2023-12-05 00:00:00 - Joint Committee on Financial Services

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REP ELLIOTT - HB 1003 - Good morning, Mr. Chairman and Chair Murphy. Thank you, and thank you for taking me out of turn, I do appreciate it. I'm here today to testify on House Bill 1003, an act further regulating the withdrawal of local subscribers from the commission. H 1003 would change the notification by a mere three months from the date of March 1st of the same year at the withdrawal. Currently under the municipal insurance law, municipality, school districts, other local units, whose retirees and employees are insured by the state GIC must notify the Group Insurance Commission by December 1st of a deadline, if it attempts to withdraw from the GIC303 effective July 1st. I can remember as a city councilor, being one309 of the communities that did join GIC, saving valuable dollars for our community. Members who are serving on local health insurance negotiating groups known as PECs, they voiced concerns to me in the time gap between the December 1st deadline in GIC's decision during the next February, March. It prevents them from331 properly comparing the GIC with other municipal health insurance in order to make the best possible decision, or even perhaps if necessary for financial reasons, leave the GIC. So, again, I won't take up your valuable time, my predecessor also filed this, but, H 1003 will address this time gap and extend the deadline by three months to ensure that the local officials and our public employee committees can make informed decisions, relative to insurance decisions for municipalities, school districts, and others. So, with that, I do369 thank you for your time. I thank you for taking me out of turn, I know, time is of the essence of a long agenda. I'm happy to take any questions, I'm hopeful the committee can look favorable on this.

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DANIEL DITULLIO - THE MASSACHUSETTS DENTAL SOCIETY - HB 1122 - HB 1123 - HB 1124 - Chairman Feeney, Chairman Murphy, members of the committee, and your staff, I appreciate the opportunity to testify here today. My name is Dan Ditullio, I am the director of government449 relations for the Massachusetts Dental Society. Since 1864, the Dental Society has been advocating on behalf of nearly 5,000 members in457 the Commonwealth and I do think it's important to note that, although, we serve the dentists in the Commonwealth, a lot of what we do is focused on the patients, those who are receiving the care from our members. Whether it's access to care, the quality of that care, insurance matters, we strongly believe that a lot of what we advocate for, goes throughout the oral health community right down to our, patients. I also want to thank, Rep Puppolo, who filed our legislation on behalf of us. Today, we're here, with the panel, who I will let introduce themselves in one moment, on behalf of House Bills 1122, 1123, and 1124. I would also like to say that we will be submitting written testimony in support of 1094, which I believe groups will also testifying on behalf. But the three Bills I've just mentioned filed by Representative Puppolo are the official advocacy Bills of the MDS.

The first one, which I will just briefly mention before I turn it over to our members to discuss the two others. 1123, which is a Bill that we filed in response to former Governor Baker's Patients First Act. During the discussions that took place while that Bill was debated, the focus was primarily on health care, large healthcare organizations, hospitals. Through some language that was in there that we discovered after the fact; dental health has been included within that. It's kind of a loophole, as far as the guidance that was given to the Department of Public Health and some existing language, which does include dental providers as health care providers. Essentially, our concern with that is the fact that the legislation was based on large healthcare organizations, with dentists, we're talking about, oftentimes, single providers, and some of the, requirements that were put forth in the Patients First Act, essentially, would be a big burden on a small dental office to do some of the paperwork, the reporting, that has been required as part of the Patients First Act. We understand it's been postponed until 2025, but this is something that we would like to see corrected as soon as we can. Obviously, our goal here609 today is to see favorable release of these three pieces of legislation which are615 currently before the committee on financial services.

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FRAN CLAIRMONT - THE MASSACHUSETTS DENTAL SOCIETY - HB 1122 - HB 1123 - HB 1124 - Good morning. Thank you so much for this opportunity to talk about House Bill 1122. My name is doctor Fran Clairmont, and I'm Chair of the government affairs committee at Mass Dental Society. House Bill 1122 is an act662 relative to financial services' contracts, the Dental Benefits Corporations. Under Massachusetts law, dental benefits companies can fix reimbursement fees even for services that dental benefit companies do not actually reimburse. This artificial price cap is unfair, unjustified and unduly forces dentists to shift costs to private pay patients who are disproportionately young people, seniors, and working families whose employers don't or can't offer dental benefits. By703 passing this Bill, consumers will be protected from unfair practices by increasing transparency and prohibiting dental benefit companies from having patients pad their bottom line through the setting of fees for services they have no intention of covering.

Where is it appropriate that one company can set the fees for another company with no regard to actual costs and where there is no intention of this company reimbursing the second company for their services. Why should742 non-insured private744 pay patients subsidize746 the care of insured patients? House Bill 1122 will prevent dental benefit companies from artificially setting the fees for services they don't pay for, which shifts the cost to patients least able to pay to bear these costs. Again, the young people, seniors, and working-class families. By passing 1122, you would protect private pay patients, that is Massachusetts residents without dental coverage from having to subsidize the care of patients788 who do have the luxury793 of dental coverage. Thank you.

ABE ABDUL - THE MASSACHUSETTS DENTAL SOCIETY - HB 1122 - HB 1123 - HB 1124 - Thank you very much for your time. I really appreciate all you folks being here today. My name is doctor Abe Abdul, I am the President of the Massachusetts Dental Society. I represent over 5,000 members of the Dental Society, but more importantly, I'm a general practitioner. I practice in Quincy, Cambridge, and Saugus. My patients are middle income patients, and I have been a MassHealth provider for two decades. I see those that very few people want to see, I see the referrals from MGH and Brigham Women's Hospital of critical care patients who are going through chemotherapy, radiation therapy, are being prepared for transplant treatment. I'm here today to talk to you about something very important, and that is, during Covid, I had the experience of serving Brigham, MGH, Tufts, and helping them854 find dental care for patients who would otherwise not have dental care because of the Covid shutdown because the list of dentists were very, very limited.864 During that experience, I built something called Dental Cupid, and using that platform, I studied why patients choose the doctors they choose, and believe it or not, it's not a platform, it's actually through word-of-mouth.

People go to the doctors because of word-of-mouth, and people go and pick their dentist because of something called trust. You trust your doctors, that's why you go to them. And how does trust actually happen? It happens through cultural connections, through language, through location, through experience, through the practitioner providing the time that you require in order to address the care you need. Currently, there are barriers to you picking that one doctor. The insurance companies through bureaucracies, through credentialing, prevents you from seeing that doctor you want to see. That is not fair, that is not right, that is not how we build a health care system. Patients have the right to choose the doctor that they want and need to see and they trust. 1124, assignment of benefits, allows you to use your insurance dollars to see that one particular doctor that you pick, that you choose, that you believe provides the best care for you and your family. I urge you to provide feedback, if necessary to me and myself and the dental society, and I urge you to support 1124. Thank you very966 much.

DITULLIO - I would just say in, summary, these three Bills that you've seen here today, access for patients to dental care, the prices that are paid by patients for their979 dental care, and even for the981 Patients First Act, the patient's dental care that can become burdened by unnecessary administrative expenses on a dentist who should be putting their focus on their patients. So, again, I do want to make clear that although we stand here as a Massachusetts Dental Society, we're going right back to the patients of doctor Clairmont and doctor Abdul.

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doctor Mark Bavares.

REP MCMURTRY - HB 1094 - Good morning, Mr. Chair, and members of the committee, thank you so much, we really appreciate the opportunity to be here today to testify on1051 behalf of House 1094. As you can see, both Senator Rush and I are committed to this process, committed to the individuals that'll be here today advocating, and I'm going to limit my conversation. I'm going to let Senator Rush make a comment, and then1070 we're going to pass it off1072 to Tom Healy, a constituent of ours from Dedham and one of the founding members of the organization that is formed out of this overall process. Also, we have doctor Mark Varvares, chief of oncology and head of neck surgery at Mass Eye and Ear. This Bill has been a multiyear process, we've, filed it session after session, it's got the favorable report of this committee. What we have today is an opportunity for us as legislators to make a difference for individuals who have already gone through a significant trauma relating to medical conditions, cancer primarily which is covered by medical insurance, but then the result of the dental needs is not covered.

Our friend here went through radiation therapy for a carcinoma, it caused significant complications, the treatment that he suffered remains uncovered, and he's committed himself to making a difference not only for what started out an effort with Senator Rush and I on his behalf, but for others. Again, as I mentioned previously, the organization that was born out of this process is called MOPSS, Massachusetts oncology patient, survivors and supporters. You're going to hear from individuals today who are going to share a lot of personal stories, and have met with them. I've heard their stories, I fear feel their pain, and, again, look to us in the legislature to make a difference, and we do believe that the timing is right, and this is something that we hope will have a favorable report. I said I'd be limited, and I apologize that I wasn't, but I want to turn over to my good friend, and colleague, Senator Rush.

SEN RUSH - HB 1094 - I want to thank you, Mr. Chairman, chairman, members of the committee. It's a pleasure to be with you this morning. I'm here because Representative McMurtry, as we all know, is an extremely passionate advocate for constituents, and this is an issue that came to his attention. He in turn brought1202 it to my1204 attention, and, certainly, we learned a lot in the process and continue to learn a lot in the process. But Mr. Healy has done an unbelievable job in taking his personal experience and relating it to others throughout the Commonwealth to form this incredible network. So, you're going to hear from him and others today as the Rep mentioned. Again, here to be fully supportive of the legislative endeavor and to try to get this to the Governor's desk this session. Thank you.

THOMAS HEALY - MASSACHUSETTS ONCOLOGY PATIENTS, SURVIVORS AND SUPPORTERS - HB 1094 - Thank you to, Chair Murphy and Chair Feeney, and the members of the joint committee on financial services for allowing me to come in and testify today. My name's Thomas Healy, and I reside in the town of Dedham. I just want you to know, I wrote out at least three different times what I am going to say to you. So, I woke up at 4:47 this morning, I think my brain was spinning all night saying, what am I going to say? And it's because there's so much to say. So, whatever I wrote down, here we go. So, it's been a long year for our group, but it's been a very productive year. We, the Massachusetts Head and Neck Cancer Survivors and supporters, also known as MOPSS. I want to stop for a second to say that last year,1306 we had three letters of support. We were able to advance House Bill 1154 over to the joint health care committee and joint care on financial services, and, we hope to do that again this year. So, I hope you take the time to read those very supportive and important documents that we've submitted to you because in those letters, we have support from all the way down the Cape, from Cape Cod Healthcare to the Western part of the state, UMass Memorial, and many more, including the Boston area, Mass General, Dana Farber, and many others. So, Massachusetts House Bill 1094 will require insurers doing business in our state to provide coverage for medical related dental treatments.

I'd like to read into the record a statement I wrote in 2020 before the financial services committee on House Bill number 1053. This affects thousands of people in our state, if something is not done to expand coverage of dental procedures as a medical necessity, in the near future, there will be thousands of people going through the doors at all the oncology treatment centers, all hospitals who otherwise will face unavoidable health risk. I'm asking you today to advance House Bill number 1094 like we did last year over to the joint committee on health and financial services. Lastly, I'd like to thank all my new friends that are with us today, we've done so much hard work this year. I wanted to say one more thing, we're only going to get bigger, we started out with me as one, then we went to three, theoretically, our group is up to 30 hospitals or other institutions in the state, like the1497 Mass Society of Otolaryngology, the Mass Society of oncologist. So, if this doesn't work this year, there's 159 hospitals across the state, not one hospital that I've reached out to over the last two years has said no, that's telling me that forever how long this goes, we will have all 159 hospitals, and I'm hoping that we can somehow get the mindset of the regulatory agencies here in the statehouse to take a great look at it and say, let's see what we can really do. So, I thank you for your time. Thank you so much.

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MARK VARVARES - MASSACHUSETTS GENERAL HOSPITAL - HB 1094 - Good morning. My name is Mark Varvares, I'm a head and neck surgeon at the Massachusetts Eye and Ear Infirmary. I'm the Chair of the department of otolaryngology at Harvard Medical School, Chief of the service at Mass Eye and Ear, and Chief of the service at Mass General Hospital. Really appreciate the committee's time and attention to this very important matter this morning. Just take a moment to say I'm also a cancer patient, I'm in the middle of treatment for acute myeloid leukemia, had a bone marrow transplant 103 days ago. But this issue is important enough for me to get out of quarantine and come and talk with you this morning. I've been taking care of head1604 and neck cancer patients for over 301606 years, and I've watched them struggle with this issue of dental coverage. It's very often the case that one cannot separate dental issues from medical issues in the care of the head and neck cancer patient. This challenge comes in many different forms, here's a couple of examples. Many of our patients, as you know, have to have radiation therapy as part of the treatment, its life-saving. But that therapy comes at a cost, and I'm not talking about financial costs, although we're here to talk about finances, it also brings other issues down the road that directly affect their dental care and their dental health.

So, before radiation therapy, patients need to have a full dental evaluation and many times have to have dental extractions done, sometimes a full mouth extraction, which can be very, very expensive. Many patients can't afford it, insurance oftentimes doesn't cover it. So many times, patients forego dental care that's necessary before radiation1667 and therefore don't get the radiation that they need. I have a patient in the last two years that fits this exact scenario, he had major surgery on his tongue to remove a cancer, he was referred for radiation therapy. The radiation therapist appropriately said you need to have dental care done; he went to a dentist. It was going to be thousands of dollars to get his teeth pulled prior to radiation, he just didn't do it, didn't get the radiation. Presented to us with a raging recurrence, fortunately, he was able to undergo chemoradiotherapy, and right now, he's disease free, but we know treating cancer the second time around is not as successful as the first time around.

So, this lack of coverage for patients to get basic dental care before their head neck cancer treatment is threatening their survival, something has got to be done about it, we see it over and over again. Here's another scenario; I'd like everybody in the room just to take their tongue and touch it to the top of their mouth. So, the roof of the mouth is the floor of the nose. We have many patients with cancer either at the palate, the roof of the mouth, or the floor of the nose. In order to cure that cancer, we have to remove that common wall. Well, guess what? That means you have a hole that goes from your mouth to your nose, okay? This can be easily managed with something called a surgical obturator, it's like a denture that pops into your mouth. These cost tens of thousands of dollars. I've had patients say they had to mortgage their home in order to get this covered. Patients should not have to do that. So, in closing, all I'd ask is the head and neck cancer patient should be able to focus on getting better, not on worrying about getting coverage or paying their dental and medical bills. So, I implore you, please, pass 1049, so our head and neck cancer patients can worry about getting better and not worrying about how they're going to pay their bills. Thank you.

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KRISTINE GRAZIOSO - SOUTH SHORE CHILDREN'S DENTISTRY - HB 1110 - Hello and thank you for having us today. I am Doctor Kristine Grazioso and I am a pediatric dentist on the South Shore and I am also the Vice President of the Alliance of Independent Dentists in Massachusetts, and I'm representing that group today in this testimony. I'm here to testify in support of House Bill 1110, an act relative to dental insurance assignment of benefits. First, I wanted to tell you a little bit about what the Alliance of Independent Dentists is. We are a grassroots group, we were founded by a handful of dentists in 2017 and we are a non-profit, it's all volunteer dentists who are in this group. We, through grassroots efforts, represent over 500 dentists in the state and our main representation is of the patients of the state. We formed as an advocacy group to try to advocate for patients' rights and for our dental profession. But for this1911 Bill, House Bill 1110, the assignment of benefits, I want to explain what assignments of benefits is. It's really simple, honestly. It means that if a patient and their dentist choose, the dental benefit company or the insurance company will send the fee to the dental office after the insurance claim has been submitted.

But currently in our state, there are some benefit companies who will not honor assignment of benefits to out of network dentists. What this means is that they send the insurance check after treatment has been rendered directly to the patient, and that leaves the patient having1946 to pay the dental office on the day of1948 service. It's not a big deal if it's just a small procedure, but if you're a family, say, of five children and you are paying for five preventive visits, that can be a lot of money to lay out on that one day. So, what this Bill would advocate is that there's a choice, a choice for the patient and a choice for the dental office, and that if each of those decides that the reimbursement should go to the dental office, that's where it should go. If this is passed, this will give patients more1978 choice and the dentist that they choose to see, and it1982 won't interfere with the doctor patient relationship. Of note, there are 35 other states around the nation who have already passed this legislation, including our neighbor, Rhode Island. It would not cost the state of Massachusetts anything, and it would only help the residents of our Commonwealth. So, it's a really simple concept, and I don't see why there should be any opposition to something as simple as this. I thank you very much, and I also wanted to thank Representative Peisch for sponsoring this, Bill.

JILL TANZI - ALLIANCE OF INDEPENDENT DENTISTS - HB 1111 - SB 697 - Good morning. I am doctor Jill Tanzi, President of the Alliance of Independent Dentists. Thank you for the opportunity to testify on behalf of the Alliance of Independent Dentists and our patients. I'm testifying today in support of House Bill 1111 and Senate Bill 697, an act relative to dental insurance consumer protections. The consumer protections Bill increases transparency in pricing and helps both consumers and dental offices determine accurate co pays in a timely manner. There was so much talk regarding price transparency in health care, and we agree patients should know exactly how much care should cost before they are treated. In the computer age, these estimates should never take more than a day. You need to give us the dental care professionals the information to provide our patients with accurate information before we treat them. This information should be up to date and accurate on a website and accessible to in network and out of network dentists. Some insurers do this better than others, but everyone could do a better job.

Not only is timely information essential, consumers should be protected from mistakes made by insurance companies regarding their benefits. It is also important that patients understand how their insurance company determines coverage, and this should be disclosed so that patients and2104 employers understand before purchasing a plan. Besides price transparency, there is the underhanded practice of sending payments to dental offices in the form of paper credit cards. This form of payment is not secure, and it also costs offices money to process the payment. This type of practice is illegal in several states and adds another layer of expense to dental office overhead, which is then passed on to the patient. Please help us help patients, let's increase price transparency and decrease overhead in our dental offices with technology and their business practices. Thank you.

Thank you both for your testimony. Appreciate it. Any questions or comments from members of the committee here or online? Seeing none, again, thank you so much for your testimony. Appreciate you being with us.

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ELIZABETH MURPHY - MASSACHUSETTS ASSOCIATION OF HEALTH PLANS - HB 1110 - 1111 - HB 1124 - SB 697 - SB 698 - HB 992 - HB 1010 - HB 1050 - SB 717 - Thank you, Mr. Chairman, committee members, nice to see everyone. My name is Liz Murphy, I'm here on behalf of the Massachusetts Association of Health Plans. We represent 16 health plans and two behavioral health patients providing coverage to 3,000,000 Massachusetts residents. I'm here to talk also about House Bills 1110, 1111, 1124 and Senate Bill 697 and 698. These Bills would impose new and onerous requirements on dental carriers, eliminate consumer protections and increase costs by expanding networks without any guarantee of more equitable health outcomes or improvement in the quality of care. As you may be aware, significant changes were made to dental insurance in Massachusetts via ballot question last year. State law now directs dental plans to spend 83% of premiums on direct dental care by reducing administrative costs. Ironically, the new requirements in the state will require significant administrative and operational work in order to implement new procedures unprecedented in our dental market.

The potential withdrawal of dental plans from the Massachusetts dental market and the loss of affordable coverage options for consumers in the Commonwealth would be an unacceptable consequence of implementation of the ballot question. Without access to affordable insured dental products, many Massachusetts residents would go without care, putting more costs on the system. The division of insurance has spent considerable time throughout this year working to implement the requirements in a thoughtful and deliberate way in order to avoid threatening the stability of our market. Multiple listening sessions have been held by the division to allow all interested stakeholders, including dental providers and consumer advocates to provide feedback, and draft regulations have been issued now to incorporate these new statutory requirements. We respectfully ask that this law be given an opportunity to be fully implemented before you consider advancing these dental Bills in the interest of avoiding imposing additional barriers that could impact access and drive up the cost of care for families and small businesses.

I also want to speak briefly in opposition to House Bills 992, 1010, 1050, and Senate 717. In Massachusetts, ambulance-based services represent the largest share of out of network claims. Payments to out of network ambulance providers grew by up to 36% between 2017 and 2020, rates that are much higher than the state's health care cost growth benchmark. Last month, the Attorney General's office issued an examination of ambulance services and concluded that the majority of health plan members transported by municipal ambulance providers are at risk of receiving a balance bill. The report also found that 80% of municipal ambulance providers in this state refused to participate in health plans' networks, asserting that they need to stay out of network in order to maximize reimbursement. The AG report concludes that funding a sustainable and adequate EMS system should not fall disproportionately on commercially insured consumers and that funding EMS through an overreliance on health insurance payments risks untenable levels of consumer medical debt due to the out of network surprise bills they receive. These Bills before you today would only codify the existing excessive rates charged, and as a solution, the AGO report recommends that Massachusetts should pass legislation prohibiting balanced billing and establishing a fair and reasonable default reimbursement rate. MAHP filed legislation this session to do just that. House Bill 997 includes comprehensive surprise billing protections that would lower costs for small businesses and families in the state and remove the disincentive for ambulance providers to avoid negotiating reasonable rates, and we ask that you give that Bill consideration. Thank you.

Thank you, miss Murphy. Appreciate you being here. Any questions, comments from members of the committee? Seeing none here, none online. Again, thank you so much.

REP KERANS - Mister chairman?

FEENEY - Yes. Sorry. Senator.

KERANS - Thank you. Just quick. Wow.

KERANS - There was a lot in that testimony. So, I just want to go back to something that you referenced, regarding the dental legislation that we just had a panel on. What about sending the payments to the dentist's office? Isn't that a change that could be made without cost? Isn't that something we should be doing?

MURPHY - You're talking about specifically out of network providers?

KERANS - I'm talking about 1111, the legislation that was testified on by doctor Jill Tanzi, I don't think she's still with us. It's a matter of its calls for more transparency for insurers. I mean, is that a cost burden, surely, there are some elements here that we can advance?

MURPHY - Absolutely. The ballot question that was enacted has significant transparency requirements around it, and you will see that implemented by the division of insurance over the next couple months. There are draft regulations out that require dental carriers to now share financial information, and also as I said, spend 83% of premiums collected on direct care, and their reporting will show those details.

Okay. Thank you.

FEENEY - Thank you, representative. Any other questions, comments? Seeing none, thanks so much for your testimony.

MURPHY - Appreciate it.

FEENEY - Grace Coughlin.

Welcome.

GRACE COUGHLIN - HEALTHCARE FOR ALL - HB 1119 - SB 676 - Good morning. Thank you, Chair Feeney, Chair Murphy, and members of the committee for the opportunity to testify today in support of H2570 1119, S 676, an act to ensure consumer cost protection under the dental medical loss ratio. My name is Grace Coughlin, and I am a policy and project coordinator at care for all. For too many people, dental care is out of reach due to costs, a lack of available providers, and prior to a couple of years ago, due to a lack of comprehensive coverage in MassHealth, we appreciate the legislature's tremendous leadership in restoring full adult dental benefits for MassHealth members in 2021. In just the first year, 63,000 people were able to get services, and it is essential that these benefits be maintained, however, costs remain a barrier for many others. Nationally, 45.1% of dental expenses are paid out of pocket, the largest percentage of any health care service. In Massachusetts, dental care is the most uncommon, unmet health care need due to costs. It is also a health equity issue; among all age groups, black and Hispanic Americans are most likely to face cost barriers to dental care and are less likely than white families to have had a dental visit in the last year.

With the passage of question two, Massachusetts became the first state in the nation to establish a medical loss ratio, also known as an MLR for dental plans. MLRs require health plans to spend a certain percentage of their premium revenue on medical services for members rather than administrative costs. This legislation would make modest adjustments to the statute to ensure that the division of insurance has the authority to take consumer costs into account in their oversight under the new dental MLR and ensuring that information is available regarding how cost sharing might be impacted by changes in payment rates. Specifically, it would require that dental benefit plans submit information on out-of-pocket costs paid by consumers for dental care through things like maximum benefit limits and cost sharing such as deductibles, co pays, and coinsurance. It would also enable the division to take the impact of increases in these costs into account when determining whether to approve dental plan premiums. This aims to help prevent potential changes in provider payment rates from being passed on through increased cost sharing to consumers, who we believe voted for the statute understanding that it would provide better value and benefits from their dental plans and who already face significant out of pocket expenses for dental care. Adopting H 1119, S 676 offers the Commonwealth an opportunity to ensure that consumers across Massachusetts benefit from the new law and set a precedent for similar efforts in other states. I ask that you please report this Bill out favorably from your committee. Thank you for your time.

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DENISE DESIMONE - HEAD AND NECK CANCER ALLIANCE - HB 1094 - Good morning, ladies and gentlemen. Thank you for giving me the opportunity to speak with you today. My name is Denise DeSimone, I come before you as a representative of the neck cancer community. Head and neck cancer is a brutal cancer that affects not only the physical health of individuals, but also their emotional well-being and quality of life. Survivors like me face numerous challenges, including the loss of vital functions such as speech, swallowing and even the ability to smile. These challenges are often compounded by the financial burden of excessive dental treatments required as a result of this journey. My personal journey began in 2005 when I was diagnosed with stage 4, throat, and neck cancer, I was given three months to live. At that time, I was an executive, and my career came to an abrupt halt. Treatments were brutal as was the financial devastation I experienced and was never able to fully recover. Radiation is devastating in so many ways, and, unfortunately, as my oncologist says, it's the gift that keeps on giving. Hence, the reason why, as time passes, dental complications worsen also because of radiation. I was fed through a tube, cans of food for nine months, couldn't drink water, couldn't speak, and most days by noon, I lost the ability to talk and even have any energy to do anything. I learned to eat again by eating baby food.

No cancer treatment is fun, and head and neck cancer are considered the worst. I have spent thousands of dollars keeping my teeth in the best shape possible and my mouth healthy. This past year alone, I have spent $15,000 in dental bills, and part of the cost was for oral surgery. The word surgery alone should indicate a medical condition that requires to be covered under insurance. Today, I urge you to support this, Bill. This Bill is not just about dental care, it is about restoring dignity, confidence, and the ability to lead healthy and fulfilling lives. By passing this Bill, we'll have the opportunity to alleviate the financial strain on individuals such as myself, dental treatments, implants, dentures, prosthetics, they're not merely cosmetic folks, they are essential to restoring basic functions in improving overall well-being. And, moreover, covering dental bills for head and neck cancer patients is not just a matter of compassion, it is a matter of cost effectiveness. Most diseases start and problems start in the mouth and by providing comprehensive dental care, we prevent further complications, reduce the need for additional medical interventions, and, ultimately, save health care dollars in the long run. So, I implore you to consider passing this Bill. By supporting it, you're not only standing up3010 to the rights of head and neck cancer survivors, but3012 also demonstrating your commitment to accessible and equitable health care for all. Thank you for your kind attention, and may you all have peaceful and healthy holidays.

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AMY GROSS - CONCERNED CITIZEN - HB 1094 - Thank you, Kathy. I do have printed testimony of Kathy's oral testimony because as you can see, the voice recognition software did not pick up for testimony. Thank you, Mr. Chairman and members of the committee. My name is Amy Gross, and I'm a resident of Arlington, Massachusetts. I'm here in support of House Bill 1094, and act expanding coverage of dental procedures. I am a stage 2 nasal cavity cancer survivor. I have been free of cancer for almost two years. When I was diagnosed, I was told the treatment, along with a3388 long list of side effects followed afterwards. The choice was pretty easy, save my life. One of the side effects included dry mouth, how bad could that be? Little did I know, today, I know according to the National Institute of Health,3407 almost 75% of head3409 and neck cancer survivors will receive radiation, and almost 90% will have some form of dry mouth at some time. The mask that Kathy brought was also what I used for radiation and familiar for those in our community. Today, I know what a large part saliva plays in tooth protection and digestion, providing enzymes and microbes in addition to a protective moisture barrier. I gave you each a couple packs of saltines, and I invite you to try a modified saltine challenge. You can do it now or later, trying to eat four saltines in 45 seconds without drinking water may allow you to experience what I go through in a 24/7 basis, even two years post radiation.

You can imagine how this affects eating, chewing, speaking, swallowing, and other issues. Again, I am not alone in this situation, it's the most common side effect. We take extra measures constantly towards dental hygiene, like rinsing, brushing, etcetera. I fear the day when my preventive measures fail and I start down the road of root canals, crowns, tooth extractions, dentures, implants, I may lose my teeth, and I have no idea if it's going3481 to be covered. I want to emphasize all cancer is horrible, my mother and aunt are breast cancer survivors. Next week, one of my best friends begins chemotherapy for breast cancer at Dana Farber. Thanks to the Women's Health and Cancer Act of 1998, they know their prosthetics, wigs,3498 reconstruction, that will all be covered, the history of the act is rather interesting too. People diagnosed with head and neck cancer do not have the support, and we can't hide our mouths. Patients find themselves well into decades of survivorship having to argue with both insurance and dental insurance companies for basic oral procedures, dentures, prosthetics, and implants that impact our health and daily quality of life. I'm proud of the3527 people sitting next to me, and I want to ensure that you understood their testimonies. Please support Bill 1094. Thank you.

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SEN TIMILTY - SB 717 - Thank you, Chair Feeney, Chair Murphy, distinguished members of the committee. If I could follow-up on that point, Chair Feeney, I was returning Chief Kelleher's phone call last night. He picks up the phone. I could hear a radio crackling. He said, I'm running into a fire right now, can I call you back? I said, sure, be safe. But that's, of course, what our fire service does, and I know each and every member of the committee believes that as well. So, thank you to, Chief Purcell and Chief Kelleher, and I must say, to follow three powerful and compelling stories from three courageous women is daunting. So, thank you very much for the opportunity to be here today. Today, Chair Murphy and Chair Feeney, and members of the committee, I am here to testify on behalf of a Bill that I have filed, Senate Bill 717, which I have worked in3690 conjunction with the Fire Chiefs Association of Massachusetts, so thank you, Chief Purcell and Chief Keller, and also the professional firefighters of Massachusetts. This Bill is a refile, it is an act relative to ambulance service reimbursement. As a baseline to underscore the importance of this issue, more than 160 communities in Massachusetts, of course, have fire-based EMS systems. Moreover, five out of seven communities in the Norfolk, Plymouth and Bristol District, which I am privileged to represent have fire-based EMS.

As such, municipalities have traditionally been afforded the ability to negotiate their own reimbursement rates with the insurance companies for the services that they provide. In addition, these municipalities, particularly their fire departments, which serve us so well, rely on these negotiated rates to ensure that they are covering the costs specific to their communities. Furthermore, the consensus among EMS stakeholders is that a reduction in ambulance revenue could jeopardize the service delivery models throughout the Commonwealth. Thus, we can all agree, in our times of need that our emergency medical technicians through our fire service, provide the most critical care to those with urgent and sometimes life-threatening medical needs. We rely on their skills and expertise to ensure that the people that we care most about are provided with the utmost standard of care. In turn, we must support a system that3776 provides the resources these EMTs need3778 to perform these critical duties. Therefore, we are all cognizant of the increases in health care costs, so we are all trying to find the best ways to initiate cost saving measures, and I know this committee leads the way. So, thank you for that, however, imposing a standard rate for ambulance reimbursements at this juncture, especially one that caps the rate at a reimbursement level that is lower than what is currently negotiated for that municipality could have serious impacts on our local fire departments and their fire-based EMS systems.

3809 This3809 is a risk that we cannot afford to take,3813 specifically, this legislation protects the current system where municipalities are able to negotiate their individual reimbursement rates, but also provides some cost control measures by locking these rates in as of July 1st, 2023. In addition, future rate increases will be capped by this legislation so as not to exceed what the Health Policy Commission establishes as their health care cost growth benchmark. A statewide target for the rate of growth of health care expenditures, which, as you folks know, is set annually. In 2021, this rate was set at 3.1%. Lastly, should an immediate need for a rate adjustment arise, this legislation provides a mechanism for the secretary of health and human services to address any request for rate increases3859 over the benchmark. To be succinct, this legislation is not3863 a permanent fix, rather, this legislation creates some stability in the system for the near-term future for our fires-based EMS systems, insurance companies, and our constituents. Accordingly, Chair Murphy and Chair Feeney, this is a first3882 step in starting a conversation for what will work best for the residents of the Commonwealth, which I know is a concept that we all embrace and seek. Thank you for your time today, and, of course, I hope that this Bill is reported out favorably. I look forward to working with each and every member of this committee, with you, Chair Murphy and Chair Feeney, and, of course, happy to answer any questions. Thank you.

MICHAEL KELLEHER - FIRE CHIEFS' ASSOCIATION OF MASSACHUSETTS - SB 717 - Thank you to the Chairs, I appreciate the opportunity to come in and testify today. If you can put this on the list of things that weren't on the brochure for being a fire chief talking about health care policy and insurance reimbursement. Needless to say, it's a really important part of what we do, and more importantly, this Bill represents sustainability in emergency medical services. We're going through a tough time post Covid. We have issues with recruitment, retention, not a lot of people are interested in going into public safety and especially emergency3937 medical services. So, when we look at how ambulance service runs, if you've seen an ambulance service or you've seen an EMS system, you've seen a single EMS system, they are not the same. EMS in Wellfleet is not the3950 same as EMS in North Adams. There's a variety of factors that factor into how that service provides, call volume, insurance reimbursement, payer mix. So, when you look at all that stuff, there's a lot of discussion about how to make EMS more sustainable. One of the things we hear is maybe potentially putting more burden on the taxpayer, again, that doesn't work, that doesn't function properly because, like, in my community, over half of the patients we transport aren't citizens of that community, so it'd be an unfair burden. We'd be subsidizing the health care of people that weren't citizens through our tax rates. EMS is very unique as we look at health care, probably the purest form of universal health care. You call 911, you get an ambulance, and everybody gets the same level of service. Another challenge that we face in emergency medical services is unless we transport you, we don't get reimbursed. So, if we go to a car accident, patch some people up, we might use $30, $40, $50 worth of bandages, there's no reimbursement for that.

So, if we don't have the insurance reimbursement from the community coming in to offset that cost, that would be, again, directly put on the4019 taxpayers. That's another challenge that we4021 have. About 30% of the times, you see that ambulance goes out, at least in my community, it doesn't transport, we use consumables, so that can be a challenge. So, one thing that we like again, as a Fire Chief, I don't want to be in the ambulance business. I never thought of4034 myself in the health care business, but the reality is4036 that's what we are. Along with that, there's issues; we bill patients, part of that money offsets, we don't make money off of it, all it does is offset the cost. What this Bill does is it takes the patient out of the middle, so it lets our billing deal directly with4054 the insurance company at a rate set by the community, which is important again because they do the costs are different. The cost an ambulance ride in Boston is not the same as an ambulance ride in Cape Cod or Southeastern Mass. So, this allows the community to set the rate, bills the insurance companies, and all insurance companies are required to pay that rate. Right now, it's a variety of different reimbursement schemes. One of them, the insurance company will give the patient a check, and then the patient's supposed to pay their ambulance bill, that doesn't work for a variety of reasons. Massachusetts was a leader, this legislation was4091 proposed 13 years ago, this same legislation was just passed by the largest red state, which is Texas, almost unanimously, and by the largest blue state, which is California, unanimously. So, this isn't something that's not controversial, it's not outlandish, it's just something that that kind of sets the path for a sustainable EMS system in the future. So, again, I thank you for your opportunity to testify today, and I really appreciate it. I'd certainly entertain any questions.

PATRICK PURCELL - FIRE CHIEFS' ASSOCIATION OF MASSACHUSETTS - SB 717 - Good morning, Senator Feeney, Rep Murphy, and the committee. Before I begin, as I'm talking, I don't want you to answer this question, but I just want you to ask yourself, like, what is my definition of an emergency? We'll get back to that. So, when you take everything that Chief Kelleher said into account, 100% factual, the cost of doing business is not the cost of doing business across the Commonwealth. These things have been looked at, and I believe that we are ahead of our time over the last 13 years, when this Bill was first written and brought4155 forward, and I think today4157 is just one more step forward to getting it accomplished. When you step back and look at the things that influence some confusion and some pay issues or some billing issues, there are things that are changing every day like co pays, deductibles, premiums, statutorily defined rates for Medicare and, MassHealth, commercial rates. I think that when you try to explain that out to a committee, whether it's local in our own town or elsewhere, it gets confusing, but at the end of the day, in our own local community, we know how much it costs to operate our department. I will tell you with 99% accuracy, there's not a municipal fire department in the Commonwealth that makes money running their EMS division at all. To go back to my question earlier, you're likely going to hear a testimony where someone's going to tell you that, well, we're looking for 911 services to contract with fire departments or insurance companies to contract with fire departments or vice versa.

So, when you go back to the question, what's your definition of an emergency? Well, that's all subjective and it influences the way that our departments run. So, if you pick up a telephone right now and you call any health care facility or you call an insurance company in the Commonwealth, what's the first thing you hear when you call that number? If this is an emergency, hang up and dial 911. So, we don't4244 really have control over what we are planning for, what we're going to respond to, and unlike other health care facilities, we don't have a waiting room. So, without that waiting room and having that capacity, we need to develop a system that's sustainable and the best way to have that sustainability is for us to set our own rates which are dependent on our own community. To piggyback off what Chief Kelleher said, the largest red state, the largest blue state just voted almost unanimously between the both of them to do exactly what we're trying to do here, so did the federal government. So, when the No Surprise Act came out, it included all areas of healthcare inclusive of air ambulance, and it eliminated ground ambulance, and they convened a study or a group to study that topic specifically. That was released in November, that came back from the federal government as well, leave it to the local community to establish their own rates because they know their department, and they know their community best. So, when you take the totality of those three things, largest blue, largest red, and the feds, and all on the same page, it's kind of staring us in the face that that is the direction we should be going. Thanks.

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SEN FEENEY - I do have one question; it just kind of came to my mind as Chief Kelleher were talking about in our community, many of the people that you're transporting or that you're responding to aren't residents of the community, and if the cost is borne by the taxpayer in that community, obviously, that's something that you got to deal with. Every municipality is different, but as you were talking, I started thinking about kind of the change in healthcare consumer behavior, in the way that they access providers. We've heard a lot from providers and insurers about urgent care. A lot people go to urgent care. Chief, if you had to transport, say, from an urgent care, somebody shows up, they present with symptoms, the provider there says, yes, you need elevated care, you need to go to a hospital. Presumably, they would call 911 or they would reach out to the municipal department, you would then transport from the urgent care to the hospital. How does that billing work? If somebody's presenting into your urgent care, they're making a decision for that patient, do they get billed? Does the patient get billed? Does the municipality bear the cost?4397 How does that work?

KELLEHER - The patient gets billed for that. So, the unique thing about urgent cares is, there's this law called EMTALA that traditional emergency rooms fall under. They're not allowed to really refuse anybody care, they can't transfer people out for reasons of homelessness or vagrancy, so they're obligated by law to treat people. One of the, I guess, I'll call it an issue with urgent cares is that they are a closed shop, if you don't have the right insurance, if your condition exceeds the ability for them to care to you, 911 is the backstop to that, they call 911, and we respond, and that cost is borne by the patient. So it is exclusively between the municipality or the inbound service and the patients. So yes, the urgent cares are a unique thing in Massachusetts when you look at probably the most profitable components of healthcare in one building, exclusive of an emergency department and an overnight unit. There's a lot of exemptions that they fall under from traditional hospitals, which is probably why you've seen the decline of traditional hospitals in Massachusetts. So, it's another issue, I think the healthcare system is facing that needs to be looked at, in my opinion.

FEENEY - No, I think that's something for a later and, longer discussion. You know, as we look at, on this committee, especially as we talk about insurance mandates, talk about all sorts of different stuff kind of specific in scope. But the larger picture, I think, is the changing health care environment. You know, as we try and do as much as we can on cost containment, that's something I think we need to look at. I've heard many, many times of municipalities responding to urgent care facilities in a community and doing it just a kind of a constant transport back and forth. I think it's something we need to address, but I appreciate your answer on that in the context of this Bill.

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REP PIGNATELLI - Thank you so4525 much,4525 Mr. Chairman and Mr. Chairman, I'm glad that Senator Timilty has filed this Bill, and I appreciate the Chief's testimonies. Speaking very parochial about my district and the Berkshires in general, very rural areas. As you can imagine, we have a mix of municipal ambulance service and private ambulance services, and I agree with the Chief that no municipality makes money on these services. They'd be lucky if every five or six years, they've generated enough revenue to replace the rig. But with volunteers going away, especially in the rural communities, it's going to be more of a hurdle for those towns to attract qualified people. And with the emergency response, we're actually getting more to the paramedic level, which as we all know is more4569 money and more benefits and the more cost to the communities. So, I've been a4573 real advocate of shared services or some regionalization of these types of services. But it's going to be a very serious problem in the rural areas as well and when a private or a municipal ambulance service can actually get a better reimbursement on the inter facility transport4589 than responding to a 911 call, I think that's becoming a very serious problem.

Give you a quick example; in my hometown of Lennox, we've had a full-time ambulance squad for probably 25 or 30 years, a town of 5,000 people. Lennox, knock on wood, is a town that can afford to do these kinds of things, I'm not sure for how much longer they can do it on their own. But because we do have mutual aid with the Town of Lee and Stockbridge and parts of the Mass Turnpike and some of the other smaller towns, a 911 call in Lenox waited 45 minutes to get an ambulance to respond and we finally were able to get an ambulance from almost 20 miles away, three communities apart that came forward to help us out. So, I think, I applaud this Bill being filed, and I think, reimbursements for ambulance services need a complete overhaul, but I can't stress the urgency enough, and I hope this committee can, do something for it this session. I appreciate your time very much.

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KERANS - Thank you. I don't want to belabor it, and my friend from Lenox clarified some of it. But I did wonder as you were speaking, if I call my local ambulance4670 in an emergency, will they bill me? Will they say, you have to go through the fire department? I'm not even sure to whom I'm directing the question, but it occurred to me, and I know I have one city, four towns, and it's a little different for all of them, but I do wonder, does the reimbursement change if you go directly to the ambulance service? We can dig into it later, it's sort of a thought that occurred, but we'll take it offline.

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SEN RAUSCH - SB 707 - Good morning, Mr. Chair, Mr. Chair, members of the committee. Thank you for hearing me today and for taking me out of turn. I'm here to testify on Senate 707, which is an act expanding health insurance access for state employees. New state employees as I bet both of you are aware,4793 sometimes, in fact, still currently must wait anywhere between 60 to 90 days for their employer sponsored health insurance to take effect. This means new hires are effectively prevented from having health insurance for up to a quarter of a year regardless of their health or individual circumstances. We, acted to shorten this time frame earlier this session, big victory with employees starting in the summer of 2024 gaining health coverage more quickly. Unfortunately, this still is not enough, new hires will still face a gap of nearly an entire month based purely on their start date. Starting in July 2024, if an employee begins on the second of the month, they must wait until the first day of the following month for their health insurance to kick in. Now, if I could hire everyone to start on the 1st of the month so they had health insurance, I would, that would be great. But hiring dates are not up to me, they have to fall within a particular schedule. People should get health insurance on day one, it's really that simple. It's true for all of us as members, and it should be true for our staff and all state employees as well.

Anything less is inequitable and unsustainable, I should add that my first job with state government wasn't as a Senator, it was as a secretariat level attorney at the Executive Office of Health and Human Services. My offer for that job actually came in the day after I got home from the hospital after delivering our first child. I started on October 6th. Every day for that month, I couldn't access health insurance or accrue certain other benefits even as a new mom with a brand-new baby at home, even with the cost of childcare and transit and all the other financial strains of having children. It's frankly ridiculous that state employees don't get the same benefits given to private employees whose health benefits begin on day one. They already take a big pay cut to work in the public sector. Without health coverage, staff are forced to delay care or pay out of pocket. Staffers who are paid less than $40,000 a year have had to incur thousands of dollars in medical debt for emergency care because of this gap in coverage. Others have foregone crucial medical treatment and medication due to cost impacting not only their health, but their ability to perform their jobs to the best of their ability. I've amplified stories of staffers in the past on this issue before, including a legislative staffer who was forced to quit antidepressants cold turkey and endure a medication withdrawal for the first two months of her Senate employment because she was notified only on day one of her employment that she didn't have health care.

A legislative staffer also paid hundreds of dollars out of pocket for an emergency wisdom tooth removal while uninsured. The State House also loses talent over this issue, including in my own office. We recently had a highly qualified applicant who turned down a job offer because they would need to forego health coverage for months and could not interrupt their health care needs. These are just employees in this building, let's not forget this policy also affects tens of thousands of state employees who currently serve and will soon serve our Commonwealth. This gap in health insurance can have severe financial and health impacts on public servants and their families. We can and must do better, and that is exactly what this Bill would do. The Bill would solve this problem by requiring the Group Insurance Commission to allow state employers to offer state employees’ health5008 coverage on day one of employment no matter what day of the month that happens to be. Passing this legislation would be a step toward leveling the playing field for state employees while supporting their labor. It's a simple yet deeply important fix5023 for state employees and their families. I ask you to issue a favorable report on the Bill. Again, I thank you for hearing my testimony this morning, and I'm happy to answer any questions.

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PAUL JACQUES - PROFESSIONAL FIREFIGHTERS OF MASSACHUSETTS - HB 1010 - SB 717 - SB 642 - Good morning, Chair Murphy, Chair Feeney, members of the5058 committee and staff. Thank you for the opportunity to testify today.5061 For the record, my name is Paul Jacques, legislative agent, professional firefighters of Massachusetts. Joined today by Craig Hardy, legislative agent, professional firefighters of Massachusetts. We have submitted written testimony, and in the interest of time, you heard from our friends, Senator Timilty and the chief on the testimony regarding the legislation we're in support of, House Bill 1010, Senate Bill 717, and Senate Bill 642. We do, thank them for their testimony, it's quite detailed,5092 we appreciate that and their support and hope that you release this Bill favorably from committee.

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ROBERT DAVID - BOSTON UNIVERSITY MEDICAL CAMPUS - HB 1094 - Thank you to all the members of the committee for this opportunity. My name is Robert David, resident of West Roxbury, and I'm the manager of the cancer and sickle cell support programs at Boston Medical Center. I've been doing that for 15 years. In my time, I can say I've worked with approximately 2,000 cancer patients, all different types, in various capacities. I run a lot of cancer support groups. I'd say in 15 years, I've run well over 1000 sessions. Any type of cancer is no picnic for anybody as we all know, and I'm sure everyone in this room knows people who have experienced cancer. The remarkable thing in my privileged position of hearing people talk about their experience is, I hear so many stories of strength, resilience, the capacity to endure a lot, to find reasons to keep going and to live, it's profound, I really feel privileged to have that. I can say that in the5274 various support groups I have run for different cancers and in the people, I've known, head and neck cancer is probably well, if not the, certainly one of the most insidious and that the after effects are enduring. As Denise DeSimone, who's testified earlier, said radiation is the gift that keeps on giving. You know, cancer can affect people physically, emotionally, socially. With head and neck cancer survivors, it does all of those things on a long-term basis. It can also affect call into question people's spiritual strength too. For head and neck cancer, you know, surgery can lead to deformation and constant adjustments that one has to make, including dental adjustments, dental prosthesis that may have to be made to just to be able to chew, to be able to maneuver your mouth, that's from the surgeries.

Radiation has other kinds of insidious effects such as damaging your salivary glands so that virtually everybody who has radiation in the mouth ends up with dry mouth, swallowing problems, muscular problems, that because radiation hardens the tissue, it doesn't soften over time, it gets harder over time, so these conditions persist. Speech issues, I think I mentioned swallowing. Can you imagine, you can no longer go out and enjoy lunch with friends. It's a hard thing to do because you have to cut your food up really small and take an hour to eat it, whereas other people are done much more quickly. It's hard to talk, all kinds of things. I'd rather you hear from people who have experienced it themselves. I wanted to mention that I'm in the privileged position also of knowing these patients for years, doctors work with them and they do their great work curing the cancer, which is their first and foremost challenge, but they are not always there to deal with the long-term side effects. I've known Randy here for about seven, eight years, I've had others who wanted to be here, but one is an 89-year-old woman I've known for 15 years, a lot of dental issues, they'll all be submitting written testimony. Joyce O'Shea, Jason McDonald, Susan Curry. Please be on the lookout for5444 it because they're all-powerful speakers, they just couldn't be here for very different reasons; funeral, being sick, but they would have been here. But I just want to say, it's heartening to hear the voices of the patients themselves, it's heartening to hear a lot of the testimony here today, speaking in favor of the needs of patients. So, with that, I'll wrap up my time. Thank you.

RANDY SHEFFIELD - CONCERNED CITIZEN - HB 1094 - Good morning, senator and the committee members. My name is Randy Sheffield, I'm a stage 4 head and neck cancer survivor. I think the common thing with cancer patients in general when you tell people, I'm cancer free, they think that’s it and your support system kind of fades away. Like I always tell Bob, I have a strong faith in God, and I take him everywhere I go. I told the doctors I'm a be a miracle patient, this, that, the other because I had stage 4 cancer from secondhand smoke, never smoked. But I don't want to go through that store the whole story I'll take up way too much time. But based on the dental portion of the complications from the radiation, my surgery, like from here to here, I have no bone gums teeth. From here to here, up the top and on the bottom. But with the radiation, it deteriorates the bone, my gums are receding, your teeth are very thin and, fragile. So, with the dental coverage would help us with more options and keeping things healthier, being able to get, like, the prosthesis. My tongue is tied to this side of my mouth is numb because of the surgery. Like, I can't tell if I'm drooling or I bite my lip, my gum. I had one tooth here, a molar, they left there, but because of the deterioration of my bone from radiation, I'm sleeping on my left side.

You know, my mouth is extremely dry, I'm, like, sometimes so dry, my tongue is, like, stuck to lose my mouth when I wake up, but I was sleeping on my left side, and I felt something in my mouth. I go to spit it out, the whole molar just fell out my mouth, the whole tooth scared the daylights out of me because they said, if you get a hole over there, it'll never heal, it's constant complications. You know, I panicked and, a lot of times people say, your cancer free, but there's so many different things we have to go through because of the radiation, dental issues, and a lot of these things aren't covered, and that's why I'm here today. I come from Taunton, and it took me over two hours to get here today because of traffic and everything, but I wanted to be here in person because it's very important to me, and I think passing this Bill 1094 will help us all in a better way to just kind of ease the rest of the issues that we have because, like they said, it's a gift5665 that's never ending because this stuff is ongoing.5669 I always say, like, I don't feel like I have been through what I've been through. I don't like to think about it too long or look in the mirror too long because I still don't feel like, because when the doctors told me stage 4, I'm like, are you sure you got the right person? Because I feel fine, but here I am, a survivor of 10 years. So, I'm very thankful for God for that, and I just pray that you guys put this through because it would make it better for all of us. Thank you for hearing me.

JUDY BURTON - CONCERNED CITIZEN - HB 1094 - My name is Judy Burton, I'm from Newton, Massachusetts, and I'm almost 20-year cancer survivor. I wrote up a whole thing, but much of what I wrote up has been said. When5720 I was diagnosed, I was told I had the best kind of cancer5724 because it was curable, but they never told me about radiation, the gift that keeps on giving. They never told me that the radiation would cause many, many issues later on, maybe they didn't know it 20 years ago. But the cost to address situations that are occurring in my mouth are prohibitive for me to even be going and seeking, getting things fixed. Last year, I had three5753 crowns fallout. Fortunately, it was just the crowns, but I was told if they fall out again, I'm going to be facing probably5761 total mouth reconstruction at some point, which would be prohibitively expensive. I'm diligent about my care of my oral cavity because I have to. All of the things that everybody else has said I've had and then some, I don't want to take up the time of the committee going through the detail, but to please consider passing 1094 for the benefit of us and for all of the people that are upcoming,5793 would be greatly appreciated for the time that any of us may need it. Thank you very much.

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OWEN URECH - NATIONAL ASSOCIATION OF DENTAL PLANS - HB 1111 - HB 1119 - HB 1122 - HB 966 - SB 676 - SB 697 - Thank you to the Chairs and members of the committee. My name is Owen Urech, I'm the director of government relations for the National Association of Dental Plans. We represent dental benefits and the companies who provide them for over 200,000,000 Americans, including a couple of dozen plans in Massachusetts. Today, there are several Bills I would like to speak on, and we will also be providing supplemental written testimony on these Bills, including House Bill 966, House Bill 1111, 1119, 1122, as well as Senate Bill 676 and 697. In my testimony today, there are a couple of Bills I want to concentrate on. First is House Bill 1122, which relates to covered services. This is a Bill that I know has been reintroduced previously in this committee, and we would like to provide our concern about the potential impact that it would have on pricing of dental treatment in the state as well as dental benefits. Currently dental plans, when you are paying your premium for your coverage, you are getting not only the benefit of the insurance covering the treatment, but you are also receiving the negotiated rate for the care that is being provided. So, when a dentist enters into a network with a dental plan, they are agreeing to accept a negotiated rate for the care that they are provided. This allows for the reimbursement from the plan and then also ensures that there's an incentive for those providers to join the network and increase access.

We're concerned that the provisions under 1122 would potentially lead to situations where if someone has either gone above a frequency limitation, say they've had both of their cleanings in a given year and are seeking a third cleaning or maybe they have reached their annual maximum for their treatment, that they would no longer have access to that in network rate. So, if somebody goes for a third cleaning that is not directly reimbursed by the dental plan, this6005 Bill would say that they would not have access to that negotiated rate, which could mean that there's still a 30% to 40% Count on the care that's being provided that the patient would have to pay, that the dentist would then be able to charge full price for that service, and that could lead to some significant sticker shock and potentially surprise billing situations for those people. The other Bill I want to briefly mention is House Bill 1119. This is a Bill related to the dental loss ratio and some changes related to rate filings that would be done by dental plans. As was mentioned in some previous testimony, the ballot initiative that passed that implemented a loss ratio for dental plans in the state has created significant disruption in the marketplace. We've already seen five dental plans leave the small group market, that's where, groups that are up to 25. So that's really having an impact on small businesses and the people who are seeking to provide coverage for their employees, and we would urge the committee to not move forward with any additional changes to the rate filing or loss ratio process at this time as we seek to implement this and work with the department on getting those regulations finalized. Thank you, and happy to take any questions.

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KERANS - Thank you, Mr. Chairman. Just wanted to be consistent because I asked a prior health plan person the same thing. Sending payments directly to dentist's offices, 1111, you ticked off a list. 1111, you're good on that? You're in favor?

URECH - So on 1111, we'll be providing some additional comments. I think the focus of our concern with the language in 1111 has to do with where the ability for plans to negotiate rates with providers, there's some language that's included within Section 2, that would say that there is a requirement that those plans would not be able to look at comparative pricing or utilize benchmarks, we think that that could have some potential impact on pricing and may lead to some increase for patients. So that's the focus of our concern, but we'll lay that out in the written comments as well.

KERANS - So what about conceptually, though? You're okay conceptually with having it go directly to the dentist office? It was described as no cost, so, are you saying there is a cost?

URECH - I'm not saying that there's a cost directly to it, there's a lot of plans that already allow for assignment of benefits, but I think that our focus is on some of the other parts of the Bills where we would have some concerns.

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AMANDA BERTHIAUME - MASSACHUSETTS DENTAL HYGIENISTS' ASSOCIATION - SB 664 - I just want to thank you, Senator Feeney, Representative Murphy and the joint committee on financial services for hearing my testimony today. My name's Amanda Berthiaume, I'm the President of the Massachusetts Dental Hygienists Association. I am in support of S 644, an act relative to the sustainability of public health dental hygienists through adequate reimbursements. On behalf of the MDHA, I respectfully request that you support this legislation. Public health dental hygienists have stepped up to cover the care, the gap in care, for the most underserved populations, especially during and post Covid-19. A public health dental hygienist is a hygienist that has taken extra training and is allowed to work in public health settings in collaboration with a dentist. They do not refuse care to any patient that they see. So, they go into these public health settings, whether it be, schools or care facilities or private homes, and currently, right now, they can only get reimbursed from Medicaid insurance.

They really did step up and when they're in a school treating all the children, they don't skip the children that have, luckily, are benefited to have some private insurance. A study done in 2017 stated that the public health dental hygienist could have a higher impact in providing care if they were able to get correct reimbursement. A lot of PHDH dental hygienists, depending on the setting may provide 50% of their services without compensation. This model is not sustainable and is undermining the effectiveness of the PHDH Profession. Hearing some of this testimony brought today from these folks who have had oral, head and neck cancers, and they've even said preventative care is so important, especially, the person who had dry mouth. These public health dental hygienists are bringing that preventative care to these folks that can't make it into a dental office. We all know, Medicaid or not, if you call for a dental appointment right now, especially in Western Massachusetts and in the Berkshires, the wait is six months to nine months, and some folks don't have that long to receive preventative care. All they're asking for is to be reimbursed, fairly, for the services that they're bringing and they are kind of holding everything together, especially in Western Massachusetts by providing these services and not turning it away. We'd like to continue to keep them working and have them reimbursed. Thank you so much, and, please find in favor of S 644.

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JENNY ERICKSON - LIFE INSURANCE ASSOCIATION OF MASSACHUSETTS - HB 965 - HB 966 - HB 1110 - HB 1111 - HB 1119 - HB 1122 - HB 1124 - SB 676 - SB 697 - SB 698 - So good morning, Chairman Feeney, Chairman Murphy and the committee. I'm Jenny Erickson, I'm the senior vice president and general counsel of the Life Insurance Association in Massachusetts. Even though we are primarily a life insurance association, we represent a number of the Commonwealth's largest dental insurance carriers. The only thing I'd like to do today is register our opposition to a number of Bills, and I'll list them here, then we will provide written testimony to you at a soon to be later date, but soon. So, our opposition is to House, 965, House 966, House 1110, House 1111, House 1119, House 1122, House 1124, Senate 676, Senate 697, and Senate 698. Again, and I echo, my colleague Owen Urech's quite testimony about the bills he testified, about, and we will be providing our written testimony on these Bills. So, thank you very much.

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CHARLES SILVIUS - MASSACHUSETTS DENTAL SOCIETY - SB 684 - Good afternoon, Chair Feeney, Chair Murphy and all the committee members present. Thank you for this opportunity. My name is doctor Charles Silvius, I practiced dentistry for 50 years before retiring last year. After serving two years as a dentist in the United States Army, I practiced the next 48 years here in the Commonwealth of Massachusetts. My clinical experience has included working in solo practice, small group practice, large group practice. So, I have a tangible sense of key different treatment modalities. I served as President of the Massachusetts Dental Society and as Speaker of the House of Delegates for the Massachusetts Dental Society. During my tenure, I had the privilege of addressing this joint committee on two occasions. I speak today in opposition to Senate Bill S 684. My testimony today is on behalf of EDIC, the Eastern Dentists Insurance Company. I have been a director on their board of directors about four years, not a policyholder since the inception of the company 32 years ago. My overarching concern is that the current public health dental hygienist policy already establishes a second standard of care for Medicaid patients. As a dentist, I have a moral, ethical, and legal obligation to safeguard the oral health of the public.

As director of a professional liability insurance company, I have an obligation to safeguard our policyholders by providing liability coverage in the event of an injury to the patient. The liability coverage is an essential element in protecting the public. To request a professional liability insurance company to indemnify participants in the public health dental hygienist program would eliminate that essential safeguard to the public. What avenue for recovery from injury would be provided and by whom? Currently, there is no professional liability insurance company today that would provide coverage to any dentist who does not actually see the patient. Additionally, as a malpractice insurance company, the dentist shelves for dentists in states outside of the Commonwealth. We would require our company to have standards for dentists in Massachusetts that would differ from those in other states. As a dentist, I hope I would never need to file a claim with my liability insurance carrier, but it is there for a reason. It provides the public with a greater protection than a suit against an individual could provide. So, I call on you to provide that protection to the public by requiring that all practitioners in the Commonwealth be required to take the responsibility for their actions and not be indemnified against legal action. Thank you, I would be happy to address any questions.

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