Boston Business Journal – Years of discussion and numerous state studies finally brought about the potential for lasting change for two thorny health care issues that had been plaguing the state when Gov. Charlie Baker signed a bill last month: behavioral health care and surprise billing.

Yet that progress — largely spurred by the pandemic — has left many other longtime goals for health care reform in the state untouched. When more fundamental change might come, and what it might look like is anyone’s guess.

“If there’s any lesson in Massachusetts, health care reform is an iterative, constant process,” Sen. Julian Cyr, who worked on a mental health care bill prior to the pandemic. “We may need some bigger-picture look here, but I also think we need to be honest that we’ve created this remarkably overly complex series of structures and systems. Undoing that is going to take some time and work.”

Legislators enacted several emergency provisions during the pandemic, and since then have extended some even further. Most prominently, the new law mandates that telehealth visits be reimbursed at rates equal to an in-person visit, a holdover from the pandemic. Such rate equivalency are permanent for behavioral health visits, but will last two years for primary care and chronic care visits, and 90 days after the end of the state of emergency for everything else. The bill also defined telehealth for the first time in statute, mandating that both video and telephone interactions should be reimbursed.

Additionally, the legislation broadened the scope of practice for a number of advance practice nurses and optometrists, eliminating certain supervision requirements while also mandating enhanced training.

The two provisions seem incremental but they are transformational for the behavioral health industry, Cyr said. Initially enacted during the emergency, the telehealth provisions have incentivized providers to take up virtual visits, and providers have seen a marked drop in the number of no-show appointments by going virtual. The bill will enable therapists and more to keep those wins long-term. The bill also permanently increased the number of therapists, through enhancements for psychiatric nurse mental health specialists.

Cyr said the bill, coupled with several mental-health policy changes enacted through the state’s budget, accomplish many of the goals laid out through mental health care legislation passed by the senate in February 2020. Given the trauma of the pandemic, the provisions are now more important than ever.

“It provides real certainty that what is a very effective way for patients to get care and for providers to give care, that it will exist in perpetuity,” Cyr said.

Beyond telehealth, the legislation also addressed the long-debated practice of “surprise billing.” In the past, patients undergoing elective or emergency procedures might receive care at a facility that contracts with their insurer, but by a doctor who didn’t. That often left patients on the hook for thousands of dollars of unexpected bills.

Now, both insurers and physicians will now be required to disclose whether doctors are “out of network.” By September, several state agencies have been tasked with recommending a default rate for out-of-network billing.

James Roosevelt, an attorney with the Boston office of Maine-based Verrill Dana law firm, and the former CEO of Tufts Health Plan, said the provisions build off federal reforms to surprise billing, and will lead to lasting change.

“Without requiring providers to be in-network, this puts a lot more pressure on them to be in-network,” Roosevelt said. “If patients are going to know ahead of time if you use this particular radiologist, it won’t be paid for by insurance, patients typically are going to say, ‘Can I go somewhere else?’”

While the bill makes strides in some areas of reform, several long-discussed changes to the health care system remain on the drawing board.

Roosevelt noted that while the bill raises telehealth behavioral health rates, it doesn’t increase behavioral health reimbursements overall, which have historically lagged other types of medical reimbursements.

Additionally, while the recent legislation provided a short-term boost for some of the state’s community hospitals, it also didn’t address the chronic reimbursement gaps between community institutions and their academic medical center peers.

Lora Pellegrini, president and CEO of the Massachusetts Association of Health Plans, also said questions about telehealth reimbursements remain for everything except behavioral health. While the legislation addresses surprise billing, it doesn’t set an out-of-network rate. Long-debated drug price transparency measures were also left out of this bill, as were the governor’s vision to shift spending toward primary care and behavioral health have not been enacted.

Work also remains on resolving racial health disparities, which were on broad display during the pandemic, added Dr. David Rosman, president of the Massachusetts Medical Society and associate chair of radiology at Massachusetts General Hospital.  The medical society is now participating in a state commission created last year to study racial disparities in maternal mortality. Rosman said that while that commission should spur legislative changes, more wide-ranging reform is critical.

“We have been so active talking about equity during this pandemic … equity in vaccine distribution and testing. And yet during the time of Covid, inequity has increased,” Rosman said. “We don’t get to despair about the lack of success, but realize we need to be more persistent. That’s where a lot of the work in the next legislative session can move things forward.”

Massachusetts will either lead the way toward that reform, or be dragged into it after it is long overdue, Cyr said.

“I hope coming out of the pandemic, the public and elected officials realize that the current way we’re doing business isn’t working when it comes to health care,” Cyr said. “Whether an equity perspective, a life-saving perspective, an economic resiliency perspective, and a business perspective, there has to be a better way to do this. For me personally, that’s what this pandemic is reiterating.”

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