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MONDAY REPORT

Doula Amendment Allows Hospital Programs to Continue

The Division of Medical Assistance is holding a hearing today on amendments it made to the regulations that govern MassHealth providers of doula services. MHA and the hospital community are supportive of the amendments mainly because under the newly rewritten rules, doulas that are not part of a non-doula-specific group practice – including doulas employed by hospital affiliated group practices with a different tax identification than the hospital – would now be eligible for MassHealth reimbursement.

Since December 2023, doulas have been able to enroll as a MassHealth doula provider and receive payment for serving MassHealth members. But the initial regulations applied only to independent doulas and those in doula-specific group practices – and, more specifically, practice entities that were not part of a hospital.

While MHA strongly endorsed MassHealth reimbursement for doulas, the association advocated for including hospital-based doulas, since some such programs have been in existence for 25 years or more bringing care to underserved populations. These have been funded historically through grants or philanthropy programs. The amendments that will be discussed at Monday’s hearing remove the billing restriction on hospital-based doulas, allowing them to receive MassHealth reimbursements. They also establish, among other things, that doula services are covered for eligible adoptive parents until the adopted infant reaches one year of age.

“Doulas provide important emotional, educational, and physical support to individuals and families from pregnancy to the postpartum period, and they are especially valuable in advancing equitable care, as evidence shows doulas improve health outcomes for historically underserved populations,” said MHA’s Senior Manager of Regulatory Policy Alex Levie. “Removing this restriction allows the programs that have been successfully operating in our hospitals for years to continue and expand.”

Update on Provider Directory Requirements for Health Plans and Providers

Massachusetts has long required health plans to establish appropriate systems for maintaining accurate provider directories. However, there have been significant gaps in what was collected and displayed, resulting in the enactment of Chapter 124 of the Acts of 2019 – a law that improved the directories so that consumers can easily locate the providers available within their policies. In 2022, the federal No Surprises Act also addressed the issue, requiring all private health plans to maintain accurate provider directories and verify and update the information in them at least every 90 days.

In November 2023, the Division of Insurance issued new regulations to implement Chapter 124 (see section 52.15), expanding the requirements that health plans have to follow for collecting, storing, displaying, and auditing provider directory information. This was followed by additional filing guidance that DOI issued in June 2024.

The majority of health plans that operate throughout Massachusetts use a single source – the Council for Affordable Quality Healthcare (CAQH) – to collect provider directory information. The new state regulation requires additional data entry fields in the CAQH Provider Data Portal. These more granular elements include, but are not limited to, practice group affiliation, open or closed panel status, office location and operating hours, ADA accessibility, languages spoken, gender-specific treatment, telehealth availability, and age groups treated. As a result of the work that had to be done to collect the new data, the new fields are just now being rolled out to providers.

Providers will be expected to populate these new data fields for health insurance companies that use alternative platforms instead of, or in addition to, CAQH. After providers submit the data, health insurers will process and integrate the information into their data systems. Due to the extensive internal processes required for complete and accurate updates, the new directory information will not be available until at least the third quarter of 2025. More details will be shared on this process, including a timeline for when providers can expect their updated information to appear.

On Tuesday, January 28, 2025, from 12 to 1 p.m., MHA, the Massachusetts Medical Society, the Massachusetts Association of Health Plans, Blue Cross and Blue Shield of Massachusetts, Healthcare Administrative Solutions, CAQH, and the Division of Insurance will host a training session for providers on the new data entry requirements. To register, please click here.

Senators Unveil New Healthcare Cybersecurity Proposal

U.S. Senator Bill Cassidy (R-La.), current ranking member of the Senate Health, Education, Labor, and Pensions (HELP) Committee and likely chairman of the committee next Congress, introduced a bill to strengthen cybersecurity requirements in the healthcare sector. He was joined by fellow members of the Senate Health Care Cybersecurity Working Group: Mark Warner (D-Va.), John Cornyn (R-Tex.), and Maggie Hassan (R-N.H.).

The Health Care Cybersecurity and Resiliency Act of 2024 directs the Secretary of Health and Human Services to share information with the Director of the Cybersecurity and Infrastructure Security Agency and collaborate in developing a resilience strategy for cyberattacks in the sector. The bill would update reporting requirements following a health information breach, clarify that authority for healthcare cybersecurity oversight lies with the Administration for Strategic Preparedness and Response, and mandate that healthcare entities adopt minimum standards such as multifactor authentication, data encryption, and regular audits, including penetration tests. The bill also authorizes Health Resources & Services Administration grants for technology updates, workforce training, and participation in health cybersecurity threat information sharing organizations.

IRS Plans to Update Nonprofit Hospital Charity Care Guidance

In November, the Internal Revenue Service (IRS) announced that it would release additional guidance on financial assistance requirements under Section 501(r) of the Internal Revenue Code for non-profit hospitals. Section 501(r) requires non-profit hospital organizations to meet four general requirements: conduct a Community Health Needs Assessment, have financial assistance policies, limit charges, and restrict extraordinary collection actions against individuals.

The IRS’s announcement follows ongoing audits that the IRS has been conducting into 35 non-profit hospitals since June. IRS officials have said that they do not necessarily anticipate these audits to result in penalties, but rather to assist in reaching voluntary compliance. It is not yet clear when the new IRS guidance will become available.

John LoDico, Editor