To ensure access and continuity of care to specialist and hospital services for dually eligible individuals
Impact
The most significant change proposed by S742 is the requirement that any dually eligible individual may access specialists and hospital services they need, regardless of any contractual limitations imposed by their health plans. The bill mandates that the reimbursement for services rendered would revert to Medicare or MassHealth fee-for-service rates in instances where no existing contract exists between the provider and plan. This not only expands the choices for patients but also seeks to address issues of healthcare accessibility for individuals transitioning between different insurance plans or providers.
Summary
Senate Bill S742, presented by Senator Sal N. DiDomenico, aims to enhance access and continuity of care for dually eligible individuals in Massachusetts. The bill proposes amendments to Section 9d of Chapter 118E of the General Laws to ensure that individuals who qualify for both Medicare and MassHealth can receive healthcare services from any participating specialist or hospital without being restricted by their health plan's network limitations. This initiative is particularly focused on improving healthcare delivery for the most vulnerable populations who rely on these programs for their health needs.
Contention
While the proponents of S742 highlight the importance of ensuring continuity of care during transitions, particularly after the termination of contracts between health plans and providers, concerns may arise regarding the financial implications on health plans and providers. Critics could argue that the mandated reimbursement rates may not cover the operational costs for specialists and hospitals, potentially leading to a reduction in available services or providers willing to accept patients under these terms. Thus, while the bill aims to improve access, it raises questions about the sustainability of services provided to this demographic.