MASSACHUSETTS: Major Managed Care Reform Bill In Works
The Boston Globe has obtained a copy of a "proposal to introduce sweeping regulations of health maintenance organizations in Massachusetts," a piece of legislation that "could affect the way millions of patients receive their health care." The Massachusetts proposal, "a redraft of an existing bill, is being circulated for comment among health insurers, employers, doctors, hospitals and patient advocates." These groups, the Globe reports, participated in a four-month discussion on crafting new legislation." Their comments are due Monday and "will be forwarded, along with the proposal, to members of the House Ways and Means Committee, which will craft a final bill." State Rep. Harriette Chandler (D), who is "one of several lawmakers spearheading the proposal," would not comment on the legislation, calling the proposal a "working draft."
The Usual Suspects
According to the Globe, the proposal would establish an "office of managed care review" within the Massachusetts Department of Public Health. The new office "would have broad powers to regulate and monitor health plans, and would develop a report card comparing health plans in the state." The measure would require health plans to comply with a number of mandates, including a "prudent-layperson" standard for emergency room care and a requirement that "[p]regnant women, the chronically ill, and terminally ill" be given "expanded access to specialist physicians." In addition, the proposal would require health plans "to provide language interpreter service to patients who request it," and "to disclose far more information, including a list of doctors and hospitals detailing how each is paid." Health care providers "would be barred from collecting unpaid claims from patients," except for "copayments, deductibles, coinsurance and services not covered by the insurer."
How health plans handle grievances would also be regulated. Managed care plans "would be required to acknowledge grievances in writing within 15 days of receiving an oral or written complaint," and final decisions on all complaints would have to be made within 30 days. Patients who are denied treatment coverage by their health plan would be informed "how to appeal the denial," and "[p]atients who are denied care would have an option to appeal to the state." According to the Globe, Massachusetts "would contract with three arbitration organizations that would make a final determination within 60 days of receiving a complaint." Patients would be required to pay $50 for the arbitration service, but the fee would be waived "for financially strapped patients."
Casting A Wary Eye
While the proposals "are meeting praise from patient advocates," businesses "say the plan could substantially raise insurance premiums." Massachusetts Business Roundtable's Director of Policy Christopher Goode said, "No one has any idea of the cost impact of this bill. We would support a cost analysis on the exact economic impact on employers, hospitals and consumers." The Globe notes that the Massachusetts proposal would not be applied to self-insured health plans, which cover about "half of those with health insurance" in the state (Pham, 4/2).