On Tuesday evening, the legislature’s conference committee negotiating health care legislation released a final bill that will be sent to the Governor for his signature once passed by the Legislature. We expect Governor Baker to take prompt action to sign this bill that culminates months of negotiation on the topics of telehealth, out-of-network billing, scope of practice, and additional provisions relating to COVID-19 and administrative simplification.
On the issue of telehealth, the bill requires carriers—including MassHealth—to cover all services that (1) can be delivered appropriately via telehealth and (2) would be covered if delivered in person. The bill defines ‘telehealth’ broadly, covering synchronous and asynchronous telecommunications technology including audio-only communications. With regard to reimbursement for telehealth services, the bill requires permanent payment parity for behavioral health services, while requiring parity for primary care and chronic disease management services for the next two years. All other health care services shall be paid at parity with in-person services for 90 days beyond the duration of the COVID-19 state of emergency. Telehealth services may be subject to utilization review to determine the appropriateness of telehealth as a means of delivering a health care service. Furthermore, the bill provides for proxy credentialing and privileging for telehealth services with other health care providers or facilities that comply with the federal Centers for Medicare and Medicaid Services’ conditions of participation for telehealth services. Lastly, the bill requires HPC, CHIA, EOHHS, and DOI to analyze and issue a report on the effects of telehealth coverage and payment within the Commonwealth, with an interim report due after one year and a final report due after two years.
On the issue of out-of-network billing, this legislation instructs several state agencies, including EOHHS and HPC, to study potential out-of-network billing solutions in light of potential changes to federal law and report their recommendations by September 1, 2021. It also establishes notice requirements for health care providers to notify patients of their network status before a non-emergency procedure. These notice provisions additionally require referring providers to notify patients of the network status of the providers to whom the patients are being referred. Failure to comply with these requirements carries a penalty up to $2,500 in each instance. This legislation does not address out-of-network billing for emergency situations and is not likely to alter the effect of recently introduced Federal legislation seeking to address out-of-network billing in a comprehensive manner.
This legislation grants independent practice authority to nurse practitioners, psychiatric nurse mental health clinical specialists, and certified registered nurse anesthetists in the case that the provider meets certain education and training standards and practices under qualified supervision for at least two years. The bill requires that all advanced practice nurses with independent practice authority are subject to requirements commensurate to physician requirements as they apply to the creation and public dissemination of individual profiles and licensure restrictions, disciplinary actions and reports, claims or reports of malpractice, communication with professional organizations, physical and mental examinations, investigation of complaints, and other aspects of professional conduct and discipline. The bill further allows optometrists to treat glaucoma.
With regard to COVID-19, this bill requires insurance carriers—including MassHealth—to cover all COVID-19-related emergency, inpatient, and cognitive rehabilitation services, including all professional, diagnostic and laboratory services, at both in-network and out-of-network providers and without any out-of-pocket costs to patients. It further requires coverage for medically necessary outpatient COVID-19 testing, including testing for asymptomatic individuals under circumstances to be defined by guidelines established by the Secretary of Health and Human Services within 30 days of the effective date of the bill. The bill additionally requires insurance carriers to cover PANDAS/PANS, ensuring that children with PANDAS/PANS and their families have access to treatment and care, and it establishes a PANDAS/PANS Advisory Council within DPH to advise the Commissioner on ongoing research, diagnosis, treatment, and education related to PANDAS/PANS.
The bill also introduces some provisions geared toward administrative simplification. It eliminates the requirement that MassHealth patients first obtain a referral from their primary care provider before seeking treatment at an urgent care facility. The bill also requires urgent care facilities to notify MassHealth when a MassHealth patient receives urgent care services in order to improve care coordination while also requiring the urgent care facility to inform MassHealth if the MassHealth patient who visited the urgent care facility does not have a designated primary care provider, thereby allowing MassHealth to follow-up with the patient and provide information and guidance on how to choose a primary care provider. Lastly, the bill extends the effective term of a licensed professional's Massachusetts Controlled Substance Registration beyond one year to equal the effective term of their professional license.
In total, the health care legislation arising out of conference committee seems to have been largely influenced by the demands felt by the health care system during this trying year.
