The Massachusetts Department of Public Health has launched an initiative that redirects patients not needing emergency-level care to urgent care providers to address "severe capacity challenges" at hospital emergency departments in the eastern part of the state.
The initiative comes in response to the typically high ED volume in the summer and the increased ED volumes that eastern Massachusetts hospitals have been experiencing in recent months.
The ongoing fallout from Steward Health Care, which operates nine hospitals in the state, was also a factor behind the decision, according to The Boston Globe. Dallas-based Steward filed for bankruptcy in May and has been unable to maintain specialized care at its hospitals, stressing nearby facilities operated by other providers.
From July 3 through Oct. 1, Massachusetts insured health plans issued by insurance companies, Blue Cross and Blue Shield of Massachusetts and HMOs will reimburse out-of-network urgent care centers even if the facility is outside their coverage network, unless a carrier is otherwise directed by the division of insurance, according to state officials. Insurers will also reimburse medically necessary urgent care services at a rate equal to 135% of the rate paid by Medicare for those services in the provider's geographic region.
MassHealth, the state's Medicaid program, will issue a separate document providing instructions for health plans contracting with the MassHealth program.
During the 90-day period, urgent care centers in eastern Massachusetts will provide medically necessary services — including to out-of-network and MassHealth patients — with no balance billing to patients for any amount above the carrier's reimbursement.
To support this initiative, the department of public health, insurers, hospitals and urgent care providers will expand patient education efforts around appropriate use of EDs and urgent care centers.