The Honorable Michael J. Rodrigues
Chair, Senate Committee on Ways & Means
State House, Room 212
Boston, MA 02133
Dear Mr. Chair:
The Massachusetts Medical Society (MMS) deeply appreciates your efforts, and those of the members and staff involved, to produce S.2871, An Act enhancing the health care market review process. The MMS is committed to working collaboratively with
the legislature to enact policies that will increase appropriate transparency and oversight in the health care market, reign in cost growth, and improve affordability and equitable access to care for patients.
In a time of immense financial pressure and unprecedented workforce shortages, the current practice environment poses immense challenges, particularly for independent practitioners. We appreciate provisions in the bill aimed at alleviating undue administrative
hassles, such as excessive quality measure reporting and prior authorization requirements. By that same token, we are wary of new rules and requirements that, despite being well-intentioned, may ultimately undermine the sustainability of independent
practices and destabilize an already fragile practice landscape.
We strongly support efforts to safeguard the clinical autonomy of physician practices and mitigate potential exploitation resulting from the corporatization of medicine, which are addressed in section 98. While we appreciate discussions with the Senate
on this provision, we remain concerned about the potential for unintended consequences that may be disruptive to practices. Physician practices should and must maintain ultimate control of clinical decisions, but an overly prescriptive approach to
regulating management services organizations may significantly impact practices that rely on contracting for a range of administrative services critical to their sustainability. Our preferred approach would be to affirmatively lay out in statute the
concepts that are clinical nature and should be within the ultimate control of the physician practice and where appropriate some of the more nuanced issues could be better addressed through the regulatory process.
We are grateful for the inclusion of Section 110, which would establish a task force to study primary care access and delivery and make recommendations to improve equitable access and affordability of primary care services. This effort is sorely needed,
as a high-functioning primary care system is critical to the overall health care system and is key to improving health outcomes, lowering costs, and ensuring equitable access to care.
We are also appreciative of the inclusion of provisions (Sections 108, 111, and 112) addressing the challenges associated with insurance-imposed prior authorization requirements. Prior authorization delays access to medically necessary care, imposes unnecessary
administrative burden on physician practices and hospital systems, and is a significant driver of physician burnout. We believe the following amendments will strengthen the Senate’s goal of improving patient care and reducing provider burden:
Amendment 82 (Oliveira) - Strengthening Patient Continuity of Care
This amendment removes language that undermines the goal of ensuring that patients who are stable on medications or a course of treatment are allowed to maintain uninterrupted access to that care during the transition to a new health plan. Health plans
would not be prohibited from applying their own prior authorization requirements or other utilization management protocols, but the amendment ensures the patient has 90 days to work out their treatment plan with their physician and the new health
plan without being denied access to medically necessary care.
Amendment 122 (Feeney) - Prior Authorization Expedited Review in Emergency Situations
Access delayed often results in access denied. One of the chief complaints from patients and providers is that prior authorization requests often take weeks to process, despite existing statutory requirements that require a response within two working
days. This amendment improves timely access to care and administrative efficiency by establishing a 24-hour response time to authorize urgently needed care, consistent with the compromise reached in the step therapy law passed in 2022. Additionally,
to promote efficiency and timeliness, this amendment would require that any prior authorization not responded to within the statutory timeframe is deemed granted. This is a policy approach increasingly adopted across the country (most recently by
TN, VT & NJ) in response to the delays in care created by prior authorization requirements.
Additionally, the Medical Society would like to be recorded in support of amendments: 28 (Office-based surgical centers), 49 (Digital Equity), 50 (Prompt Access to Health Care), 52 (Modifier 25), 53 (Anesthesiologist Assistants), 63 (Comprehensive
Coverage for Treatment of Obesity), 117 (Service Preauthorization), 120 (Measuring Administrative Burden on Physicians), and 148 (Relative to Independent Private Practices).
Lastly, we would like to be recorded in opposition to amendments: 9 (Removing Barriers to Care for Physician Assistants), 78 (Pharmacists as Healthcare Providers), 88 (Preserving Quality of Care and Cost Containment in Continuity of Care Provisions),
and 93 (Board of Registration in Naturopathy).
Thank you for your consideration of these comments.
Sincerely,
Hugh M. Taylor, MD
