SECTION 1. Section 19 of Chapter 118E, as appearing in the 2014 Official Edition, is hereby amended by adding after the first paragraph, the following new paragraph:-
“The division and its contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third party administrators under contract to a Medicaid managed care organization or primary care clinician plan shall not require preauthorization or prior authorization before obtaining medically necessary mental health services within an inpatient psychiatric facility licensed by the Department of Mental Health; provided that the facility shall provide the division or its contractors notification of admission within 48 hours of admission; provided further, that utilization review procedures may be initiated after 48 hours of admission; and provided further, that Emergency Service Program teams, so-called, as contracted through MassHealth to conduct behavioral health screenings, shall not be considered a preauthorization or prior authorization requirement pursuant to any admission under this section. Medical necessity shall be determined by the treating healthcare provider and noted in the member’s medical record.”
SECTION 2. Notwithstanding any general or special law, rule or regulation to the contrary, the Office of Medicaid shall develop a streamlined process to enhance the current community-based behavioral health screening process and direct Medicaid contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third party administrators under contract to a Medicaid managed care organization or the Medicaid primary care clinician plans to allow admission to inpatient behavioral health services from a community-based setting where a patient is presenting with a behavioral health condition that requires such admission but does not require a medical screening examination in an emergency department. Said process shall be developed after consultation with a working group that includes representatives from the Association for Behavioral Healthcare, Massachusetts College of Emergency Physicians, Massachusetts Psychiatric Society, Massachusetts Health and Hospital Association, National Alliance on Mental Illness, the Massachusetts Association of Behavioral Health Systems, and all applicable carriers that cover such services. The Office of Medicaid shall file a report on the status of the working group, progress of the streamlined process, and, if necessary, legislative recommendations with the clerks of the senate and house of representatives, the house and senate chairs of the joint committee on mental health and substance abuse, the joint committee on public health, the joint committee on health care financing and the house and senate committees on ways and means no later than six months after the first meeting of the working group. A report of the final implemented streamlined process shall be filed with said committees no later than July 31, 2019.
SECTION 3: Notwithstanding any general or special law to the contrary, the secretary of the Executive Office of Health and Human Services, or a designee, in conjunction with the chief justice of the Trial Court, or a designee, shall develop a statewide sequential intercept model to identify opportunities for early intervention and treatment for those with serious mental illness and co-occurring mental health and substance use disorders in the criminal justice system in order to improve coordination and collaboration, identify gaps in services, and prioritize action steps to develop best practices for improving access to mental health and substance use disorder treatment services in the commonwealth. The Secretary and Chief Justice shall develop the model in coordination with a working group consisting of representatives from the Association of Behavioral Healthcare, Massachusetts College of Emergency Physicians, Massachusetts Psychiatric Society, Massachusetts Health and Hospital Association, National Alliance on Mental Illness, the Massachusetts Association of Behavioral Health Systems, Blue Cross Blue Shield of Massachusetts, the Massachusetts Association of Health Plans, the Massachusetts Department of Correction, the Massachusetts Sheriffs’ Association and other criminal justice reform advocacy groups as designated by the Secretary and Chief Justice. Based on the results of the completed sequential intercept model, the Secretary, or a designee, shall further develop and manage a statewide database for providers, the office of Medicaid, carriers, sheriffs, corrections facilities, and the trial courts that provides up-to-date information on: 1) existing inpatient, outpatient, and community-based mental health and substance use disorder providers by location; 2) the types of services provided at each location; and 3) the commercial insurance, Medicaid or other forms of benefit coverage available for each service at each location. Such database may be incorporated as part of an existing website or provider-based forum for communicating access to mental health and substance use disorder services. The database should be completed and available to healthcare providers and carriers for care management purposes, including the ability to develop a process to allow for such data to be transmitted to a provider’s electronic medical record through a Health Information Exchange platform or care coordination tool no later than January 1, 2019
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