The state’s HealthyMass Initiative, which brings together a number of state agencies to work on ensuring access to care, containing costs, advancing quality, promoting individual wellness, and developing healthy communities, has finalized guidelines relating to nonpayment for costs associated with Serious Reportable Events (SREs).
The Initiative convened a Serious Reportable Events Task Force to develop the guidelines. You may remember that in mid-May, the Department of Public Health finalized regulations for implementing a number of provisions of Chapter 305, including an SRE nonpayment provision (read this Healthy Blog post about the final regulations). The DPH regulations went into effect last Friday and apply to all acute-care hospitals and ambulatory surgery centers across the Commonwealth. The HealthyMass guidelines, which apply to health care payments made through the Office of Medicaid, the Health Safety Net, Commonwealth Connector, GIC and the Department of Correction, enhance the DPH regulations in a number of important ways. The HealthyMass guidelines state that if an SRE was preventable, then there can be no charge to a payer or a patient for services related to the occurrence of the event as well as any services needed as a result of the event (for up to 30 days). The DPH regulations prohibit billing only for care needed as a result of the event but do not prohibit billing for the actual event. Also, under HealthyMass, physician(s) who performed the event during which an SRE occurred are subject to the nonpayment policy, in addition to the hospital or ambulatory surgery center where the event occurred. The DPH regulations do not apply to individual providers. A third major difference is that the HealthyMass guidelines specify that not only can patients not be billed but also their next of kin or the patient’s representative, as well as any other payer.
Massachusetts is the first state to take these bold steps towards, hopefully, eliminating SREs (also called “never events” because they should never happen). As these guidelines are implemented, and as DPH implements the regulations, consumers should be consulted, especially when it comes to working with providers on how to notify patients and their families about the occurrence of an SRE and the potential consequences to their health, further follow-up care that is needed, whether or not the SRE was deemed preventable, and therefore non-billable, etc. Much care must be taken to do this in a way that is informative and also sensitive to the patients and family members. In some cases, they may not be aware that an SRE occurred and this must be conveyed in an appropriate way, by a trained individual. The HealthyMass SRE Task Force specifically states that consumers, along with other groups, will be consulted as the policy is implemented, and we strongly urge them to follow through and involve consumers in this process.
Click here to read the HealthyMass press release.
-Deborah Wachenheim
