Governor Baker Lays Out Newest Health Reform Plan

Governor Charlie Baker last Friday introduced the latest legislative proposal to reform the state’s healthcare system – a multi-part initiative that focuses on improving access to behavioral health, managing high drug costs, expanding care via the use of telemedicine, adopting the Nurse Licensure Compact, and ending “surprise billing” for patients, among many other moving parts.
A major portion of the bill addresses the shared, long-standing concerns of the healthcare community that behavioral health is a much-in-demand component of the system but suffers from workforce shortages and administrative burdens.
The administration’s bill – An Act to Improve Health Care by Investing in VALUE – would, among other things outlined in a summary, compel insurance companies and providers to increase combined expenditures on primary care and behavioral health by 30% over three years. The bill promotes behavioral health reimbursement parity “through the establishment of a rate floor” for certain services, and requires payers to reimburse “non-licensed behavioral health professionals-in-training working in clinical settings.” Acute care hospitals would be required “to maintain clinical capacity to provide or arrange for the evaluation, stabilization and referral of patients with behavioral health conditions in emergency departments.”
Baker’s bill would prohibit providers from charging facility fees for certain procedures, strengthen enforcement of the state’s healthcare cost-growth benchmark, and prohibit surprise billing. Surprise billing disputes between providers and insurers would be resolved by establishing “an out-of-network default rate” based on the Medicare fee schedule.
MHA President & CEO Steve Walsh said after reviewing the top-line features of the bill released on Friday, “This legislation is a tremendous opportunity to evolve and improve the best healthcare system in the world. The commonwealth’s hospitals thank Governor Baker, Secretary Sudders, and their staff on this important next step in Massachusetts healthcare reform. Just as the needs of our patients change, so must the way we deliver accessible, high-quality care.”
The governor’s bill advances two of MHA’s priorities – allowing Massachusetts to join the multi-state Nurse Licensure Compact, and promoting telemedicine by establishing a regulatory framework and ensuring coverage parity by prohibiting insurers from denying coverage based on the sole fact that the service is provided via telemedicine. The bill also would place greater oversight on the pharmaceutical industry, and impose penalties on manufacturers that increase the price of a drug by a certain percentage tied to the Consumer Price Index.
“While we are still reviewing the details of the governor’s bill, we commend his continued focus on addressing some of the commonwealth’s most challenging healthcare issues, including increasing state oversight of the pharmaceutical industry, the necessary expansion of telemedicine services, and adding Massachusetts to the 34 other states already participating in the Nurse Licensure Compact to alleviate our current workforce shortage,” Walsh said. “Additionally, MHA stands with Governor Baker to end surprise billing, get patients out of the middle, and keep negotiations where they belong: between providers and insurers. We continue to advocate for a solution similar to the law adopted in New York State, which has ended the practice of surprise billing without disrupting patient access or increasing healthcare costs.”