Health Care Reform Consensus Reached; Historic Bill to Win Approval This Week

Embarking on a new era of health care reform in Massachusetts, members of a House-Senate Conference Committee today filed comprehensive consensus legislation to cover virtually all of the state’s uninsured residents within three years, State Representative Barbara L’Italien (D-Andover) announced today. The bill is expected to be approved by both chambers and sent to the Governor this week.

Based on the principle of shared responsibility, individuals, employers and government will play an active role in ensuring near-universal access to health care and preserving hundreds of millions of dollars in federal funding.

“I am happy to report that the Legislature is going to make real health care reform a reality here in Massachusetts,” said L’Italien. “My colleagues and I have seized this historic opportunity to overhaul a broken system and deliver affordable, quality coverage to nearly all of the state’s uninsured residents over the next three years.”

Major provisions of the legislation include:

• Individual Mandate: Holding true to a long tradition of Massachusetts “firsts,” the bill creates a first-in-the-nation individual mandate to require all residents who can afford it to purchase health insurance.
• Employer Responsibility: The legislation creates a new Fair Share Contribution by requiring all businesses to contribute toward employee health insurance costs. This provision levels the playing field to ensure that employers who provide insurance no longer pay twice: once for their own employees and again for their competitors’ employees.
• New State Subsidies: The bill establishes new state subsidies for individuals with incomes less than 300% of the Federal Poverty Level (FPL). Adults with incomes up to 100% FPL ($9,700) will be eligible for coverage without premiums.
• MassHealth Expansion: The legislation expands the Commonwealth’s MassHealth program to include children from families up to 300% of FPL ($48,000 for a family of three). In addition, it restores all previously cut benefits, including dental and vision services, chiropractic and prosthetics, and creates a smoking cessation pilot program for Masshealth enrollees.
• Fair Reimbursement Rates: The bill calls for long overdue increases in reimbursement rates to hospitals, physicians, and community health centers for treating the Commonwealth’s MassHealth patients. These increases are tied to quality and other performance measures.

“The House feels very strongly that everyone should to be part of this solution,” said L’Italien. “We went on record in support of shared responsibility to ensure that government, individuals and businesses are all working towards the same goal of significantly reducing the number of uninsured in Massachusetts and reining in costs for everyone. I am pleased that the final version contains these essential parts.”

Once implemented, the consensus plan will be a national model. “Massachusetts once again leads the nation with an innovative plan that will achieve our longstanding goal of expanding health care for all,” said United States Senator Edward M. Kennedy (D-Massachusetts). “We could not have achieved today’s landmark agreement without the strong leadership of Senate President Travaglini and House Speaker DiMasi. Their skill in crafting this legislation and their dedication to seeing it through have been extraordinary. I’m optimistic that it will quickly be signed into law and I’ll continue to fight to keep the federal dollars that will be critical in enabling this plan to become a reality.”

Prescription Advantage

State Representative Barbara L’Italien (D-Andover). Co-Chair of the Elder Affairs Caucus, is pleased to announce that Prescription Advantage, the Commonwealth’s pharmacy assistance program administered by the Executive Office of Elder Affairs, will conduct an Open Enrollment March 15 through April 28. This is the first open enrollment since Prescription Advantage became a program that wraps around Medicare Part D, the new Medicare prescription drug benefit.

“I hope all eligible seniors will examine the Prescription Advantage plan, which can assist them with the additional, and sometimes unexpected, cost of prescription drug payments and gaps in coverage.” commented Rep. L’Italien.

Prior to Jan. 1 when Medicare Part D took effect, Prescription Advantage was the state’s prescription drug insurance program, providing primary coverage for seniors and younger disabled individuals who meet specific income requirements. The new Prescription Advantage “wraps around” or supplements the Medicare prescription drug benefit for Medicare eligible individuals by helping pay for co-payments and coverage gaps for an individual’s Part D plan. Those with limited income may also receive help paying for Medicare Part D plan premiums. Prescription Advantage will also provide primary coverage that is comparable to Medicare Part D plans for those who are not eligible for Medicare.

“It is important for people who were not eligible for Prescription Advantage before, or who did not consider the program, to understand how much Prescription Advantage can help them now,” said Elder Affairs Secretary Jennifer Davis Carey. “We are pleased to announce the open enrollment. I encourage people to consider joining Prescription Advantage in order to reduce their out-of-pocket costs for their prescription medications. There is no monthly premium for people who join Prescription Advantage to receive help paying for their prescriptions.”

Who Can Join Prescription Advantage?

Prescription Advantage is available to those who are:

• 65 years of age or older who do not have a gross annual income that exceeds 500 percent or more of the Federal Poverty Level (single $49,000, married $66,000),
• Under age 65, work no more than 40 hours per month, meet MassHealth’s CommonHealth disability requirements, and have a gross annual household income at or below 188 percent of the Federal Poverty Level (single $18,424, married $24,816).

How Will Prescription Advantage Work for Those Eligible for Medicare?

• If you are Medicare eligible, you must join a Medicare Part D drug plan in order to be eligible for Prescription Advantage benefits;
• Limited income applicants (those at or below 188 percent of the Federal Poverty Level – single $18,424, married $24,816) must apply for “Extra Help” also known as “Low Income Subsidy” administered by the Social Security Administration to be eligible for Prescription Advantage benefits.
• Medicare Part D will be the primary drug insurance. Prescription Advantage will be the secondary payer supplementing the Medicare coverage during coverage gaps and will provide protection from catastrophic drug costs.
• Prescription Advantage will cover portions of co-payments. Co-payment amounts are on a sliding scale according to the member’s income.
• There will be no monthly premium for Prescription Advantage members with incomes below 300 percent of the Federal Poverty Level (single $29,400, married $39,600). There will be a $200 annual enrollment fee for those between 300 and 500 percent of the Federal Poverty Level (single $29,401 – $49,000, married $39,601 – $66,000).
• Prescription Advantage may also pay all or part of your Medicare Part D premium.

How Does Prescription Advantage Work for Those with Coverage that is “Creditable” or Comparable to Medicare Part D through a Union or Employer?

• Prescription Advantage will provide secondary coverage to members who are not in a Medicare Part D plan, but have “creditable coverage,” meaning that Medicare has determined that the prescription drug coverage is as good as Medicare Part D coverage. Creditable coverage is typically provided through an employer or union.
• How Does Prescription Advantage Work for Those Not Eligible for Medicare?
• For members not eligible for Medicare, Prescription Advantage will continue to provide primary prescription drug coverage.
• There will be no monthly premium for this coverage; however, members will pay a quarterly deductible and co-payments until an annual out-of-pocket spending limit is reached. At that time, Prescription Advantage will pay the full cost of the member’s covered prescription drugs through the end of the plan year.

Prescription Advantage Open Enrollment will run from March 15 through April 28. Those seeking more information or an application should call 1-800-AGE-INFO (1-800-243-4636) and press 1. Applications will be available on-line at www.mass.gov/elders and www.800ageinfo.com on March 15.

Enrollment in Medicare Part D prescription drug plans is open through May 15. To talk to a local SHINE (Serving the Health Information Needs of Elders) counselor for help making decisions about prescription drug coverage, including information on Medicare Part D and Prescription Advantage, call 1-800-AGE-INFO (1-800-243-4636) and press 2. MassMedLine staff is also available to help with decisions about prescription drug coverage at 1-866-633-1617.

Anyone with additional comments and concerns may contact Rep. L’Italien’s office at (617) 722-2080.

State Aid for Special Ed

L’Italien proposes more state aid for special ed

By Edward Mason
Staff writer for Eagle Tribune

With area school districts struggling to do more with less, state Rep. Barbara A. L’Italien is proposing the state spend millions more on one of North of Boston municipalities’ biggest budget busters – special education.

The Andover Democrat is preparing a multipronged, incremental plan to get more money for cities and towns’ special education costs.

A major part of the plan is to overhaul the so-called “circuit breaker” formula which determines how much money a school district can recoup from the state for educating a special needs student – a cost which is often several times more expensive than schooling an average student.

Also, L’Italien wants the state to help defray the cost of transporting special education students to other school districts, which cost school districts statewide $50 million in fiscal 2005.

“Every city and town is struggling to pay for the cost of special education,” L’Italien said. “We (the state) need to do a better job.”

Under the circuit-breaker formula, the state reimburses cities and towns 72 percent of the cost of educating a special needs child whose education costs more than $30,340 a year. L’Italien wants to increase that rate to between 75 percent and 80 percent.

According to state figures, Andover had 59 students who fell into that category last year. At 72 percent, the town got back $1.24 million of the $3.57 million cost. If the rate were 75 percent, Andover would have received another $49,740 in reimbursement, and at 80 percent, the figure climbs to $132,639.

Other North of Boston districts would benefit. Haverhill, for instance, spent $4.48 million in fiscal year 2005 on 60 students whose cost exceeded the $30,340 threshold. It would see a $60,321 increase at 75 percent and $160,857 at 80 percent.

Raising the reimbursement rate for the most expensive special education students addresses only one piece of a troubling puzzle for local school districts trying to cope with rising costs.

To help embattled school districts, L’Italien wants to further tinker with the circuit breaker by allowing municipalities to get back money on more special education students. She would do that by lowering the eligibility threshold from $30,340 to as little as $22,755.

She also wants the state to kick in to offset transportation costs. Cities and towns pay for transporting their students within their districts and to outside districts. L’Italien said she wants transportation costs phased into the circuit breaker formula over a two- or three-year period.

To help pay for her plan, L’Italien wants to tap into $20 million she says was put aside in this year’s fiscal budget for special education but never used.

Special education is a heavy responsibility for local cities and towns, which are legally responsible for the schooling of special needs students.

According to the state Department of Education, a number of Merrimack Valley municipalities on average pay more than double to educate a special needs student. In North Andover, a special needs student costs $16,716 a year, compared with $6,194 for all other students. In Haverhill, a special needs student costs $13,029 versus $6,334 for others.

And costs are rising. Andover Superintendent Claudia Bach estimates special education costs will climb nearly $900,000 for fiscal year 2007. Bach said she would support a plan to have the state take on a greater share of the cost of special education.

“We get very little from the state in comparison to what we spend on special education,” Bach said.

Kara Kosmes, Haverhill’s assistant superintendent, said cities and towns would benefit from a reworking of the circuit breaker, particularly lowering the eligibility threshold.

“Sometimes you’ll have a student who’s not quite at $30,000 but could be at $20,000 to $25,000,” Kosmes said. “It’s still significant when you think of spending per pupil. Lowering of the threshold will help most districts.”

L’Italien’s proposal comes as tight municipal budgets are putting the squeeze on education spending. North Andover, for instance, is contemplating cutting 65 school positions and is considering a Proposition 21/2 override.

Local officials say the effects of rising special education costs send a ripple felt throughout the entire municipal budget process. Because the state requires special education to be funded, municipal officials point out it has to be paid for before other city or town obligations, meaning that cuts come from other education programs, like art, music and drama. Rosemary Smedile, a North Andover selectman, said the state needs to recognize the cost of special education.

“I am not saying we shouldn’t be funding (special education), that these kids should not have proper care and education. I’m not looking to shortchange the kids,” Smedile said. “But what we are looking for is a funding mechanism that doesn’t severely impact the regular education students.”

Smedile said that while special education students’ needs are important and worthy, the high cost threatens to diminish the education mainstream students get and lead them to “slip through the cracks.” It’s a concern echoed by a number of officials interviewed for this story.

Indeed, L’Italien recognizes the state needs to do more. Rather than filing a sweeping overhaul, L’Italien is focusing on incremental changes. She acknowledges that lawmakers are heading into budget season with big-ticket items, like health-care reform. But she also knows the places she represents – Andover, Boxford, Georgetown, Methuen, North Andover and Haverhill – are crying out for help.

“I’m responding to a dire need I’m hearing from my communities,” L’Italien said.

House Plan Would Speed Up Local Permit Process

Published: 03/08/2006

By Edward Mason
Staff writer for Eagle Tribune

House Plan Would Speed Up Local Permit Process

BOSTON – Massachusetts House leaders want to offer financial incentives to cities and towns to shorten the time it takes to approve permits for business and housing developments to 180 days or less.The proposal addresses complaints by business leaders that Massachusetts is a daunting place for companies to build or locate. But it also would help North of Boston cities and towns attract new employers, create jobs and relieve their overburdened tax bases.Massachusetts, under the House plan unveiled yesterday, would spend $6.6 million in fiscal 2007 to speed up the local permitting process.

Cities and towns that agree to vote up or down on permitting requests within 180 days could get grants of up to $100,000 to pay for additional professional permitting staff. They also could get $500,000 to promote sites to potential developers.

The plan also would provide financial assistance to regional planning agencies, such as the Merrimack Valley Economic Development Council, to help cities and towns streamline their permitting process.

Finally, the House would unclog the appeals process by creating a Division of Administrative Law Appeals within the Superior Court system which would have 90 days to render a final opinion on an appeal.

Rep. Barbara A. L’Italien, D-Andover, is a member of the House committee that crafted the plan. L’Italien said the House legislation would help spur economic development in the North of Boston region.

L’Italien pointed out that Haverhill and North Andover are trying to encourage development but have limited resources. State assistance would make it possible to handle permit requests faster to attract employers to the area.

William Pillsbury, economic development and planning director for Haverhill, welcomed getting state money to hire additional professional staff. His office is staffed by him and two secretaries.

Pillsbury also welcomed trimming the appeals process. Right now, most developers face a lengthy approvals process in Haverhill that includes multiple meetings, some of them duplicative, before the City Council and the Planning Board. Public hearings can take two to three months, Pillsbury said.

“If they know they can get in and out and get an answer in a certain number of days, that’s more palatable to a lot of developers,” Pillsbury said.

North Andover Selectman Rosemary Smedile said the state’s reputation as a place with a lengthy permitting process discourages companies from locating in the Merrimack Valley.

“We need to get away from the reputation of being (a state) bogged down in red tape,” Smedile said. “We’re losing out to other states.”