An Act to improve patient access to non-emergency medical transportation
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13 section(s) · formatted for easier reading
▸SECTION 1
Chapter 32A of the General Laws is hereby amended by inserting the following new section:-
▸SECTION 35
If required by the commission, any prior authorization for nonemergency ambulance and wheelchair van transportation to inpatient and outpatient dialysis treatment, inpatient and outpatient behavioral health services, and inpatient and outpatient post-acute care, shall be valid for a minimum of 3 business days.
▸SECTION 2
Chapter 118E of the General Laws is hereby amended by inserting the following new section:-
▸SECTION 87
(a) The division and its contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third-party administrators under contract to a Medicaid managed care organization or primary care clinician plan shall issue payments to eligible providers, as defined by regulation 101 CMR 327.00, and nonpublic ambulance service providers, as defined by regulation 101 CMR 327.00, in an amount no less than 2 and one half times the determined rates for authorized ambulance and wheelchair van services for: ambulance service, advanced life support, nonemergency transport (101 CMR 327.00 Code A0426); ambulance service, basic life support, nonemergency transport (101 CMR 327.00 Code A0428); nonemergency wheelchair van transportation (101 CMR 327.00 Code A0130); nonemergency wheelchair transportation with loaded mileage (101 CMR 327.00 Code S0215) and; nonemergency wheelchair transportation with patient attendant or escort (101 CMR 327.00 Code T2001) when transporting covered members to inpatient and outpatient dialysis treatment, inpatient and outpatient behavioral health services, and inpatient and outpatient post-acute care, inclusive. Any required prior authorization for these services shall be valid for a minimum of 3 business days.
(b) The executive office shall promulgate regulations as necessary to carry out this section.
▸SECTION 3
Chapter 175 of the General Lawsis hereby amended by adding the following new section:-
▸SECTION 231
If required by a policy, contract, agreement, plan or certificate of insurance issued, delivered or renewed within or without the commonwealth, which is considered creditable coverage under section 1 of chapter 111M, any prior authorization for nonemergency ambulance and wheelchair van transportation to inpatient and outpatient dialysis treatment, inpatient and outpatient behavioral health services, and inpatient and outpatient post-acute care, shall be valid for a minimum of 3 business days.
▸SECTION 4
Chapter 176A of the General Laws is hereby amended by adding the following new section:-
▸SECTION 39
If required by a contract between a subscriber and the corporation under an individual or group hospital service plan that is delivered, issued or renewed within the commonwealth, any prior authorization for nonemergency ambulance and wheelchair van transportation to inpatient and outpatient dialysis treatment, inpatient and outpatient behavioral health services, and inpatient and outpatient post-acute care, shall be valid for a minimum of 3 business days.
▸SECTION 5
Chapter 176B of the General Laws is hereby amended by adding the following new section:-
▸SECTION 26
If required by a subscription certificate under an individual or group medical service agreement delivered, issued or renewed within the commonwealth, any prior authorization for nonemergency ambulance and wheelchair van transportation to inpatient and outpatient dialysis treatment, inpatient and outpatient behavioral health services, and inpatient and outpatient post-acute care, shall be valid for a minimum of 3 business days.
▸SECTION 6
Chapter 176G of the General Laws is hereby amended by adding the following new section:-
▸SECTION 34
If required by an individual or group health maintenance contract that is issued or renewed within or without the commonwealth, any prior authorization for nonemergency ambulance and wheelchair van transportation to inpatient and outpatient dialysis treatment, inpatient and outpatient behavioral health services, and inpatient and outpatient post-acute care, shall be valid for a minimum of 3 business days.
▸SECTION 7
Notwithstanding the provisions of any general or special law to the contrary, the health policy commission, in collaboration with center for information and analysis, shall study the adequacy of reimbursement rates of MassHealth and commercial carriers for nonemergency medical transportation, including but not limited to, the role of external economic factors on the development, sustainability, and retention of the emergency medical service workforce, such as the increases in the minimum wage and competition from for-profit industries.
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SECTION 1. Chapter 32A of the General Laws is hereby amended by inserting the following new section:-
Section 35. If required by the commission, any prior authorization for nonemergency ambulance and wheelchair van transportation to inpatient and outpatient dialysis treatment, inpatient and outpatient behavioral health services, and inpatient and outpatient post-acute care, shall be valid for a minimum of 3 business days.
SECTION 2. Chapter 118E of the General Laws is hereby amended by inserting the following new section:-
Section 87. (a) The division and its contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third-party administrators under contract to a Medicaid managed care organization or primary care clinician plan shall issue payments to eligible providers, as defined by regulation 101 CMR 327.00, and nonpublic ambulance service providers, as defined by regulation 101 CMR 327.00, in an amount no less than 2 and one half times the determined rates for authorized ambulance and wheelchair van services for: ambulance service, advanced life support, nonemergency transport (101 CMR 327.00 Code A0426); ambulance service, basic life support, nonemergency transport (101 CMR 327.00 Code A0428); nonemergency wheelchair van transportation (101 CMR 327.00 Code A0130); nonemergency wheelchair transportation with loaded mileage (101 CMR 327.00 Code S0215) and; nonemergency wheelchair transportation with patient attendant or escort (101 CMR 327.00 Code T2001) when transporting covered members to inpatient and outpatient dialysis treatment, inpatient and outpatient behavioral health services, and inpatient and outpatient post-acute care, inclusive. Any required prior authorization for these services shall be valid for a minimum of 3 business days.
(b) The executive office shall promulgate regulations as necessary to carry out this section.
SECTION 3. Chapter 175 of the General Lawsis hereby amended by adding the following new section:-
Section 231. If required by a policy, contract, agreement, plan or certificate of insurance issued, delivered or renewed within or without the commonwealth, which is considered creditable coverage under section 1 of chapter 111M, any prior authorization for nonemergency ambulance and wheelchair van transportation to inpatient and outpatient dialysis treatment, inpatient and outpatient behavioral health services, and inpatient and outpatient post-acute care, shall be valid for a minimum of 3 business days.
SECTION 4. Chapter 176A of the General Laws is hereby amended by adding the following new section:-
Section 39. If required by a contract between a subscriber and the corporation under an individual or group hospital service plan that is delivered, issued or renewed within the commonwealth, any prior authorization for nonemergency ambulance and wheelchair van transportation to inpatient and outpatient dialysis treatment, inpatient and outpatient behavioral health services, and inpatient and outpatient post-acute care, shall be valid for a minimum of 3 business days.
SECTION 5. Chapter 176B of the General Laws is hereby amended by adding the following new section:-
Section 26. If required by a subscription certificate under an individual or group medical service agreement delivered, issued or renewed within the commonwealth, any prior authorization for nonemergency ambulance and wheelchair van transportation to inpatient and outpatient dialysis treatment, inpatient and outpatient behavioral health services, and inpatient and outpatient post-acute care, shall be valid for a minimum of 3 business days.
SECTION 6. Chapter 176G of the General Laws is hereby amended by adding the following new section:-
Section 34. If required by an individual or group health maintenance contract that is issued or renewed within or without the commonwealth, any prior authorization for nonemergency ambulance and wheelchair van transportation to inpatient and outpatient dialysis treatment, inpatient and outpatient behavioral health services, and inpatient and outpatient post-acute care, shall be valid for a minimum of 3 business days.
SECTION 7. Notwithstanding the provisions of any general or special law to the contrary, the health policy commission, in collaboration with center for information and analysis, shall study the adequacy of reimbursement rates of MassHealth and commercial carriers for nonemergency medical transportation, including but not limited to, the role of external economic factors on the development, sustainability, and retention of the emergency medical service workforce, such as the increases in the minimum wage and competition from for-profit industries.