Advocacy Highlights

April 2024

The following are highlights of MACEP advocacy over the past few years:

Out of Network (OON)
Since the passage of the federal No Surprises Act (NSA), signed into law on December 27, 2020, MACEP has been the strongest voice in successfully urging the legislature to take no action on out of network on the state level, specifically the imposition of an inadequate default rate for the provision of OON services.
Once the NSA is fully implemented, all commercially insured patients in Massachusetts, including self funded plans, will be protected from surprise medical bills, and a fair, uniform system would be enacted to determine the reimbursement rate paid by insurers to hospitals and physicians for the services provided.
MACEP continues to believe that state legislative action on this issue is ill-advised.  The risk of unintended consequences is high and could result in significant financial pressure on smaller, rural and community hospitals who lack leverage to negotiate fair rates, which would lead to increased consolidation of hospitals, increased cost and reduced access to care for patients.  Additionally, an acute labor shortage across the continuum of care is further exacerbating the difficult financial challenges for hospitals – all pointing to the risk of passing unnecessary state restrictions on out of network reimbursement that may conflict with federal law and complicate implementation on the state level.

Point in Time/Boarding/Crowding
MACEP continues to engage with all stakeholders relative to reducing emergency department crowding and improving hospital throughput.  These efforts include meetings and discussion with legislators, the Healey administration, the Health Policy Commission and hospitals.
Thanks in part to MACEP surveys on ED boarding, an agreement was reached by the MA Executive Office of Health and Human Services and health insurers to waive prior authorization for admissions from acute care hospitals to post-acute care facilities. Under the agreement, hospitals have agreed to start patient discharge planning as early in the day as possible and will "seek innovative ways" to improve staffing so that all of their licensed medical/surgical beds can be put into use with patients, and nursing homes agreed to extend their admission hours. While not addressing all the issues contributing to the crowding problem, like workforce shortages, this agreement demonstrates the political commitment to the issue and is widely viewed as a strong step in the right direction.
MACEP also continues to share its biannual Point in Time data with legislators and the Healey administration as evidence of the College’s longstanding commitment to the issue and to help inform policymakers of the boarding in emergency departments across the Commonwealth.

Prior Authorization Reform
MACEP supports H.1143/S.1249, An Act Relative to Reducing Administrative Burden.  This legislation would reduce boarding and improve the throughput of patients by putting in place comprehensive legislative protections for patients and providers to reduce and streamline prior authorization processes uniformly across all commercial insurance carriers in Massachusetts.
Importantly, these bills will directly benefit patients by reducing the unnecessary complexity associated with prior authorization. Patients commonly experience delays in care while PA requests are being submitted and processed, even when their requests are ultimately approved.

Section 35 Reform
MACEP’s support for H.1966/S.1129, “An Act Ensuring access to Addition Services” has been instrumental in the advancement of the bill.  This legislation would require EOHHS to ensure an adequate supply of beds for men admitted under Section 35 for the treatments of alcohol or substance use disorder in facilities licensed or approved by DPH/DMH. Similar protections intended to separate treatment from incarceration have existed for women since 2016.

Workplace Violence
MACEP has been a strong advocate for H.2381/S.1538, An Act Requiring Health Care Facilities to Develop and Implement Programs to Prevent Workplace Violence (M. Moran/Lewis).  These identical bills would require DPH to develop and monitor new statewide standards for evaluating and addressing known security risks in hospitals, including requirements for the development of a written violence prevention plan and in-house crisis response team.
Importantly H.2381/S.1538 includes penalty provisions for whoever knowingly and intentionally interferes with the conduct of a health care facility or commits aggravated interference with the conduct of a health care facility.  Other workplace violence bills pending on Beacon Hill do not include penalty provisions and, thus, are not supported by MACEP.

Overdose Prevention Center’s (OPC’s)
MACEP supports H.1981/S.1242, “An Act Relative to Preventing Overdose Deaths and Increasing Access to Treatment” would establish a 10-year pilot project for overdose prevention centers (OPC’s) to allow for the consumption of pre-obtained controlled substances under clinical monitoring. Approval by the local Board of Health would be required. Outcomes from OPC’s operating in New York have been positive, including the reversal of over 1,000 overdoses, reduced incidence of HIV and Hepatitis C, and increased access to treatment.

MACEP supports H.2250/S.1427, “An Act Relative To Improving The Outcomes For Sudden Cardiac Arrest In The Commonwealth (Philips/Moore).” Also called the “T-CPR” bill, this legislation would ensure that all 911 call dispatchers are trained and able to coach bystanders to perform cardiopulmonary resuscitation (CPR).  With more than 350,000 out-of-hospital cardiac arrests occurring each year in the United States, this legislation is important because 911 dispatchers are often the first point of contact in an emergency, and the gateway to our emergency response system.

Modifier 25
MACEP supports H.1011/S.699, “An Act Relative to Fair and Equitable Compensation for Medical Services.” The “Modifier 25” bill would prohibit insurers’ from inappropriately reducing physician and hospital reimbursement when a modifier 25 code is applied, a common occurrence with emergency care.  This legislation is aimed at reducing insurer interference in the practice of medicine and opposition to policies that favor profit over patients.Favorably reported out of HCF. 

MACEP advocates for passage of gun law reform. Legislation passed by the House and Senate is before a conference committee charged with reconciling differences between the 2 bills before final passage and moving to the Governor’s desk for her signature into law.