Reps. Stanley and Lawn Support Healthcare System during Pandemic

(BOSTON) – Rep. Tom Stanley and Rep. John Lawn joined their colleagues in the Massachusetts House in passing a bill that will enable patients to access healthcare services via telemedicine and provide vital funding to community hospitals in the midst of COVID-19.

An Act to promote resilience in our health care system (H.4916) mandates telehealth coverage for primary care services, behavioral health and chronic disease management – all areas that have experienced success with remote care in recent months – for at-home patients. It also enables telehealth in the provider-to-provider context for all healthcare services, including when delivered to a patient located in a healthcare facility. The bill also authorizes the Health Policy Commission to issue recommendations on future telehealth services for at-home use. Under the bill, insurers must cover services delivered by a wide range of technologies, including audio-only telephone calls, but may also pay a greater rate for the use of audio-video technology. MassHealth would be able to reimburse audio-only telephone calls at the same higher rate as audio-video technology, in recognition of the barriers in access many MassHealth enrollees may face.

The bill also creates a structure whereby the Secretary for Health and Human Services can provide direct payments to independent community hospitals – often the best source for healthcare in many Gateway cities as well as their economic engine (vital during the COVID-19 created financial downturn.) Under the bill HHS will disburse Medicaid payments to independent community hospitals in payments equal to 5 percent of the hospital’s average total MassHealth payments received for inpatient and outpatient services in the previous fiscal year.

“This legislation will help patients across the Commonwealth get better access to care in times when they need it most,” said Rep. Stanley. “By ensuring this access to Telehealth, patients can focus on their health needs, rather than worrying over whether insurance would cover this access or the potential effects of COVID-19 if they had to visit a doctor in person.”

“This legislation applies lessons learned from the pandemic to make lasting changes to our health care system, including a permanent commitment to ensuring behavioral health services are covered by telehealth at the same rate as in-person care,” said Rep. Lawn. “The targeted investments and system changes in this bill will help the residents of the Commonwealth access and navigate health care safely as we continue to battle this pandemic.”

o The bill provides payments to non-profits with:a statewide relative price below 0.90;
o a public payer mix at or above 60 percent; and
o not be corporately affiliated with a provider organization with 2 or more hospitals with total net assets greater than $600M.

The bill also:

• Requires payers to reimburse telehealth services at the same rate as in-person services until July 31, 2021;

• Establishes a credentialing by proxy process for physicians through the Board of Registration in Medicine;

• Extends, until July 31, 2021, Governor Baker’s emergency order which mandates insurance coverage for COVID-19 emergency and inpatient services, including all professional, diagnostic, and laboratory services;

• Authorizes independent prescriptive practice for nurse practitioners and psychiatric nurse mental health clinical specialists after completing 2 years of supervised practice;

• Extends emergency orders granting temporary licenses to certain health care providers during the pandemic, by one year, to expire on December 31, 2021;

• Requires the Assistant Secretary of MassHealth to testify at the HPC’s annual Health Care Cost Growth Hearing;

• Extends COVID-19 insurance coverage for outpatient testing for asymptomatic individuals who work in high-risk industries, like health care, retail, restaurant, and hospitality;

• Eliminates the requirement that MassHealth enrollees get a referral from a primary care provider before accessing care at an urgent care facility, eliminating a barrier to affordable care;

• Requires MassHealth to pay to reserve a member’s bed in a nursing home for up to 20 days if the resident is being treated in a hospital for COVID-19.

The bill is now in conference committee.