S.671 An Act relative to long-term care insurance consumer protections
This bill would create a cap on lifetime rate increases for long-term care insurance of 20%, protecting consumers from sudden unexpected and sizeable increases in premiums. The bill would also mandate a higher loss ratio of between 80% and 90%, ensuring that a greater percent of premiums are spent on claims. Currently, loss ratios are around 60% for these policies. In 2017, the Attorney General’s Office made similar recommendations in testimony submitted to the Division of Insurance (DOI), but so far, DOI has not adopted regulations to affect these recommendations.
S.672 An Act to require health care coverage for emergency psychiatric services
Emergency services programs (ESPs) are community-based and recovery-oriented programs that provide behavioral health crisis assessment, intervention, and stabilization services for people with psychiatric illness. ESP teams include trained psychiatric clinicians that travel to the location of a crisis, including homes, schools or other community locations. ESP teams also include “certified peer specialists”, individuals with lived experience, and “family partners”, individuals that have raised a child that used ESP services.
Individuals on MassHealth are currently covered by ESP services, but many people with private health insurance do not have access to ESPs. Since the vast majority of Massachusetts residents have commercial insurance, the vast majority do not have access to ESPs. This bill would require commercial insurance companies and the Group Insurance Commission to also provide benefits for medically necessary behavioral health emergency services provided by ESPs around the state on a nondiscriminatory basis.
A cost study completed by the Center for Health Information and Analysis (CHIA) in November of 2018 determined that the costs that would result from passage of this bill would be minimal.
S.673 An Act ensuring access to full spectrum pregnancy care
This bill would require that insurance coverage for all medical care related to pregnancy, including c-section, abortion, and abortion-related care, be provided free of any deductibles, co-insurance, co-pays or other cost-sharing. The bill would provide an exemption from covering abortion or abortion-related care at the request of an employer that is a church or qualified church-controlled organization.
S.674 An Act relative to out-of-network billing
This bill would establish the rates of payment for out-of-network care delivered during an emergency or delivered without the patient’s knowledge or notice that the provider was out-of-network, or when an in-network provider is not available. It would task the Division of Insurance (DOI), in consultation with the Center for Health Information and Analysis (CHIA) the Health Policy Commission (HPC) and the Executive Office of Health and Human Services (EOHHS) with establishing a noncontracted commercial rate for emergency services and a noncontracted commercial rate for nonemergency services to be paid to a provider by an insurer when the provider is not part of the insurer’s network. Before establishing the rates for out-of-network care, DOI would be required to hold a public hearing. The rates established by DOI would be in effect for 5 years, and in year 4, DOI would initiate a new review and public hearing in order to set rates for the next 5-year term.
S.675 An Act relative to mental health parity implementation
Despite significant legislative efforts at both the state and federal level to achieve true parity in insurance coverage for mental health and substance use disorders relative to insurance coverage for physical health problems, widespread coverage barriers to behavioral health care remain. This bill would help to create more equitable access to behavioral health care for families and children in a number of ways, including:
- improving parity law enforcement through enhanced insurance carrier self-reporting;
- addressing barriers created by insurers such as onerous and time-consuming approval processes;
- applying parity across insurers, including the Group Insurance Commission and MassHealth; and
- ensuring consistent and fair application of medical necessity criteria.