Summary: An Act promoting a resilient health care system that puts patients first

Telehealth – Sections 3, 27, 40, 46, 47, 49, 51, 53-61, 65-69

This bill mandates telehealth coverage for all health care services that are covered in-person and appropriate to be delivered via telehealth. Telehealth is defined broadly to include synchronous and asynchronous technologies, including audio-only telephone.

The bill also recognizes interactive audio-video technology as the gold standard for delivery of telehealth services by allowing payers to reimburse for this technology at a greater rate than for other telehealth modalities. Under MassHealth, however, audio-only telephone calls will be reimbursed at the same rate as interactive audio-video technology in order to address issues of access and health care equity.

The bill mandates permanent rate parity for behavioral health services delivered by telehealth. The rate of payment for chronic disease management and primary care services must be at parity with in-person services for two years. All other health care services will be paid at parity for the remainder of the state of emergency and for 90 days after its termination.

The bill also establishes a credentialing by proxy process for physicians through the Board of Registration in Medicine, and for all other health care workers through DPH and the Office of Consumer Affairs and Business Regulation.

Enhanced Medicaid payments for independent community hospitals – Section 63

The bill directs the Secretary for Health and Human Services to distribute enhanced Medicaid payments to independent community hospitals. Support will come in the form of monthly supplemental Medicaid payments equal to 5 percent of the hospital’s average total MassHealth payments received for inpatient and outpatient services in the previous fiscal year. Total expenditures under the program are limited to $35 million per year and will sunset after two years. 

·      Eligibility criteria: To receive funds, a hospital must be a non-profit with…

o   (i) a statewide relative price below 0.90;

o   (ii) a public payer mix at or above 60 percent; and

o   (iii) not be corporately affiliated with a provider organization with 2 or more hospitals with total net assets greater than $600M.

Out-of-network billing – Sections 25, 62, and 71

This bill helps consumers avoid surprise medical bills by requiring health care providers and insurance carriers to notify patients of a health care provider’s network status before a non-emergency procedure occurs. The bill also 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 and make recommendations on establishing a process to determine a fair and sustainable out-of-network rate to resolve the costs of uncovered care no later than September 1, 2021.

Access to urgent care facilities by MassHealth members – Section 39

This bill eliminates the requirement that MassHealth enrollees first obtain a referral from a primary care provider before accessing care at an urgent care facility, eliminating a barrier to affordable care for low-income patients. For better care coordination, urgent care facilities would also be required to notify MassHealth each time they are visited by a MassHealth patient and if the patient does not have a designated primary care provider.

COVID-19 coverage mandate – Section 70

This bill requires insurance carriers, including MassHealth, to cover, without any out-of-pocket costs to patients, 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. 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.

Health care workforce – Sections 4-9, 10-24, 28-38

This bill enables nurse practitioners, nurse anesthetists and psychiatric nurse mental health clinical specialists to practice independently, provided that they meet certain education and training standards and practice under physician supervision for at least 2 years.

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 identify areas for care improvement. Finally, for the purposes of administrative efficiency, this 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.

APRN Admit, Assess and Restrain – Sections 41-45

This bill allows qualified advanced practice registered nurses working in DMH-licensed hospitals to admit, assess and restrain someone who is experiencing an acute mental health crisis. 

PANDAS/PANS – Section 26

Pediatric acute-onset neuropsychiatric syndromes (PANS) and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) are life-changing conditions that are often triggered by an infection such as strep throat that occurs suddenly in previously healthy children between the ages of two and twelve. These conditions result in a marked detrimental personality change, which typically includes obsessions and compulsions, extreme anxiety, trouble sleeping, difficulty with schoolwork, bodily tics and urinary frequency or incontinence.

 This bill requires insurance carriers to cover PANDAS/PANS, ensuring that children with PANDAS/PANS and their families have access to treatment and care. The bill also establishes a PANDAS/PANS Advisory Council within the Department of Public Health (DPH) to advise the DPH commissioner on ongoing research, diagnosis, treatment, and education related to PANDAS/PANS.

Access to Cancer Clinical Trials – Section 26

Travel and accommodation costs can pose a barrier to participation in cancer clinical trials, especially among low-income cancer patients. This bill eliminates that barrier by allowing reimbursement for a cancer patient’s reasonable travel and accommodation expenses associated with participating in a cancer clinical trial.

Rare Disease Advisory Council – Section 26

This bill establishes 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. The council will also be tasked with creating a rare disease plan for the state and developing methods to publicize the profile of the social and economic burden of rare diseases to ensure health care providers are more informed about the unique challenges of those living with rare diseases.

Registered Nurse on HPC Board – Section 1

This bill ensures 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.