportunity to7042 join Illinois and other states who have passed or are considering passing similar legislation. For the well being of our young people in the Commonwealth dealing with serious mental illness, we urge you to report favorably on H 1062, S 646 to provide the supportive care our loved ones and family members deserve. Thank you for your time.

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DOST ONGUR - MCLEAN HOSPITAL - SB 646 - HB 1062 - Thank you, Senator Crighton, Representative Murphy and other members of the committee for hearing my testimony. My name is Dost Ongur, I'm the Chief of the psychotic disorders division at7079 Mclean Hospital and William P and Henry B Test, professor of psychiatry at Harvard Medical School. I'm responsible for all clinical services at7087 our hospital for individuals with psychotic disorders including the Mclean program of assertive community treatment or ACT. I'm testifying today on Senate 646 House 1062, an act for supportive care for serious mental illness. In the fall of 2017, we established the act program at McLean Hospital because we identified7108 a missing support and the services for individuals with psychotic disorders. To explain, there are very expensive programs available in Massachusetts7116 for those who can afford them, but otherwise only programs provided by the DMH at taxpayer expense and available to a small number.

Our program is person centered, it incorporates principles for open dialogue and includes peer support, specialists and a multidisciplinary team. We support high acuity individuals meeting their medical needs and supplying7138 wraparound services such as jobs, school and housing supports. The program is available 24/7, 365 and it provides families and caregivers an alternative to calling 911 during a crisis. These are important hallmarks of ACT and other coordinated specialty programs. ACT takes place in the community and our team members travel to our participants, meeting them literally where they are. ACT sometimes seen as a never ending program. But thus far we have successfully helped 25% of those we serve to move along in their recovery journey, or as we say, graduates from the program.

Among our participants, 61% have gotten jobs, 32% have returned to school. The medical literature, in addition to these gains also shows that ACT improves quality of life and satisfaction with care for the people we serve and also their families. While these improved outcomes should be reason enough to support increased availability of ACT programs, these programs are also very cost effective because ACT reduces the need for inpatient hospitalization. Participants in Mclean ACT program had an average of about two inpatient hospital stays per year prior to joining, and this dropped to 0.7 states per year while in the program, and they also required shorter stays when hospitalized once they were in our program.

Our ACT program has accompanied individuals to court proceedings and in one case, we helped a young man receive probation rather than a four year prison sentence. There are too few ACT programs available in Massachusetts. As a consequence, far too many young people spend years cycling in and out of hospitals, lurching from crisis to crisis, adversely impacting their brain function and reducing the possibility of staging a full recovery. Requiring health insurers to cover these life changing programs would change that trajectory, and it's a painful irony that these services are cost effective to insurance payers and to society. For all these reasons, I strongly support and respectfully ask on behalf of myself, my division and McLean Hospital that you report S 646 and H 1062 favorably from your committee. Thank7271 you for your time.

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ERIC BUEHRENS - RELIANT MEDICAL GROUP - HB 1062 - SB 646 - Thank you, Senator Crighton, Representative Murphy and members of the Financial Services committee for the opportunity to speak in support of an act for supportive care for serious mental illness. My name is Eric Buehrens. For more than 20 years, I have managed lead and consulted two leading healthcare organizations in the commonwealth and beyond as executive Dean for administration at Harvard Medical School, as chief operating officer and interim CEO at7305 Beth Israel Deaconess Medical Center and as chief operating officer and executive vice president and Reliant Medical Group, a prominent multi specialty medical group that provides health care to tens of thousands across Worcester county. Daily on the ground, management experience in these and other Health Care post has convinced me that the provisions of this bill, which would require commercial insurance to cover evidence based programs to treat serious mental illness, will not only result and significantly improve care for these patients, but will reduce the overall cost of medical care in the commonwealth and ensure that the state's commercial insurance sector plays an equitable role in funding to carry these patients.

Since the passage of Chapter 58 Act of 2006, so called Romney Care, the policy of the commonwealth has been to encourage the transition of the care model from the fee for service model that dominated the preceding decades to the so called value based or risk based care model, in which healthcare providers are compensated and rewarded for providing quality care outcomes across a patient population, rather than simply paying providers for discreet and often ineffectual encounters with a disjointed and difficult to navigate healthcare system. This General Court led the way nationally in this important policy shift and our7386 commercial insurance sector were likewise national leaders in incentivizing healthcare organization to assume population health risk for cohorts of patients and their systems of care. In7399 the past several years, the Baker administration has also encouraged providers in the Mass health system to move to value based accounting, the result that many of our community health centers are participating in7410 accountable care organizations to pool risk and streamlined the provision of care for these vulnerable populations.

My experience in leadership of Reliant medical group provides played an important illustration of how this transition can catalyst improved care for behavioral health conditions.7427 Under a fee for service in the 90s and the early years of this millennium, Reliant was forced to curtail its provisions of behavioral health care because the reimbursement available to it for these services from both governmental and commercial payers was significantly less than cost, losses mounted and no viable alternative was available. But to reduce the complement of behavioral health providers, a robust service necessary to patients was reduced to a skeleton, patients were therefore referred to other available resources in the community, typically funded by Mass health.

After the passage of Chapter 58, Reliant made a strategic commitment to cover risk-based care converting most of its commercial insurance contracts to fully delegated risk arrangements in which we assumed responsibility for the total cost of care, including the cost of behavioral health care. It quickly became clear that a very large percentage of the burden of disease for our patient population, both commercially insured and Mass health was behavioral in nature or had a significant behavioral component. In order for us to be successful in controlling the total cost of care, it was necessary to focus on the provision of behavioral health care, it's quality and ensuring access to the patient. We needed to increase our investment in behavioral health to ensure7511 our overall solvency.

Therefore, Reliant during my tenure there from 2013 to 16, rapidly rebuilt its behavioral health staff and infrastructure and integrated this care within an enhanced focus7524 on multidisciplinary primary care. We hired dozens of new behavioral health providers, we embedded them with our primary care teams because it was obvious that if these patients continued to fall through the cracks of a disjointed care model, we would fail in both our clinical and financial goals. Since patients with7544 serious mental illness are known to incur significant medical expense, we put plans in place to manage this care in a cost effective way, just as we did for patients with medically complex needs. The present system of reimbursement for serious mental illness, incentivizes health care providers to neglect the care infrastructure needed for these patients and pass the buck to the taxpayers to fund this care.

When that happens, care7571 is disrupted, continuity is lost, and too often, patients and families end up lurching from crisis to crisis rather than receiving the ongoing care that they need. My experience and reliant and elsewhere has convinced me that mandated commercial insurance coverage for these patients, along7589 with the incentives already promoted by both the commonwealth and commercial payers to move provider organizations of value based care to accountable care organizations or other risk mechanism. These measures can significantly improve the coordination of care, improve quality and patient outcomes and lower the total cost of care.

Massachusetts has already been a leader in expanding health care coverage through Chapter 58 the ACA and is engaged in a long term effort to control the cost of health care by restructuring the incentives provided given to providers. Requiring commercial health insurance to cover7629 the cost of evidence based programs to treat the onset of serious mental illness is another step towards7635 a more integrated and effective system of care for the citizens of the commonwealth. I'm confident this approach will be successful and strongly urge the committee to move this Bill along. Thank you very much for your time.

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CRIGHTON - Just had a brief question. I was really gonna ask us to Wells, but I guess anyone on the panel feel free to jump in. It's a question around parity and I think given how important timely access is to care and how difficult it may be for many families to navigate the mental health system and care, can you just talk a little bit about the current process and timeline for parity complaints7684 in how this bill could help improve that process and timeline?

WILKINSON - Sure, Senator. So right now at the federal level, if you file a parody complaint for what we call a self-funded plan, a plan that's not subject to state law here in Massachusetts, the average is about 12 months for that agency to investigate a parody complaint, and those are based on published reports by that agency. Here in Massachusetts, we don't have documentation or records of that sort, but in7717 HLAs experience, we filed about three or four different parody complaints with the division of insurance, we're yet to hear7725 a response or decision on any of them, right? And it's been well over 12 months or 18 months at least. So that's what this bill would actually introduced a requirement that parody complaints be investigated in a prompt like 90 day manner, both by the division of insurance and also by Mass health.
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REP KERANS - Thank you, Senator. I just had a question and I think a couple of people could probably, let me start with the fellow from Dost Ongur from Mclean. If a family brings their 16 year old in crisis to McLean, they show up at the door, do you ask for their insurance? I don't mean to sound accusatory, just trying to understand, does someone say, what's your insurance or do you kind of get them stabilized and say, well, we'll deal with that down the road?

ONGUR - No treatment decisions are made based on insurance status, including no insurance, but, you know, we collect the insurance information of course, so if it's available so that it can be built, but that does not impact whether the person is going to go in the hospital, go to our clinic and so on.

KERANS - Roughly how many people come with some insurance, even if it's inadequate?

ONGUR - So with the reforms over the past decade, plus that number has risen. At this point, so, you know, I'm not an administrator, I'm a psychiatrist here, but my understanding7843 is that it's north of 95% of all people walking7846 in the door have some kind of health insurance when they come to McLean.
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PATRICK AQUINO - BETH ISRAEL LAHEY HEALTH - HB 1057 - Good afternoon, I am Dr Patrick Aquino and thank you for having us here. I'm a psychiatrist and Chair of the division of psychiatry at Lady Hospital Medical Center, Medical Director for Integrated Services for Beth Israel Lahey health, Behavioral services and the senior representative to the American psychiatric association for the Massachusetts psychiatric society. I would like to thank7897 the committee Chair, Senator Crighton, Representative Murphy for the opportunity to speak today on House Bill 1057, an act relative to collaborative care. Collaborative care7905 is an evidence based model of enhanced integrated primary and behavioral health care designed to meet whole person care. Too often individuals are unable to get the care they need when they need it most.

Collaborative care works by bringing the necessary care to individuals in the trusted space of their primary care providers office and surrounding them by a team of professionals led by their primary care provider. As an example, at BILH, we have committed to integrating behavioral health into all of our employed primary care practices. And since coming together as a system, we have already done so and over 50% of those practices with more being added every other month. Let me share a recent story that highlights what are collaborative care program and Beth Israel Lahey Health is all about and how it is one means of breaking down the barriers to access to psychiatric care for patients.

During a routine appointment in primary7956 care, an individual is found to be suffering from his depression. Instead of referring him into the community where he may wait for weeks or months for an appointment, the primary care provider was able7966 to introduce him to a behavioral health clinician in the office and get started in treatment that same day. With the leadership of his primary care provider, the expertise of a consulting psychiatrist and the support of the behavior health clinician, this individual is able to feel better, get back to work and have his depression treated in the same amount of time. Unfortunately takes too many other people to just get7988 in to see a mental health professional in the community.

The commonwealth has an acute shortage7993 of psychiatrists and do the pandemic in ever increasing need for mental health treatment. Collaborative care is a proven and effective strategy to increase access to specialty psychiatric input in the care of individuals, thereby providing timely, personal and effective care in their primary care setting. As a practicing psychiatrist, I see individuals in my office one on one and I practice as a consulting psychiatrist to several primary care8018 practices in this collaborative care model. In the same amount of time it takes me to evaluate and treat one person in my office through case review with the embedded behavioral health clinician as part of this collaborative care program, I can provide psychiatric input to advance the care of 6 to 7 individuals in the primary care space.

This particular evidence based model allows us to scale by orders of magnitude the psychiatric care available to individuals here in the commonwealth. Our member psychiatrists at the Massachusetts psychiatric society are interested and eager to partner with our primary care colleagues to find more ways to reach more people in need. We need your support to break down those barriers of payment and coverage that have to date stymieing many of these efforts. We are thankful that as July 1st of this year, Mass health began paying for this critical integrated behavioral health service. This is one of a number of steps Mass Health has made in recognizing the critical need for behavior health treatment, promoting more effective treatment and advancing health equity.

We respectfully ask you to pass this bill allowing members of the commercial insurance plans to have access to this important health care service. On behalf of the Massachusetts psychiatric society and Beth Israel Lahey Health, I want to thank you all for providing this opportunity to comment on this bill and help bring greater access to psychiatric services to people in need here in the commonwealth. Thank you for listening to this testimony.
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CLEMENT - HB 1057 - Again, I appreciate the opportunity to comment again. This time, I will be testifying strongly in support of H 1057 which doctor Aquino, you know, just so eloquently described what collaborative care is and how it works and how he practices in that. I won't go over too much of the mechanics of how it works,8132 I think Dr Aquino did a fabulous job doing that. What I will do is emphasize when he talked about evidence based, he wasn't kidding. There's over 90 randomized controlled8141 trials showing the collaborative care not only8143 works, but it works a lot better than8145 usual care. This is one of the most highly evidence based interventions we have in behavioral health care.

Unfortunately, there's not enough private insurance reimbursement for collaborative care, that's why this legislation is critically important. This is something that works and it works really well. Also evidence cost benefit analyses that show collaborative care is highly cost effective and probably more cost effective than traditional methods of behavioral health care, and this is something that we think that if most insurers in Massachusetts were fully acquainted with collaborative care , they'd be fully supportive this as well. The reason I think this is because earlier this year, an identical piece of legislation passed in Montana. In Montana, multiple insurers testified strongly in support of this legislation.

In fact, the blue cross blue shield representative from blue cross blue shield Montana said he called collaborative quote a force multiplier. That's exactly what Dr Aquino just described, it takes existing behavioral health care workforce and allows it to practice more efficiently and more effectively, meaning that more patients get care, they get better care, it probably saves money as well. So I think with all those things combined, this legislation I think is a no brainer and we strongly urging to support and and recommend this immediately.
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GARY CHINMAN - HARVARD MEDICAL SCHOOL - HB 1041 - SB 675 - I'm Gary Chinman, I'm a psychiatrist and a former president of the Massachusetts psychiatric society. I want to thank, Chair Crighton and Chair Murphy for giving all of us the opportunity to give testimony. I want to speak in support8246 of bills, H 1041 and S 675 having to deal with parity in health care because parity will improve access. A study produced by the militant organization supports the unfortunate conclusion that health insurance companies are misrepresenting their products to consumers in Massachusetts by showing them health plans that do not have an adequate number of in network providers to treat the beneficiaries, mental health and substance use disorders.

As a result, consumers who purchase these health plans and then try to access in network8286 behavioral health care cannot find an in network provider. As a result, in either a, the beneficiary goes without treatment or b, the beneficiary goes out of network for their psychiatric treatment. The study also suggests that the health plans are intentionally limiting access to in network psychiatrists by paying these8310 providers lower reimbursement rates than they pay8313 to other physicians for comparable services. Militiamen used medical claims data from major insurers, covering nearly 42 million lives over a several year period and found a nationwide patients used an out of network provider for a substantially higher proportion of mental health8336 and substance use disorder care than they did for other physical8340 illnesses.

In Massachusetts, proportion of inpatient facility services for mental health and substance use disorder care that were provided out of network was 2-6 times higher than for physical illnesses and the proportion of mental health and substance use disorder office visits that were provided out of the network was 2-5 times higher than for physical illnesses, and even 3-4 times higher than for specialist office visits for physical illnesses. Compared to all other states, Massachusetts has a 400-500% higher behavioral health out of network use. Not coincidentally, the study also found that physicians providing physical health and surgical services received higher reimbursement rates than psychiatrists providing mental health and substance use disorder services.

Numerous studies have shown that lower reimbursement rates paid to psychiatrists is a major contributor to lower network participation rates by these behavioral health providers. As a result, accessing these services in network is often challenging. In Massachusetts, provider payment levels for primary care, office visits are 40-70% higher as compared to payments for comparable psychiatrist office visits, making Massachusetts payment disparity8441 one of the highest in the nation. In other words, very unfortunately, parody has not been implemented in Massachusetts as insurance companies have found ways to circumvent existing laws meant to address the discriminatory disparity in health care. This law before us today can help Massachusetts residents finally access to behavioral health and substance use care they need and deserve. Thank you very much for this opportunity to talk about these bills.

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TANZI - HB 1172 - SB 236 - I'm Dr Jill Tanzi again. Our second bill is the patient bill of rights, it's House Bill 1172 Senate Bill 236. The patient's Bill of Rights will not only help lower dental costs overall, but it will also help create price transparency for consumers. This will allow them to receive care sooner rather than wait for weeks to receive an estimate that8568 may not even be a guarantee of benefits from the insurance company. Here are the highlights, it requires dental plans to explain if the treatment is based on the least costly option rather than the best option. This is important for the patient to understand because insurers often downgrade treatment to the least costly option, which is not in the patient's best interest. Insurers should never interfere with a8592 diagnosis or treatment plan without seeing a patient clinically.

Discussing the amount of amount8599 covered or method used in determining reimbursement aides dental offices in accurately determining the patient's copay. This is important to create transparency in pricing for the patient. This information should be available online8613 and should be accurately updated when plans change. Any plan must have a website with accurate and non misleading information to assist offices in providing patients with estimates.8626 In or out of network. Again,8628 this is necessary to provide the patient accurate and timely information for his case so there is no surprise billing. In cases where dentists and a predetermination of benefits. It is important that the dental plan honor this information and not change its determination after treatment is performed.

8648 To8648 avoid surprising patients with unanticipated copays, dental plans must honor predetermination of benefits. If all dental plans could follow these rules, we could lower the cost of administering dental care. We currently spend hours and hours each day calling some dental plans on hold for more than hour who do not provide complete information on websites. It is a tedious job and should not be necessary with computers and the internet, we're not in the 1980s anymore. In addition, emergency care cannot be preauthorized and we need accurate information the same day. It is just another way to slow patient treatment and create tension between offices and patients. I am available for questions on any of our bills and would like to work together to help patients and dentists in our state. Once again, Susan will give you a couple of examples for the committee.
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ROTH - HB 1172 - SB 236 - Hi again, I am Susan Roth and I am the office manager of my husband's small dental practice as I have been for the last 30 years and I8712 have seen a whole host of situations that would be resolved if we had more transparency in pricing and accuracy of websites to prevent surprise billing. Dentists are trained to provide the highest standard of care to patients while the insurance company's goal is to pay for the lowest cost alternative. This is disguised as providing usual and customary dentistry for the area. This is lack of pricing transparency and leading to surprise billing as well as interfering with the dentist patient relationship. I'm going to give you a couple of examples.

One, we have a 59 year old female patient had8751 four implants and came to us needing a fifth implant. She had 50% coverage for implants with 2500 maximum per year. The insurance company downgraded the implant to a removable partial Since she had four8767 other teeth missing on that same arch. A year later, the same patient needed a sixth implant, which was denied because there is a five year replacement rule for a partial, which they based their prior payment on. It doesn't make sense for a patient who has four or five implants to now8788 have a removable partial, that is not the standard of here. She has the benefits of $2500 maximum, she's paying for that in a premium and they're not allowing her to access that gear.

The explanation of benefits in this particular case states that the alternative service covered is a partial leading a patient to believe from the language on the claim that the dentist is making a poor choice when there is an alternative. The language should state just like the disclaimer on a cigarette pack that this is the lowest cost alternative service that has nothing to do with the standard of care in dentistry. The policy and the language is not transparent, it's misleading and breeds mistrust between the dentist and the patient. I want to give another example, what is the most common reason people go to the dentist? You go for a cleaning, right? So in order to have a, patients rely on whether or not they're cleaning will be paid, the limitations in frequencies variations are onerous to track, leading to surprise billing.

Patients do not understand that he are splitting distinctions between in fluctuations on planned provision, which change with the acquisitions emerges of parent companies and renegotiations of insurance contracts at random times of the year. Cleaning frequencies can be two times a year, three times a year, four times a year or every six months in a day. It could be based on a calendar year, a fiscal year or a policy year beginning on a random month. It is the year a 12 month year or 365 days, it does matter. Two representatives from the same insurance company reveal the wrong answers on these issues. Dental offices interpret8894 this wrong from an unclear website and then the patients blame the dental office, not the insurance company for giving the wrong information.

This is not a Saturday night live improv skip, this is every hour in the dental office Administration, patients and dental offices need transparency and consistency of information and access to information. In particular, although our office is currently in network with blue cross blue shield, those officers who are out of network have no access to information about frequency and limitations or explanations of benefits. This drives a wedge between the dental offices and the patients and it's sort of like playing a game of cards and the rules change whether the aces are high to low mid game basically.

In closing, dentists are trained to provide the highest standard of care to patients and we should be able to rely on websites and calling claims representatives but many of the claims representatives that we're speaking to are outsourced to other countries, they're working for multiple insurance companies at the same time with different policies and they're giving us the wrong information. Thank you for the opportunity to present this testimony to you today about8974 real life situations that would be resolved if we had a dental bill of rights.



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