The new legislative session got underway in January. We will be updating this page with revised fact sheets with updated bill numbers once they become available.
The Clawback Bill
This bill establishes fair parameters around the health insurance practice of reverting payments (clawbacks) for which providers of behavioral health services had received previous authorization and been paid by health insurers.
Our Legislation will: Limit both MassHealth and commercial health insurers to a six-month period for recovering payments to a behavioral health provider for behavioral health services completed.
CU’s third priority bill is House Bill 925, An Act to limit retroactive denials of health insurance claims for mental health and substance abuse services. Health insurance companies have the ability to audit and take back reimbursements ( often called “clawbacks”) given to health care providers for services rendered, sometimes years in the past. The process for doing this is not transparent and has a chilling effect on how health care providers practice and the access to services. Currently, many other states have statutes on the books that protect health care providers from this practice.
This bill will:
• Limit both MassHealth and commercial health insurers to a six month period for recovering payments to a provider for services completed. When providers deliver a service in good faith and in compliance with eligibility rules, they should be compensated without fear of insurance companies taking back these reimbursements years or months after the services were provided.
• Require that MassHealth institute a back-end process to reconcile payment between payers withoutinvolving the provider. This process could mirror the current process in the auto insurance industry.
Senate Bill 649, An Act to promote the accessibility, quality and continuity of care for consumers of behavioral health, substance use disorder and mental health services was filed in January of 2015 by Sen. Dan Wolf. This bill addresses access challenges by creating state action immunity for providers who choose to engage in joint negotiations with insurance providers on issues such as reimbursement rates and medical necessity criteria.
House Bill 1812, An Act to promote accessibility and affordability of behavioral health and substance abuse services for recipients of MassHealth was filed in January 2015. This bill, filed by Rep. Jim O’Day, will require mental health carve-outs to make their contracts and executive compensation publicly available. The purpose of this bill is to shine a light on how effectively tax dollars are being spent to provide essential behavioral health and substance abuse services to those that need them most.