Anti-clawback legislation, telehealth parity and protecting continuity of care will be the top three priorities for the Massachusetts Psychological Association when the next session of the State Legislature begins Jan. 4, 2017.
Legislative sessions run for two years in Massachusetts. At the beginning of each new session, legislators file bills to be considered during that session. Each session sees an estimated 6,000 bills filed in the House of Representatives and 2,000 in the Senate. All bills must be filed by mid-January.
“We’re kind of starting with a clean slate in each January of an odd numbered year,” MPA Executive Director Brian Doherty said.
Jennifer Warkentin, Ph.D., who became MPA’s director of professional affairs last June, succeeding Michael Goldberg, Ph.D., developed the list of proposed action items with Doherty and Goldberg’s input. The list comprised of three main priorities and five additional concerns was adopted by the 1,700-member association’s Board of Directors in October after first being reviewed by its Advocacy Committee.
The number one priority will be to pursue a time limit where none currently exists on the ability of a health care plan to retroactively deny claims already paid, a maneuver called a clawback. Health plans can sometimes retract payments years after they were billed.
“It creates a lot of economic uncertainty for providers,” Warkentin said. “Even if you do due diligence later on, that money can be just taken away from you.”
MPA sees clawbacks as an access issue because such uncertainty may deter providers from joining health plans, Warkentin said.
In the last session, an unsuccessful House bill sponsored by Rep. James J. O’Day (D-West Boylston) sought to impose a six-month limit on clawbacks. Six months would be twice as long as the typical timeline providers have to submit claims.
Massachusetts has no telehealth parity law despite several bills introduced in the last session to achieve pay parity under private insurance, Medicaid and state employee plans.
Efforts to promote payment parity for telehealth services have met with resistance from the Massachusetts Association of Health Plans (MAHP), which has argued that rates should be set through negotiations with providers and not dictated by statute.
MAHP Senior Vice President for Public Affairs and Operations Eric Linzer said using technology to deliver services should mean lower costs that “should flow back to employers and consumers.”
But Warkentin disputed the claim that telehealth services mean less overhead for a provider, adding that MPA will continue to advocate for covering telehealth services at the same reimbursement rate as providing them face-to-face.
“Some health plans have been proposing a lower rate for telehealth sessions basically under the assumption that it costs less. That’s only true if the provider only provides telehealth services. For providers that have a brick and mortar practice, to add that onto their service actually costs them quite a bit of money,” Warkentin said.
In the last session, MPA strongly supported a bill by Rep. Ruth Balser (D-Newton) to ensure continuity of care for mental health treatment by protecting patients from disruptions in care caused by a change in their health care plan or provider’s network status.
The bill was referred to the Committee on Financial Services but did not make it out of study. Doherty said MPA plans to meet with Balser on the matter before the new year.
“We don’t feel that the bill needs to be changed in its current form to make it more palatable because it’s one of the
bills that we strongly support as providing better access for consumers,” Doherty said.
In other areas, MPA will:
- Oppose efforts to establish a separate licensure for psychoanalysts, who have less training and education than a psychologist. “As it stands right now, psychotherapy and psychotherapist is a term that can be used freely in Massachusetts so somebody can simply call themselves a psychotherapist,” Warkentin said. “And of course the public isn’t necessarily going to know that a psychotherapist is very different from a psychologist.”
- Support legislation or regulatory changes that would index psychological evaluations for children and adults reimbursed by the state to market rates. Doherty said that the status quo is a below market rate structure that makes it difficult for some families seeking a clinician who will provide an independent evaluation.
- Support legislation that authorizes nurses to follow the written orders of a psychologist. Although Massachusetts nurses can follow the orders of other nurses, nurse practitioners and speech and language therapists, psychologists are excluded from the list, Warkentin said. “It’s one of the things that we see as important in terms of streamlining care, eliminating an additional step that isn’t necessary and making sure that the care that a patient needs can be provided right away,” Warkentin said. “The majority of other states have already taken care of this legislation. We’re in the minority.”
- Support legislation or regulatory changes that allows Massachusetts Medicaid (MassHealth) to reimburse psychologists in independent practice for psychotherapy services. Only community mental health centers and group practice settings are currently eligible for reimbursement for such services.
- Oppose any bills filed that would increase liability for psychologists engaged in professionally appropriate forms of health care.
By Janine Weisman