The
Massachusetts Medical Society wishes to be recorded in support of Senate bill 692,
legislation that will provide MassHealth consumers access to patient protection
services afforded by sections 12 through 14 of chapter 176O of the general
laws.
Senate bill 692
would extend health insurance consumer protections contained in chapter 176O that
are not currently available to MassHealth consumers. These protections include utilization
reviews, formal internal grievance processes, and review panels for filed
complaints. Expanding these protections
to cover MassHealth members will help to reduce administrative costs by setting
expedited timelines for utilization reviews, clarifying bases for adverse
determinations, and freeing physicians from excessive administrative burden
caused by the complicated prior authorization processes. Additionally, patients would receive greater
protections regarding adverse determinations through the use of an expedited
resolution policy and a review panel established by the Office of Patient
Protection.
Adopting
these protections, already provided to consumers of private insurance by the
Massachusetts Patient’s Bill of Rights, would decrease disparities in health
care by ensuring parity in access to the aforementioned benefits for MassHealth
patients and the physicians who treat them.
The Medical
Society also wishes to be recorded in support of H.1157/S.666, which are
identical bills to provide national standards to Medicaid medical necessity
review.
Like the bill
mentioned above, these bills will bring MassHealth into line with more
generally applicable standards for the benefit of patients. MassHealth does not currently provide detailed
explanations for adverse determinations made by MassHealth for coverage of
services. Moreover, clinical reviewers
in MassHealth case reviews are not necessarily clinicians of the same specialty
and do not necessarily follow national guidelines. Administering national
utilization review standards for MassHealth and requiring prompt, specific
adverse determination information to be provided to both the patient and the
provider helps to minimize administrative costs and improve patient outcomes by
mandating a timeline for reconsideration of adverse determinations and
requiring the specification of alternative treatment options, if any are
available. These requirements will
afford physicians the opportunity to better update their clinical practices
based on local and national standards of care and to streamline operational
systems in order to deliver quality care to their patients in a more efficient
manner.
Additionally,
these bills would help to address the issue of “administrative complexity,”
which the Health Policy Commission has identified as an area of explicit
focus. Members of the Health Policy
Commission’s Advisory Council were surveyed regarding numerous types of
administrative complexity and specifically ranked prior authorizations as one
of two areas of high priority concern.
These bills help to address issues of administrative complexity by
streamlining and explicating more precise timelines for these administrative
procedures.
The Medical
Society appreciates this opportunity to be heard regarding these bills and
recommends favorable reporting on H.1963/S.692 and H.1157/S.666.
