Comprehensive Healthcare Reform

At a time when Massachusetts is in the midst of yet another COVID-19 surge, the Legislature has prioritized the development of new healthcare policy, We have learned a lot during the pandemic about how to increase telehealth services, broaden the scope of practice for certain health care professionals, and this legislation will do those things and more to protect our most vulnerable populations during these challenging times. There is more work to do, but this is a significant step in the right direction.

The bill’s components are highlighted below:

The bill makes telehealth permanently accessible to all in Massachusetts. From the outset of the COVID-19 pandemic, these services experienced a dramatic expansion, enabling patients across the state to continue receiving vital medical care through videoconference or phone without risking exposure to the coronavirus. The bill requires insurance carriers, including MassHealth, to cover telehealth services in any case where the same in-person service would be covered, and the use of telehealth is appropriate. This coverage mandate will give providers certainty and allow them to make investments that will expand geographic access, reduce delays in care, and improve both pre- and post-care treatment.

Under the bill, behavioral health treatment delivered via telehealth will be permanently reimbursed by insurers at the same rate as in-person services. A similar reimbursement structure will also be implemented for primary care and chronic disease management services delivered via telehealth for two years. All other telehealth care services will be reimbursed at the same rate as in-person services for the duration of the COVID-19 state of emergency, and 90 days after its expiration. Equalizing telehealth and in-person payment rates as the state emerges from the pandemic is critical to offering safe care options for patients, incentivizing continued expansion of services, and providing a financial lifeline for hospitals, doctors and community health centers that have shifted largely to telehealth services.

Since expanded use of telehealth has and will continue to affect the Commonwealth’s health care system in a variety of ways, the bill also includes an analysis of telehealth coverage and payment to inform future policy decisions.

Expanding Patient Access
Building on additional lessons learned during the pandemic, An Act promoting a resilient health care system that puts patients first authorizes several health care professionals to practice at the top of their license and training while reducing barriers to care and maintaining patient safety. The bill enables nurse practitioners, nurse anesthetists and psychiatric nurse mental health specialists to practice independently, provided that they meet certain education and training standards, and practice under physician supervision for at least two years. These standards are consistent with a March 10, 2020 Executive Order that expanded this same practice authority to advanced-practice registered nurses during the COVID-19 emergency.

In addition, the bill allows Massachusetts optometrists to treat glaucoma and recognizes pharmacists as health care providers, enabling them to integrate more fully into coordinated care teams and work with patients to review medications to ensure medication adherence and identify areas for care improvement.

COVID-19 Testing and Treatment
As the pandemic continues, it is crucial to ensure that COVID-19 testing and treatment services are as widely accessible as possible. To that end, this bill ensures that critical services related to treatment of COVID-19 would be covered by insurance carriers, including MassHealth, at no cost to consumers. These covered services include 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. This bill also 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 this bill.

Surprise Billing
The bill increases protections for patients against the unfair practice of surprise medical billing. In the short term, the bill immediately institutes requirements for health care providers and insurance carriers to notify patients of a health care provider’s network status before a non-emergency procedure occurs. The patient can thereby avoid a surprise medical bill and make an informed decision about where to seek care. In the long term, this bill tasks the Secretary of Health and Human Services—in consultation with the Health Policy Commission, the Center for Health Information and Analysis and the Division of Insurance—to develop a report by September 1, 2021 that makes recommendations on establishing a fair and sustainable out-of-network rate to resolve the costs of uncovered care.

Improving Future Care
To understand the ongoing effects of COVID-19 on health care accessibility, quality and fiscal sustainability and the implications of those effects on long-term policy considerations, the bill directs the Health Policy Commission and the Center for Health Information and Analysis to analyze and report on the state of the Commonwealth’s health care delivery system amid COVID-19. The analysis will include an inventory of all health care services and resources serving Massachusetts residents from birth to death, as well as an analysis of existing health care disparities due to economic, geographic, racial or other factors.

Other notable reforms in An Act promoting a resilient health care system that puts patients first include:

  • Requiring insurance carriers to cover pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) and pediatric acute-onset neuropsychiatric syndromes (PANS) and establishing a PANDAS/PANS Advisory Council within the Department of Public Health;
  • Providing assistance by authorizing enhanced monthly Medicaid payments for certain community hospitals for two years to help mitigate the unprecedented financial challenges community hospitals continue to face during the COVID-19 pandemic;
  • Eliminating a barrier to participation in cancer clinical trials by allowing reimbursement for a cancer patient’s reasonable travel and accommodation expenses associated with participating in a cancer clinical trial;
  • Eliminating a barrier to access urgent care services for low-income residents by ending the requirement that MassHealth patients first obtain a referral from a primary care provider before seeking care at an urgent care facility, while also ensuring that urgent care facilities and MassHealth assist patients with the process of designating a primary care provider;
  • Establishing a Rare Disease Advisory Council to advise the Governor, the Legislature and the Department of Public Health on the incidence of rare disease in the Commonwealth and the status of the rare disease community; and
  • Ensuring that a registered nurse with demonstrated expertise in the development and utilization of innovative treatments for patient care is a member of the Health Policy Commission’s board.
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Phone: 617-722-2263
Mail: State House Room 473B, Boston, MA 02133