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MPA Testifies in Support of Anti-Clawback and Provider Network Transparency Bills

Tuesday, May 14, 2019   (0 Comments)
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MPA Testifies in Support of Anti-Clawback and Provider Network Transparency Bills
On May 7, 2019, the Joint Committee on Financial Services heard testimony on two bills supported by MPA:
1. H.1078 / S.589, An Act to limit retroactive denials of health insurance claims for mental health and substance abuse services: Currently, there is no time limit on a health plan's ability to retract funds (also called clawbacks), even if the payment was due to the health plan's error or later change of policy. In contrast, under most contracts, providers have only 60 to 90 days in which to file a claim for services, after which they are told it's too late to request payment. This legislation would place a 12-month limit on the ability of a health plan to retract payments made in good faith (i.e., claims which were not fraudulent).
2. H.913 / S.610, An Act to increase consumer transparency about insurance provider networks: Currently, there is no requirement that health plans verify or update their provider directory for consumers. As a result, some health plans may appear to have a wide range of providers, but an untold number of those listings may providers who are no longer contracted with that plan, have moved, or even retired (sometimes referred to as "ghost networks" or "phantom networks").   The very real consequence of this is that consumers waste time trying to contact providers who cannot see them, which creates delays in access to care, and may even result in consumers being so frustrated with the inability to find a provider that they stop looking altogether. This bill would require health plans to keep accurate, up-to-date directories, as well as create a task force of representatives from health plans, consumer groups, and provider groups to develop guidelines for those requirements and reasonable timeframes for them to go into effect.
MPA's Director of Professional Affairs, Jennifer Warkentin, Ph.D., provided oral testimony to the committee as part of a panel consisting of Rebekah Gewirtz, MPA (National Association of Social Workers, MA Chapter) and Vic DiGravio (Association for Behavioral Healthcare). In her testimony, Dr. Warkentin discussed the impact these practices have on access to healthcare for consumers. In particular, she highlighted the constant threat of clawbacks that lead providers to leave health plan networks, thereby decreasing access to mental health care, and how it penalizes providers, even if they followed all necessary steps to verify coverage and get authorization for treatment. You can read Dr. Warkentin's complete written testimony on behalf of MPA for both the anti-clawback bill here and the provider directory transparency bill here.  
The next step in the process: MPA will advocate in meetings with legislative committee members and staff that the committee recommend the bills favorably to advance them to the next level of the process. Members who live in the districts represented by Committee Chairs Sen. James Welch of the Hampden District (representing parts of Springfield and Chicopee) and Rep. James Murphy of the 4th Norfolk District (representing parts of Weymouth) are encouraged to communicate their support for this bill directly to their legislator. Not sure who represents you? Find your legislators.
For members that do not live in one of these districts but who want to support our efforts on this vital legislation, keep an eye out for updates. If and when the bill is advanced to another committee or brought to the full House or Senate for a vote, we'll send out notifications with suggestions for how you can help.

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