Amendment #119 to S3141
Commercial Payer Adoption and Reimbursement of Primary Care Management Services
Mr. Moran of Boston moves to amend the bill by adding the following section:
SECTION XXXX. (a) Adoption of Medicare Payment Codes.
Notwithstanding any general or special law to the contrary, every Commercial Payer offering health insurance plans in the Commonwealth shall, no later than January 1, 2027, adopt and incorporate into their payment policies and provider contracts all Medicare Payment Codes for primary care management services and continuity that have been proposed and adopted by CMS. Commercial Payers shall not deny coverage for services appropriately billed under these codes or require any patient copay, deductible or coinsurance for these primary care services. The codes shall include, but not be limited to, the following:
(1) Chronic Care Management: 99490, 99439, 99491, 99437, G0506.
(2) Principal Care Management: 99426, 99427.
(3) Transitional Care Management: 99495, 99496.
(4) Remote Patient Monitoring: 99457, 99458, 99473, 99474.
(5) Behavioral Health Integration: 99484, 99492, 99493, 99494, G0323, G0568, G0569.
(6) Advanced Primary Care Management: G0556, G0557, G0558.
(7) General Care Management (FQHC/RHC-specific): G0570.
(8) Pharmacy Clinical Services: G0553, G05549
(9) Continuity: G2211
(b) Reimbursement Methodology.
(1) For the Medicare Payment Codes specified in subsection (a), each Commercial Payer shall, within their contracts with provider organizations or other contracting organizations, reimburse for such services at a rate not less than the Medicare rate for the services and the average multiple of Medicare payments established within the same contract for commonly used Primary Care Services
(c) Implementation and Enforcement
(1) The Division of Insurance shall promulgate regulations to ensure compliance with this section.