What is ahead for Chapter 224 in 2013

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In an effort to achieve greater transparency, I decided to pull the requirements listed in the new healthcare law in Massachusetts that promises to save the Commonwealth billions. I have blogged about my skepticism numerous times before.

It is important to keep in mind that these are the explicit implementation requirements or permissions granted to existing or new agencies in 2013. Many other implementation actions were intentionally left vague or were not assigned a start date, but can commence in 2013 or in the years to come. Those statutory requirements are not included in this list. The list also does not include the significant requirements that will take place every year, such as reporting by the Health Policy Commission (HPC) or the Center for Health Information Analysis (CHIA).

Let me know if I missed any, read the law in its entirety here.

Implementation Deadlines in 2013

January 1, 2013- HPC can start to conduct a market impact review for a “material” change by a provider. Material changes shall include, but not be limited to: a corporate merger, acquisition or affiliation of a provider or provider organization and a carrier; mergers or acquisitions of hospitals or hospital systems; acquisition of insolvent provider organizations; and mergers or acquisitions of provider organizations which will result in a provider organization having a near-majority of market share in a given service or region. (section 283)

January 1, 2013- December 31, 2017- Health care cost growth benchmark will be set.

For calendar years 2013-2017, the growth benchmark shall be equal to the growth rate of the “potential gross state product” (PGSP), provided that the growth rate for 2013 shall be 3.6%.

For calendar years 2018-2022, the benchmark shall be the PGSP growth rate minus 0.5 percent.

For calendar years 2023 and beyond, the benchmark shall be the PGSP growth rate.

January 1, 2013- Recommendation for legislative action on eligibility system as to the status of or termination of unemployment benefits and the associated insurance coverage by the medical security plan.

January 1, 2013- Creation of a model wellness guide. (DPH)

January 1, 2013- Medicaid promulgates regulations for the federal Mental Health Parity and Addiction Equity Act.

January 1, 2013-  Commissioner of the Division of Insurance promulgates regulations to implement the federal Mental Health Parity and Addiction Equity Act.

January 1, 2013- Wellness Program tax credit. Up to $10,000 in 1 tax year.

February 1, 2013- Implement system to access information as to the status of or termination of unemployment benefits and the associated insurance coverage by the medical security plan.

April 1, 2013- Study report on the methods to improve access to Department of Veterans’ Affairs benefits for qualified veterans, survivors and dependents currently enrolled in the MassHealth program. (EOHHS)

April 1, 2013- HPC report on increasing the use and adoption of flexible spending accounts, health reimbursement arrangements, health savings accounts and similar tax-favored health plans. (HPC)

April 1, 2013- Study to investigate the implementation of a pilot program to increase the adoption of health reimbursement arrangements, health savings accounts, flexible spending accounts and similar plans in the marketplace, including state employees and persons receiving subsidized health care. (Department of Revenue)

April 1, 2013- Investigation of federal and state programs that can share data with MassHealth for the purposes of renewing eligible children and their parents through an express-lane option. (EOHHS)

April 1, 2013- Special commission report to review public payer reimbursement rates and payment systems for health care services and the impact of such rates and payment systems on health care providers and on health insurance premiums in the commonwealth.

April 1, 2013- Special commission report to examine the economic, social and educational value of graduate medical education in the commonwealth.

April 1, 2013- Carriers must offer at least 1 plan in at least 1 geographic area with either: a reduced or selective network; a smart tiering, which offers a cost-sharing differential based on services rather than facilities providing services; or a plan in which providers are tiered and member cost sharing is based on the tier placement of the provider. The base premium rate discount must be at least 14%.

June 30, 2013- Payment due for $225 million assessment on insurers and providers.

FY 14  (July 1, 2013)

FY 2014+- EOHHS shall provide an increase of 2% in Medicaid payments for hospitals and primary providers that accept alternative payment methodologies. ($20 m max)

FY 14 only, Medicaid reimbursement rates for inpatient services provided by chronic disease rehabilitation hospitals that serve solely children and adolescents, shall apply a multiplier of 1.5x the hospital’s inpatient per diem rate in fiscal year 2012.

July 1, 2013- Report on potential for out-of-state physicians to practice telemedicine in the commonwealth. (Division of Insurance)

July 1, 2013- Medicaid shall pay for health care utilizing alternative payment methodologies for no fewer than 25 per cent of its enrollees that are not also covered by other health insurance coverage, including Medicare and employer-sponsored or privately purchased insurance.

July 1, 2013- Special task force report to examine behavioral, substance use disorder, and mental health treatment, service delivery, integration of behavioral health with primary care, and behavioral, substance use disorder and mental health reimbursement systems

July 1, 2013- Fair share assessment change increasing the full time equivalent level to 21 and allowing employees with insurance from another source to not count against an employer’s employee number before being assessed. (New legislation file by Governor Patrick moves the threshold in Massachusetts up to 50 FTE to comply with the ACA. It is unclear if this provision will be repealed if the bill becomes law before this date.)

July 13, 2013- Medicaid regulation on the federal Mental Health Parity and Addiction Equity Act must be part of any provider contracts and any carrier’s health benefit plan.

July 31, 2013- Federal Mental Health Parity and Addiction Equity Act regulations implemented in any provider contract and any carrier’s health benefits plan.

October 1, 2013- Division of insurance shall develop uniform prior authorization forms.

October 1, 2013- Carriers shall disclose patient-level data to providers in their network. (Chapter 175, repeated?)

October 1, 2013- Every non-profit hospital service corporation shall disclose patient-level data to providers in their network. (176A)

October 1, 2013- Every medical service corporation shall disclose patient-level data to providers in their network (Chapter 176B)

October 1, 2013- Every HMO organization shall disclose patient-level data to providers in their network (Chapter 176G)

October 1, 2013- Every carrier shall disclose patient-level data to providers in their network. (Chapter 176J)

October 1, 2013-  Any carriers or third party administrators must provide a toll-free telephone number and website that enables consumers to request and obtain, within 2 working days, the estimated or maximum allowed amount or charge for a proposed admission, procedure or service and the estimated amount the insured will be responsible to pay for a proposed admission, procedure or service that is a medically necessary covered benefit, based on the information available to the carrier or third party administrator at the time the request is made, including any facility fee, copayment, deductible, coinsurance or other out of pocket amount for any covered health care benefits. (Section 36)

October 1, 2013- Medical necessary review must be conducted in 7 working days.

October 31, 2013- Report on feasibility of contracting for recycling durable medical equipment.

December 31, 2013- Determination of Need application cut off. (i.e. projects filed before this date will not be subject to new full review)

 

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