BOSTON (SHNS) – State senators plan to vote next week on a bill that aims to take lessons learned during the COVID-19 pandemic and incorporate them as regular features of the state’s health care system.
The bill includes measures around telehealth services, out-of-network billing and scope of practice, according to a summary. It also directs a pair of state agencies, the Health Policy Commission and the Center for Health Information and Analysis, to analyze the pandemic’s short- and long-term effects on the health care system’s accessibility, quality and fiscal sustainability.
“What we are trying to do with this bill is ensure that the health care system can continue to provide access in some very fundamental ways as we go through this uncertain time period,” Sen. Cindy Friedman, the co-chair of the Health Care Financing Committee, said in an interview.
“I believe that even once we get through maybe the next surge or whatever the uncertainty of the pandemic is, we are still going to need to make sure that there are some important pieces in the health care system that stay in place for a while, because it’s about patient access,” she said.
Friedman said the bill — expected to move through the Senate Ways and Means Committee on Thursday and be scheduled for a full Senate vote next week — is not intended to create “a whole new world of health care.”
Telehealth and scope of practice standards were subjects of executive orders that Gov. Charlie Baker issued to help health care providers respond to a surge in COVID-19 cases and continue offering the services that other patients need.
Friedman said the bill “gives that further protection of, everyone can just take a breath because things aren’t going to change under you because of the end of an executive order.”
The bill, dubbed by sponsors as the Patients First Act, would allow nurse practitioners, nurse anesthetists and psychiatric nurse mental health specialists to practice independently, subject to education and training requirements. The Senate’s bill summary says that same authority was extended to advance practice registered nurses during the COVID-19 emergency under a March 10 order.
Other emergency orders have expanded access to telehealth so providers can diagnose and treat patients remotely through videos and phone calls. The bill would require insurance carriers “to cover telehealth services in any case where the same in-person service would be covered,” according to the summary.
Friedman said it would direct the Health Policy Commission to develop recommendations on “how to parse how you pay for a particular telehealth session as compared to in-person.”
Aiming to protect patients from being saddled with unexpected costs arising from seeing an out-of-network provider, the bill tasks the HPC and Division of Insurance with “determining an appropriate default rate for out-of-network charges that is fair for providers and insurers, and takes patients out of the middle,” according to Senate President Karen Spilka’s office. That rate would be instituted in 2021.
Negotiations over competing House and Senate health care bills collapsed in the final moments of formal legislative business last term, in the summer of 2018. Almost two years later, Beacon Hill has yet to coalesce behind a new approach.
The Senate has also passed bills this session dealing with prescription drug costs and behavioral health care. Baker filed a sweeping bill last fall that called for providers and payers to boost their spending on primary care and behavioral health and also included measures around telemedicine, scope of practice and surprise out-of-network billing.
The Health Care Financing Committee, which lost its House chair in January when Jennifer Benson left the Legislature to head the Alliance for Business Leadership, twice extended its time to consider Baker’s bill (H 4134). It’s now due to report on the bill by Friday.
“Anything could happen, but I came out of that feeling like we have a pretty good chance of seeing something happen before the end of the session,” Baker said after a late January hearing on his health care bill.
Much of the Legislature’s focus over the past few months has been on responses to COVID-19, like restaurant relief measures, liability protections for health care providers and procedures for upcoming elections. While the health care bill does relate to the pandemic, it’s an indication that, with about six weeks remaining until formal sessions end for the term, lawmakers are also still looking to tackle other policy areas.
Senate President Karen Spilka and House Speaker Robert DeLeo have both said they want to act on racial justice and police reform legislation before July 31, and the branches have also been engaged in transportation matters.
In early March, before COVID-19 had erupted in Massachusetts, the House passed an $18 billion transportation borrowing bill and a package of tax and fee increases intended to generate revenue for transportation projects. The Senate last week passed legislation that included two components of those bills — authorizing a new governance structure for the MBTA, and directing $300 million to cities and towns for road and bridge repairs.
The Senate and House appear to be at odds over those two measures, and the MBTA’s existing Fiscal and Management Control Board expires at the end of the month.
Friedman compared the new health care bill to the road and bridge repairs program, saying there’s a need to “have some infrastructure pieces in place to make sure that the health care system can continue while we get through these really uncertain times.”
“I think this is fundamental infrastructure stuff. This is not a whole new frontier,” she said. “This is, you’ve got to patch the roads. You’ve got to make sure people can get to their health care provider. It’s just so fundamental, and that’s why we believe very strongly we need to do this.”