Testimony In Support of House 2212, an Act Relative to Extending Patient Protections to Recipients of Masshealth, before the Joint Committee on Health Care Financing

The Massachusetts Medical Society wishes to be recorded in strong support of the above referenced legislation  legislation that would expand patient protections for MassHealth recipients and require MassHealth to adopt administrative reforms that would encourage physicians and other health care providers to participate in the program.

Specifically, H. 2212 would allow MassHealth recipients to appeal adverse determinations through the Office of Patient Protection (OPP).  The OPP was created in 2000, through the enactment of Chapter 141 of the Acts of 2000 – the “Patients’ Bill of Rights, to protect Massachusetts managed care consumers and to grant healthcare consumers the right to challenge health plan coverage denials.”  Chapter 224 of the Acts of 2012 transferred authority of the OPP from the Department of Public Health to the newly created Health Policy Commission (HPC).  However, the OPP is not available to MassHealth recipients, nor to state employees or consumers insured through self-insured plans, the latter of which is prohibited by federal ERISA statutes.  H. 2212 would allow MassHealth recipients access to the benefits of the OPP. 

H. 2212 also includes several important provisions that would protect physicians who contract with MassHealth and encourage physicians to participate in the program.  The bill would extend Timely Payment requirements, currently in place for private insurers, to MassHealth.  The Division would have to pay for clean claims within 45 days of receipt and to notify providers within 15 days for written claims or 48 hours for electronic claims of any reasons for non-payment.  H. 2212 would also prohibit MassHealth from recouping, reducing, or retroactively denying payments to physicians for services provided over one year earlier.  In cases where recouping, reducing, or retroactively denying payments to physicians is allowed, the Division would have to provide written notice at least 90 days prior to the implementation of such review.

The MMS urges the Health Care Financing Committee to support the above referenced legislation to ensure that MassHealth recipients, and indeed, all public and privately insured citizens have access to the newly expanded Office of Patient Protection and that MassHealth adheres to the same fair contracting standards as are required for private insurers. 

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