Senate Unveils Patients First Act

On Thursday, June 18, 2020, the Massachusetts Senate unveiled the Patients First Act, comprehensive healthcare legislation that aims to increase access to health care, protect patients, and enhance quality care. The legislation builds on vital lessons learned during the COVID-19 public health crisis, as unprecedented demands on the healthcare system have prompted innovation and the expedited adoption of policy changes.

This session, the Senate has shown its strong commitment to making health care more affordable and accessible by passing the Pharmaceutical Access, Costs and Transparency (PACT) Act and the Mental Health Addressing Barriers to Care (ABC) Act. The Patients First Act builds on this progress by removing financial and insurance barriers to telehealth services, protecting patients from out-of- network “surprise” billing for out-of-network health care services, improving access to high quality care and expanding the healthcare workforce, and analyzing health system impacts of COVID-19.

“The Senate set out this session committed to making our health care system more affordable, equitable and accessible for residents, and this bill is consistent with that effort,” stated Senate President Karen E. Spilka (D-Ashland). “We have learned a lot about how to deliver care during the global pandemic, and I am happy that this legislation will use experiences from these challenging times to benefit and protect patients going forward. Increasing telehealth services, ending surprise billing and expanding scope of practice are reforms that truly put patients first. I’d like to thank Senators Friedman and Rodrigues for their commitments and collaboration on this effort.”

“The Patients First Act builds on the Senate’s commitment to supporting our healthcare system during the COVID-19 pandemic by expanding access to care, including vital telehealth services, and bolstering patient protections,” said Senator Michael J. Rodrigues (D – Westport), Chair of the Senate Committee on Ways and Means. “Thank you to Senator Friedman for her tireless efforts to safeguard the healthcare system and thank you to all frontline healthcare workers for keeping us safe in the face of unprecedented challenges.”

"The Senate's longstanding commitment to making healthcare more affordable and accessible to patients across the Commonwealth is reflected in this legislation," said Senator Cindy F. Friedman (D-Arlington), co-chair of the Joint Committee on Health Care Financing. "The components of this bill are basic principles that will allow our healthcare system to continue meeting the needs of patients during this unprecedented time and long after the COVID-19 pandemic has ended, improving patient outcomes and ensuring equitable access to care. I'm grateful to the Senate President and Chair Rodrigues for their collaboration on this effort and continued dedication to improving our healthcare system so that it works for everyone."

The Patients First Act brings telehealth services to the Commonwealth—services that have experienced a dramatic expansion during the COVID-19 pandemic, enabling patients across the state to continue receiving vital medical care through phone or videoconference without risking exposure to the coronavirus. Experience from the last few months has shown that telehealth has the ability to improve efficiency and expand access to care, these services, however, were not widely utilized before COVID-19.

The bill will make telehealth services permanently available for Massachusetts patients long after the COVID-19 state of emergency has ended. The Patients First Act requires that insurance carriers, including MassHealth, cover telehealth services in any case where the same in-person service would be covered. It also ensures that telehealth services include care through audio-only telephone calls, and requires telehealth services to be reimbursed at the same level as in-person health care services over the next two years.

In addition, the Patients First Act seeks to protect patients by ending the unfair practice of surprise billing. Out-of-network billing, or “surprise” billing, occurs when patients who have inadvertently received health care services outside of their insurance network receive bills from a provider for costs that the insurance carrier refuses to pay. Patients are often unaware or unable to determine whether or not a given provider is covered by their health plan prior to a planned procedure, and it can be impossible to avoid uncovered services, particularly in emergency situations.

The bill immediately requires health care providers to notify patients of a health care provider’s network status before a non-emergency procedure occurs so that the patient has the opportunity to make an informed decision about where they seek their care. The bill also tasks the Health Policy Commission (HPC) and the Division of Insurance (DOI) 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. This rate will be instituted in 2021, ending once and for all the practice of “balance billing” patients for surprise out-of-network care.

Currently, Massachusetts lags far behind other states with regard to expanding the scope of practice for certain healthcare professionals, thereby inhibiting patient access to critical care. The Patients First Act authorizes several healthcare professionals to practice at the top of their licensure and training while reducing barriers to care and maintaining patient safety.

Under the bill, registered nurse practitioners, nurse anesthetists and psychiatric nurse mental health specialists can practice independently as long as they meet certain education and training standards and practice under physician supervision for at least two years. It also creates a new professional license for “dental therapists” who will be authorized to provide dental hygiene and other oral health services under the supervision of a dentist. In addition, the bill allows optometrists to treat glaucoma and podiatrists to treat ankle conditions.

Finally, the bill directs the HPC and the Center for Health Information and Analysis (CHIA) to analyze and report on the state of the Commonwealth’s health care delivery system, the effect of COVID-19 on health care accessibility, quality and fiscal sustainability in the short-term and the implications of those effects on long-term policy considerations. The analysis will include an inventory of all health care services and resources serving Massachusetts residents from birth to death, as well as an analysis of existing health care disparities due to economic, geographic, racial or other factors.

The Senate is expected to debate the Patients First Act next week.