The Massachusetts Medical
Society wishes to be recorded in strong support of the above referenced
legislation legislation that would expand
patient protections for MassHealth recipients and require MassHealth to adopt
administrative reforms that would encourage physicians and other health care
providers to participate in the program.
Specifically, H. 2212 would
allow MassHealth recipients to appeal adverse determinations through the Office
of Patient Protection (OPP). The OPP was
created in 2000, through the enactment of Chapter 141 of the Acts of 2000 – the
“Patients’ Bill of Rights, to protect Massachusetts managed care consumers and
to grant healthcare consumers the right to challenge health plan coverage
denials.” Chapter 224 of the Acts of
2012 transferred authority of the OPP from the Department of Public Health to
the newly created Health Policy Commission (HPC). However, the OPP is not available to
MassHealth recipients, nor to state employees or consumers insured through
self-insured plans, the latter of which is prohibited by federal ERISA
statutes. H. 2212 would allow MassHealth
recipients access to the benefits of the OPP.
H. 2212 also includes several
important provisions that would protect physicians who contract with MassHealth
and encourage physicians to participate in the program. The bill would extend Timely Payment
requirements, currently in place for private insurers, to MassHealth. The Division would have to pay for clean
claims within 45 days of receipt and to notify providers within 15 days for
written claims or 48 hours for electronic claims of any reasons for
non-payment. H. 2212 would also prohibit
MassHealth from recouping, reducing, or retroactively denying payments to
physicians for services provided over one year earlier. In cases where recouping, reducing, or
retroactively denying payments to physicians is allowed, the Division would
have to provide written notice at least 90 days prior to the implementation of
such review.
The MMS urges the Health Care
Financing Committee to support the above referenced legislation to ensure that
MassHealth recipients, and indeed, all public and privately insured citizens
have access to the newly expanded Office of Patient Protection and that
MassHealth adheres to the same fair contracting standards as are required for
private insurers.
