Senate bill extends telehealth, scope of practice 

THE MASSACHUSETTS SENATE is poised to extend the governor’s emergency order on insurance payments for telehealth, while at the same time reviving controversial proposals related to the types of services different medical professionals can provide. 

Senate leaders on Thursday released a health care bill, called the Patients First Act, which addresses telehealth, out-of-network billing, and scope of practice changes. The Senate plans to vote on the bill next week and send it to the House.  

While the bill is only partially related to COVID-19, Sen. Cindy Friedman, an Arlington Democrat who co-chairs the Committee on Health Care Financing, said the pandemic makes it urgent that lawmakers pass reforms to ensure the health care system is financially sustainable and people continue to have access to care. “The impact on the health care system has been so profound we’ve got to make sure we have policies in place that allow providers to continue to do the work as things ramp up and as people come back into the system,” Friedman said.  

During the pandemic, the state has seen a boom in the use of telehealth as doctors’ offices shut down for non-emergency care and patients became scared to enter a hospital. According to recent Health Policy Commission data, the use of telehealth in the northeast jumped from fewer than 1 percent of medical visits in March 2019 to 11 percent of visits in March 2020. Under emergency orders put in place by Gov. Charlie Baker, insurers must cover telehealth visits at the same rate as they cover in-person appointments. 

The expanded use of telehealth raises questions like whether it will supplant regular office visits, lowering costs, or become an addition to office visits, raising costs. Doctors have questioned what counts as a telehealth visit – can a doctor bill for a phone call or just a video conference?  

Friedman said the two-year period will ensure patients can continue to access telehealth, while giving experts time to analyze the nuances of telemedicine and determine the best way to use and pay for it. And, she said, telehealth has let physicians stay afloat financially as they lose revenue from cancelled office visits. “To take that away from them right now makes no sense,” Friedman said. 

But insurers are likely to question why they will have to pay the same rate for telehealth as for an office visit for two years, especially once the pandemic winds down, since telehealth costs less than an in-person visit. Lora Pellegrini, president and CEO of the Massachusetts Association of Health Plans, said telehealth is important to provide health care access, but also to save money. 

“Moving forward, it is vital that the state thoughtfully monitor the provision of in-person care and telehealth coverage to determine when we can remove statutorily mandated payments in order to build on telehealth’s promise of providing cost-savings for employers and consumers, ensuring access to high-quality care for members that improves their patient experience and is appropriate for delivery via telehealth technologies,” Pellegrini said in a statement. 

The bill would also prohibit surprise out-of-network billing – for example, when a patient has surgery in an in-network hospital then is billed for an out-of-network anesthesiologist. The House and Senate both agreed to eliminate surprise billing in health care bills passed in 2018, but a final version of the bill never became law after negotiations fell through at the end of the legislative session.  

The new Senate bill would require doctors to inform a patient when they are being referred to an out-of-network specialist. Long-term, the Healthy Policy Commission and Division of Insurance would set the rates that doctors could charge for out-of-network care.  

Perhaps the most controversial piece of the bill is its “scope of practice” regulations, expanding what certain medical professionals can do. Scope of practice bills have been floating around the Legislature for years, but generally get derailed due to conflicts between professional organizations.  

The Senate bill would establish licensing for dental therapists, let optometrists treat glaucoma, let podiatrists treat ankle injuries, and let nurse practitioners, nurse anesthetists, and psychiatric nurse mental health specialists practice independently. It would also give pharmacists more authority. Baker already gave the nursing specialists more leeway to practice independently during the pandemic through executive orders. 

Advocates for expanding scope of practice say it will improve access for underserved populations – for example, a rural community health center could hire a lower-priced dental therapist to perform some procedures when a patient could not afford a dentist. Opponents say less skilled practitioners will provide less safe care. 

The Massachusetts Medical Society has typically opposed these types of expansions. A spokesman said the society was still reviewing the bill. 

The bill also requires the Health Policy Commission to study the effects of COVID-19 on the health care system. 

Senate President Karen Spilka said the bill builds off knowledge gained during the pandemic. “We have learned a lot about how to deliver care during the global pandemic, and I am happy that this legislation will use experiences from these challenging times to benefit and protect patients going forward,” Spilka said in a statement. “Increasing telehealth services, ending surprise billing, and expanding scope of practice are reforms that truly put patients first.” 

Health Care for All, a pro-consumer advocacy group, said the bill “includes important provisions that expand and ensure continued access to health care, including oral and behavioral health services.”  

It remains to be seen whether lawmakers and the governor can agree on a health care bill with only six weeks remaining in the legislative session. 

Baker in October released his own health care bill, which would prohibit surprise billing for emergency room services and increase the scope of what nurses, optometrists, and dental practitioners can do, among other provisions. But the bill is still in a House committee.