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July 30, 2020

House unanimously passes healthcare reform bill

Photo | Flickr | Ajay Suresh The Massachusetts State House

House lawmakers on Wednesday unanimously voted to take another pass at infusing additional cash into financially strapped community hospitals, a key feature of a health care bill that collapsed two years ago when House and Senate Democrats could not reach agreement by a July 31 deadline.

"The last couple of bills that we've worked on here in the House have not gotten across the finish line, the main sticking point being money -- how do you spread the money out, who gets what, who pays, who are the net payers, who are the net gains," Majority Leader Ron Mariano said on the House floor Tuesday night.

This year, Mariano said, the House would "try something a little different," by building on a step Gov. Charlie Baker took earlier in the COVID-19 crisis to buoy the state's hospitals.

"He added a 7 percent surcharge on MassHealth bills to hospitals that are community hospitals which are 60 percent public payers, and he added a 20 percent surcharge to COVID-related diseases in the same hospitals," Mariano said. "We're going to try that approach and I think it's a much cleaner and easier way to fund helping our community hospitals."

After the House's Wednesday evening vote, the bill's next stop is likely to be a conference committee, where three senators and three representatives will negotiate over two competing bills. Both the House and Senate bills aim to build on lessons learned during the COVID-19 pandemic and make a commitment to telehealth access, though their particulars differ.

The House bill (H 4888) would require insurers to cover telehealth visits for primary care and chronic disease management at the same rate as in-person service for one year. Behavioral telehealth services, over both phone and video, would be covered at the same rate as in-person care permanently, under the House bill.

The bill the Senate passed unanimously on June 25 requires insurers to reimburse providers at the same rate for telehealth as they would for in-person care for the next two years.

The Senate bill (S 2796) also includes protections against surprise out-of-network charges -- it tasks the Health Policy Commission and the Division of Insurance with determining a default rate for out-of-network charges, to take effect in 2021 -- and expands scope of practice for nurse practitioners, nurse anesthetists and psychiatric nurse mental health specialists, allowing them to practice independently as long as they meet certain education and training standards.

"The citizens across the commonwealth are really hurting, and there's uncertainty, and I think they're really depending on us to reform our health care system," Sen. Cindy Friedman, the Senate chair of the Health Care Financing Committee, said in an interview last week.

Mariano said the House bill extends a Baker emergency order on out-of-network billing for a year, and addresses scope of practices for nurse practitioners, who he said are "the first line of defense."

Introducing their bill on the House floor Tuesday night, Mariano and Rep. Dan Cullinane, the acting House chair of the Health Care Financing Committee, both described it as taking a "measured step."

"Responsible government is not about who can be the boldest or who gets credit for making the fastest change, no matter how good it may sound or how desirable the ultimate or aspirational goal may be," Cullinane said. "There are moments when responsible government is about slowing down, about being surgical, making key tweaks at difficult times and then making sure we got it right. Still confronting a global pandemic while facing budget shortfalls of billions, this is a moment to be surgical."

After the Senate passed its bill in late June, Senate President Karen Spilka struck a note of urgency around the measures it contained and said she hoped the Senate's prescription drug and behavioral health bills would "continue to move forward in the legislative process."

"When it comes to making telehealth services permanently accessible, ending surprise billing and expanding scope of practice, let me be clear: we cannot wait," Spilka said in a statement. "We have learned a lot about how to deliver accessible health care during the global pandemic, and we can and should implement these changes now."

Before passing the bill Wednesday, the House shot down a Rep. Christopher Hendricks amendment that would have created a "rebuttable legal presumption" for certain medical workers who contracted COVID-19. As the law currently stands, medical personnel can file workers compensation claims related to COVID-19, but "unfortunately have the burden of showing that the COVID-19 diagnosis was a result of their job," Hendricks said.

"This will allow workers comp insurers to deny claims entirely, because while it is obvious that these diagnoses are the result of being on the front lines during this pandemic, it is also impossible to show where that COVID-19 molecule was actually ingested," the New Bedford Democrat said. "In short, this threshold is far too high for these workers, and we as legislators owe them to ease that burden."

The amendment failed on a 62-94 vote, and Cullinane said the idea needed additional vetting.

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