Health-Care Law Addresses Telehealth, Surprise Billing, COVID

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Health-Care Law Addresses Telehealth, Surprise Billing, COVID

Health Care Costs News | January 4, 2021
By: Vasundhra Sangar

Governor Charlie Baker on January 1 signed into law compromise health-care legislation known as S.2984, An Act promoting a resilient health care system that puts patients first, which was enacted by both the House and Senate on December 23, 2020.

Key elements include:

Telehealth: Leaning on experiences brought on by the COVID-19 pandemic, the legislation requires insurance carriers including MassHealth to cover all appropriate telehealth services if coverage is provided for the same services in-person. The provision establishes telehealth as a permanent fixture of the health care landscape in Massachusetts. Coverage rates for behavioral telehealth services will match rates for in-person behavioral health services in perpetuity, while coverage for primary care and chronic disease management telehealth services will match in-person rates for the next two years. All other health-care services delivered by telehealth shall be reimbursed at the same rate for 90 days after the end of the COVID-19 public health emergency.

Out of Network/Surprise Billing: To tackle surprise billing or out-of-network billing, which occurs when a patient unknowingly receives care from a provider or health-care facility that is outside his or her coverage network, the new law requires patients to be notified of a provider’s network status before any scheduled, non-emergency procedure or treatment can take place. In the long term, the legislation also charges the state’s Secretary of Health and Human Services (HHS) to work with the Health Policy Commission (HPC), the Center for Health Information and Analysis (CHIA) and the Division of Insurance (DOI) to recommend a process for establishing a sustainable out-of-network rate by September 1, 2021.

COVID-19: The newly signed legislation requires all carriers including MassHealth to cover COVID-19 related emergency, in-patient, and cognitive rehabilitation services, including diagnostic and laboratory testing, at both in-network and out-of-network facilities, and prohibits any patient cost-sharing for such services. The new law also requires coverage of all medically necessary COVID-19 testing, including testing for asymptomatic individuals whose coverage requirements will be further clarified under upcoming guidelines required from the state’s Secretary of Health and Human Services within 30 days of the bill’s signing. Finally, the legislation directs the HPC and CHIA to analyze and report on COVID-19’s overall effect on health-care accessibility, quality and fiscal sustainability in Massachusetts while examining existing health disparities due to socioeconomic, geographic, racial or other factors.

The new law includes steps to remove barriers to urgent-care center services for MassHealth patients; expands the scope of practice for optometrists, nurse practitioners, nurse anesthetists, and psychiatric nurse mental health clinical specialists; mandates carrier coverage of treatment following a diagnosis of pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS/PANS); authorizes two years of enhanced Medicaid payments to eligible community hospitals; and creates a seat for a state-registered nurse on the HPC board.

The Senate passed its original version of health care legislation in June 2020 and the House responded with their iteration at the end of last July. This final compromise was struck by Senate Chair of Health Care Financing Cindy Friedman, Senator Julian Cyr, Senator Dean Tran, as well as House Public Health Chair John Mahoney, Representative Randy Hunt, and then-Majority Leader and current Speaker of the House, Ron Mariano.