Massachusetts Health Care Bill Makes Several Significant Changes

The Act’s balance billing-related requirements differ somewhat from the recent similar federal legislation on the topic, the No Surprises Act. Again, the Massachusetts law applies only to non-emergency services; the federal law addresses non-emergency, emergency, and air ambulance services. Yet the Massachusetts Act is also somewhat broader than the federal law, as the Act imposes requirements on all providers—participating and non-participating—while the No Surprises Act’s non-emergency services provisions apply only to non-participating providers at participating facilities and to non-participating facilities. And the two laws may conflict in some contexts. For example, the Massachusetts Act would allow any non-participating provider to balance bill if notice and consent requirements are met. Yet the federal law prohibits certain non-participating providers at participating facilities—such as emergency providers, radiologists, pathologists, anesthesiologists, and neonatologists—from balance billing at all.

COVID-19 testing, treatment, and coverage: The Act ensures continued treatment and coverage for COVID-19 by requiring that plans cover medically necessary outpatient testing (including testing for asymptomatic individuals in accordance with guidelines that the Massachusetts Secretary of Health and Human Services will develop), as well as treatment (including emergency department visits, inpatient, professional, and laboratory services) without any patient cost-sharing. Again, plans must pay for services provided via telehealth at the same rates as in-person services for 90 days after the end of the COVID-19 state of emergency. The Act also requires the Massachusetts Secretary of Health and Human Services to promulgate guidelines regarding testing of asymptomatic individuals in industries with increased COVID-19 exposure, such as the health care, restaurant, retail, and hospitality industries.

Source: https://www.jdsupra.com/legalnews/massachusetts-health-care-bill-makes-2786212/