In December of 2015, CliniciansUNITED members, staff, and bill sponsor Representative Jim O’Day testified in support of House Bill 925, An Act to Limit Retroactive Denials of Health Insurance Claims for Mental Health and Substance Abuse Services. 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 without involving the provider. This process could mirror the current process in the auto insurance industry.
To read our submitted testimony, click here.
For more information about the bill, click here for the fact sheet.
In August, CliniciansUNITED submitted testimony to the Health Policy Commission on proposed changes to medical necessity criteria. You can read the full request for testimony with description of the proposed changes here. A snippet of our testimony:
“Clinicians spend an inordinate amount of unpaid time on the phone and completing online authorizations with insurance companies making the case for why their clients meet medical necessity requirements to continue treatment. The insurance representatives have never met the client, yet they make the decision on whether or not treatment is approved. How is this the standard of care that we are working toward keeping?”
To read CU’s full submitted testimony, click here.
On June 24th, 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, had a hearing in front of the Joint Committee on Health Care Financing. CU members, staff, and allies testified in support of this important piece of legislation that would drastically increase access to mental health care in Massachusetts. 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.
On July 16th, CU testified in front of the Joint Committee on Mental Health and Substance Abuse in support of House Bill 1812, An Act to promote accessibility and affordability of behavioral health and substance abuse services for recipients of MassHealth. 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.