The Massachusetts legislature’s Joint Committee on Financial Services holds an important hearing tomorrow, Tuesday, November 9, beginning at 11 a.m. to review a host of bills, including some priority legislation from MHA. The committee is co-chaired by Sen. Brendan P. Crighton (D-Lynn) and Rep. James Murphy (D-Weymouth).
Among the proposed bills MHA strongly supports are:
H.1148/S.688 AN ACT TO PREVENT INAPPROPRIATE DENIALS BY INSURERS FOR MEDICALLY NECESSARY SERVICES
(filed by Rep. Elizabeth Malia and Sen. John Keenan). This bill would prohibit insurers from denying payment for services solely on the basis of an administrative or technical defect in a claim. It also requires insurers to provide clarification of the reasons for claim denials, and allows providers sufficient time to re-submit curative claims. The bill establishes a 30-day timeframe for insurers to respond to provider appeals for retrospective reviews of medically necessary services. If upon review the service is deemed to be medically necessary, the insurer must reverse the denial and pay the claim.
H.1086/S.670 AN ACT RELATIVE TO UNILATERAL CONTRACT CHANGES
(Rep. Michael Moran, Sen. John Velis). The bill prohibits MassHealth, the Group Insurance Commission, and commercial carriers from entering into a contract with healthcare providers that allows them to make unilateral changes to a material term or condition of such contract other than a change expressly required by law. Currently, carriers may unilaterally change the terms of the contract while it is in force, causing operational, financial, and medical consequences for both patients and providers.
H.1086/S.670 AN ACT RELATIVE TO UNCOLLECTED CO-PAYS, CO-INSURANCE AND DEDUCTIBLES
(Rep. Carole Fiola, Sen. Barry Finegold). This bill requires insurance companies, who design and sell health plans, to share accountability with providers for uncollectible patient obligations after insurance. This legislation would require insurers to reimburse healthcare providers 65% of an uncollected co-payment, co-insurance, and/or deductible that exceeds $250 if the provider does not receive payment after the provider has made reasonable collection efforts. The process for reasonable collection efforts outlined in the bill is similar to the processes that Medicare and the state’s Health Safety Net use, with the 65% reimbursement similar to the Medicare methodology.