Bill H.1061

HOUSE DOCKET, NO. 3139 FILED ON: 2/18/2021

HOUSE . . . . . . . . . . . . . . . No. 1061

By Ms. Decker of Cambridge, a petition (accompanied by bill, House, No. 1061) of Marjorie C. Decker and others for legislation to strengthen and expand access to behavioral healthcare. Financial Services.

The Commonwealth of Massachusetts

_______________

In the One Hundred and Ninety-Second General Court
(2021-2022)

_______________

An Act to strengthen and expand access to behavioral healthcare.

Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:

SECTION 1. Chapter 6A of the General Laws, as appearing in the 2018 Official Edition, is hereby amended by inserting the following new section:-

Section 16CC. (a) The executive office of health and human services shall convene an advisory committee on the Graduate Medical Education program established pursuant to section 78 of chapter 118E. Said committee shall include representatives from the executive office of health and human services, including but not limited to representatives from the division of medical assistance, the department of public health and the department of mental health. Said committee shall work in consultation with the Health Policy Commission and the Center for Health Information and Analysis.

(b) The advisory committee shall annually collect publicly available data regarding the Graduate Medical Education program. Such data shall include, but not be limited to: (i) the hospitals participating in the program; (ii) the amount of funding received per hospital for the program; (iii) the number of licensed psychiatrists in the commonwealth, disaggregated by specialty where possible; (iv) the identification of regions in the commonwealth that experience shortages in access to licensed psychiatrists; (v) estimates of patient populations, disaggregated by demographic metrics, including but not limited to, race, age and gender identity, who lack access to psychiatric care; (vi) estimates of retention of psychiatrists in the commonwealth, disaggregated by specialty where possible.

(c) The advisory committee shall submit a report including, but not limited to: (i) the number of licensed psychiatrists in the commonwealth, disaggregated by specialty; (ii) an analysis of the impact of the Graduate Medical Program on the number of licensed psychiatrists in the commonwealth, disaggregated by specialty; (iii) an analysis of the impact of the Graduate Medical Program on the retention of licensed psychiatrists in the commonwealth, disaggregated by specialty; (iv) an analysis of the impact of the Graduate Medial Program on increasing access to psychiatric services across regions of the commonwealth and across patient populations, disaggregated by demographic metrics, including but not limited to, race, age and gender identity; (v) an evaluation of the impact of the Graduate Medical Education program on the quality of psychiatric care received by patients; (vi) an evaluation of the impact of the Graduate Medical Education program on the well-being of psychiatrists in the commonwealth; (vii) the cost of the Graduate Medical Program; (viii) an evaluation of the impact of the Graduate Medical Education program on the cost of psychiatric services in the commonwealth; (ix) recommendations, where appropriate, regarding higher education policies and programming to support the psychiatric workforce in the commonwealth, based on an evaluation of the experiences and outcomes of Graduate Medical Education participants; and (ix) legislative and regulatory recommendations, where appropriate, to support the Graduate Medical Education program. The report shall be submitted to the governor, the chairs of the house and senate committees on ways and means, the chairs of the joint committee of healthcare financing, the chairs of the joint committee on mental health, substance use and recovery and the chairs of the joint committee on labor and workforce development every five years.

(d) The executive office of health and human services shall develop a communication and outreach program to inform hospitals of the availability of Graduate Medical Education funding to train psychiatrists.

SECTION 2. Section 9 of chapter 13 of the General Laws, as appearing in the 2018 Official Edition, is hereby amended by inserting after the word “workers”, in line 8, the following words:- , the board of registration of social workers, the board of registration of psychologists, the board of registration of allied mental health and human services professions.

SECTION 3. Section 76 of chapter 13 of the General Laws, as appearing in the 2018 Official Edition, is hereby amended by inserting the following new sentence:-

The governor shall not leave a member of said board unappointed for a period longer than six months.

SECTION 4. Section 79 of chapter 13 of the General Laws, as appearing in the 2018 Official Edition, is hereby amended by striking out, in lines 17 and 18 and in line 27, the words “director of consumer affairs and business regulations” and inserting in place thereof, in each instance, the following words:- commissioner of public health.

SECTION 5. Chapter 13 of the General Laws, as appearing in the 2018 Official Edition, is hereby further amended by striking out section 80 and inserting in place thereof the following section:-

Section 80. There shall be a board of registration of social workers that shall consist of: the commissioner of children and families or a designee who is licensed as either a certified social worker or an independent clinical social worker under sections 130 to 137, inclusive, of chapter 112; the commissioner of mental health or a designee who is licensed as either a certified social worker or an independent clinical social worker under said sections 130 to 137, inclusive, of said chapter 112; and 7 members to be appointed by the governor, 1 of whom shall be a representative of an accredited school of social work, 3 of whom shall be licensed as a certified social worker or an independent clinical social worker under said sections 130 to 137, inclusive, of said chapter 112, 1 of whom shall be licensed under said sections 130 to 137, inclusive, of said chapter 112 and an active member of an organized labor organization representing social workers and 2 of whom shall be members of the general public. At least 1 licensed social work member and at least 1 member from the general public shall represent an underserved population, as defined by the United States Department of Health and Human Services. Not more than 6 members of the board shall belong to any 1 political party.

The governor shall not leave a member of said board unappointed for a period longer than six months.

SECTION 6. Section 84 of chapter 13 of the General Laws, as appearing in the 2018 Official Edition, is hereby amended by striking out, in lines 8 and 9, the words “division of professional licensure” and inserting in place thereof the following words:- department of public health.

SECTION 7. Section 84 of chapter 13 of the General Laws, as appearing in the 2018 Official Edition, is hereby further amended by striking out, in lines 44 and 45, inclusive, the words “Division of Professional Licensure Trust Fund established in section 35V” and inserting in place thereof the following words:- Quality in Health Professions Trust Fund established in section 35X.

SECTION 8. Section 88 of chapter 13 of the General Laws, as appearing in the 2018 Official Edition, is hereby amended by striking out, in lines 1 and 2, the words “division of professional licensure” and inserting in place thereof the following words:- department of public health.

SECTION 9. Said section 88 of chapter 13 of the General Laws, as appearing in the 2018 Official Edition, is hereby further amended by inserting the following new sentence:-

The governor shall not leave a member of said board unappointed for a period longer than six months.

SECTION 10. The first paragraph of section 90 of chapter 13 of the General Laws, as appearing in the 2018 Official Edition, is hereby amended by striking out the third sentence.

SECTION 11. Section 90 of chapter 13 of the General Laws, as appearing in the 2018 Official Edition, is hereby further amended by striking out the third paragraph, as so appearing, and inserting in place thereof the following paragraph:-

The commissioner of public health may review and approve the rules and regulations proposed by the board.

SECTION 12. Chapter 29 of the General Laws, as appearing in the 2018 Official Edition, is hereby amended by inserting after section 2CCCCC the following section:-

Section 2DDDDD.

(a) There shall be a Behavioral Health Investment Trust Fund, in this section called the fund. The fund shall be administered by the secretary of the executive office of health and human services. The purpose of the fund shall be to support investments in the behavioral health infrastructure in the commonwealth, including but not limited to: (i) establishing additional inpatient psychiatric beds and providing supplemental payments, as needed, for said beds; (ii) expanding outpatient and partial hospitalization treatment settings, intensive community based acute treatment programs, community based acute treatment programs, substance use treatment programs, crisis stabilization units and community mental health centers; (iii) supporting increased rates of payment for behavioral health providers; (iv) establishing a behavioral health home hospital pilot program; (v) supporting an expanded and culturally and linguistically-competent behavioral health workforce in the commonwealth, including but not limited to psychiatrists, psychologists, nurses, social workers, mental health workers, sitters, certified nursing assistants, licensed mental health counselors, recovery coaches and peer specialists via programs including, but not limited to, psychiatric Graduate Medical Education payments and loan forgiveness programs to increase access to behavioral healthcare equitably across the commonwealth.

SECTION 13. Chapter 32A of the General Laws, as appearing in the 2018 Official Edition, is hereby amended by inserting after section 17O the following new section:-

Section 17OO. The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for medically necessary mental health treatment and shall not require a preauthorization prior to obtaining treatment. Medical necessity shall be determined by the treating clinician in consultation with the patient and noted in the patient’s medical record.

SECTION 14. Section 25C ½ of chapter 111 of the General Laws, as appearing in the 2018 Official Edition, is hereby amended by inserting after subsection (a)(4) the following subsection:-

(5) A health facility if the facility plans to make a capital expenditure for the development of acute psychiatric services including, inpatient, community based acute treatment, intensive community based acute treatment and partial hospitalization program; provided that the health facility demonstrates the need for a license from the department of mental health pursuant to paragraph c of section 19 of chapter 19 of the general laws, as so appearing.

SECTION 15. Chapter 111C of the General Laws, as so appearing, is hereby amended by adding the following subsection:-

(c) MIH programs that are focused on behavioral health services shall not be subject to application and registration fees.

SECTION 16. Section 2 of chapter 112 of the General Laws, as appearing in the 2018 Official Edition, is hereby amended in the first paragraph by inserting after the second sentence the following sentence:-

The board shall implement administrative procedures to ensure that applications for registration, including registration of qualified physicians who have been licensed or registered upon a written examination in another state pursuant to paragraph 3 of this section, are reviewed and processed within 90 days from the date of submission.

SECTION 17. Section 2 of chapter 112 of the General Laws, as appearing in the 2018 Official Edition, is hereby further amended by inserting after the sixth paragraph the following paragraph:-

If the board has not made a determination on a physician’s application for renewal of the certificate of registration within 90 days from the date of submission of a complete renewal application, the board shall issue a temporary registration to the physician so that the physician can complete the internal hospital credentialing and privileging process at the hospital at which the physician is employed or at the hospital at which the physician will be employed.

SECTION 18. Section 61 of chapter 112 of the General Laws, as appearing in the 2018 Official Edition, is hereby amended by striking out, in line 18, the words “A board of registration” and inserting in place thereof the following words:- Each board of registration under the supervision of the department of public health may discipline a holder of a license, certificate, registration or authority issued pursuant to this chapter and each board of registration.

SECTION 19. Section 61 of chapter 112 of the General Laws, as appearing in the 2018 Official Edition, is hereby further amended by striking out, in lines 49 and 50, the words “a board of registration” and inserting in place thereof the following words:- each board of registration under the supervision of the department of public health and each board of registration.

SECTION 20. Section 65B of chapter 112 of the General Laws, as appearing in the 2018 Official Edition, is hereby amended by striking out, in line 1, the words “A board of registration” and inserting in place thereof the following words:- Each board of registration under the supervision of the department of public health and each board of registration.

SECTION 21. Section 65F of said chapter 112, as appearing in the 2018 Official Edition, is hereby amended by inserting after the word “licensure”, in line 4, the following words:- or a board of registration under the supervision of the department of public health.

SECTION 22. Section 126 of chapter 112, as appearing in the 2018 Official Edition, is hereby amended by adding the following paragraph:- All application fees and civil administrative penalties and fines collected by the board under sections 61 and 118 to 129B, inclusive, shall be deposited into the Quality in Health Professions Trust Fund established in section 35X of chapter 10.

SECTION 23. Section 136 of chapter 112, as appearing in the 2018 Official Edition, is hereby amended by adding the following paragraph:- All application fees and civil administrative penalties and fines collected by the board under sections 61 and 130 to 137, inclusive, shall be deposited into the Quality in Health Professions Trust Fund established in section 35X of chapter 10.

SECTION 24. Section 168 of chapter 112, as appearing in the 2018 Official Edition, is hereby amended by adding the following paragraph:- All application fees and civil administrative penalties and fines collected by the board under sections 61 and 163 to 172, inclusive, shall be deposited into the Quality in Health Professions Trust Fund established in section 35X of chapter 10.

SECTION 25. Chapter 118E of the General Laws, as appearing in the 2018 Official Edition, is hereby amended by inserting after section 10L the following new section:-

Section 10M. 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 provide coverage for the administration of all medically necessary services for mental health treatment and shall not require a preauthorization prior to obtaining treatment. Medical necessity shall be determined by the treating clinician in consultation with the patient and noted in the patient’s medical record.

SECTION 26. Chapter 118E of the General Laws, as appearing in the 2018 Official Edition, is hereby amended by inserting at the end the following new section:-

Section 78. MassHealth shall make Graduate Medical Education payments to address psychiatrist, and especially child and adolescent psychiatrist, shortages in the commonwealth.

SECTION 27. Section 24B of chapter 175 of the General Laws, as appearing in the 2018 Official Edition, is hereby amended by inserting after the first paragraph the following paragraphs:

A carrier, as defined in section 1 of chapter 176O, shall be required to pay for health care services ordered by the treating health care provider if (1) the services are a covered benefit under the insured’s health benefit plan; and (2) the services follow the carrier’s clinical review criteria. Provided however, a claim for treatment of medically necessary services may not be denied if the treating health care provider follows the carrier’s approved method for securing authorization for a covered service for the insured at the time the service was provided. A carrier shall have no more than twelve months after the original payment was received by the provider to recoup a full or partial payment for a claim for services rendered, or to adjust a subsequent payment to reflect a recoupment of a full or partial payment. However, a carrier shall not recoup payments more than ninety days after the original payment was received by a provider for services provided to an insured that the carrier deems ineligible for coverage because the insured was retroactively terminated or retroactively disenrolled for services, provided that the provider can document that it received verification of an insured’s eligibility status using the carrier's approved method for verifying eligibility at the time service was provided. Claims may also not be recouped for utilization review purposes if the services were already deemed medically necessary or the manner in which the services were accessed or provided were previously approved by the carrier or its contractor. A carrier which seeks to make an adjustment pursuant to this section shall provide the health care provider with written notice that explains in detail the reasons for the recoupment, identifies each previously paid claim for which a recoupment is sought, and provides the health care provider with thirty days to challenge the request for recoupment. Such written notice shall be made to the health provider not less than thirty days prior to the seeking of a recoupment or the making of an adjustment.

SECTION 28. Chapter 175 of the General Laws, as appearing in the 2018 Official Edition, is hereby amended by inserting after section 47KK the following section:-

Section 47LL. Any policy, contract, agreement, plan or certificate of insurance issued, delivered or renewed within the commonwealth, which is considered creditable coverage under section 1 of chapter 111M, shall provide coverage for medically necessary mental health treatment and shall not require a preauthorization prior to obtaining treatment. Medical necessity shall be determined by the treating clinician in consultation with the patient and noted in the patient’s medical record.

SECTION 29. Section 8A of chapter 176A of the General Laws, as appearing in the 2018 Official Edition, is hereby amended by inserting after the word “specialist”, in line 125, the following words:- , a clinician practicing under the supervision of a licensed professional, and working towards licensure, in a clinic licensed under chapter 111.

SECTION 30. Chapter 176A of the General Laws, as appearing in the 2018 Official Edition, is hereby amended by inserting after section 8MM the following section:-

Section 8NN. Any contract between a subscriber and the corporation under an individual or group hospital service plan which is delivered, issued or renewed within the commonwealth shall provide coverage for medically necessary mental health treatment and shall not require a preauthorization prior to obtaining treatment. Medical necessity shall be determined by the treating clinician in consultation with the patient and noted in the patient’s medical record.

SECTION 31. Section 4A of chapter 176B of the General Laws, as appearing in the 2018 Official Edition, is hereby amended by inserting after the word “specialist”, in line 120, the following words:- , a clinician practicing under the supervision of a licensed professional, and working towards licensure, in a clinic licensed under chapter 111.

SECTION 32. Chapter 176B of the General Laws, as appearing in the 2018 Official Edition, is hereby amended by inserting after section 4MM the following section:-

Section 4NN. Any subscription certificate under an individual or group medical service agreement delivered, issued or renewed within the commonwealth shall provide coverage for medically necessary mental health treatment and shall not require a preauthorization prior to obtaining treatment. Medical necessity shall be determined by the treating clinician in consultation with the patient and noted in the patient’s medical record.

SECTION 33. Section 4M of chapter 176G of the General Laws, as appearing in the 2018 Official Edition, is hereby amended by inserting after the word “specialist”, in line 117, the following words:- , a clinician practicing under the supervision of a licensed professional, and working towards licensure, in a clinic licensed under chapter 111.

SECTION 34. Chapter 176G of the General Laws is hereby amended by inserting after section 4EE the following section:-

Section 4FF. Any individual or group health maintenance contract that is issued or renewed shall provide coverage for medically necessary mental health treatment and shall not require a preauthorization prior to obtaining treatment. Medical necessity shall be determined by the treating clinician in consultation with the patient and noted in the patient’s medical record.

SECTION 35. Notwithstanding any general or special law to the contrary, the so called expedited psychiatric inpatient admissions protocol, developed by the executive office of health and human services, department of mental health, department of public health, division of medical assistance and division of insurance, shall include within the escalation protocol patients who initially had a primary medical diagnosis or primary presenting problem requiring treatment on a medical-surgical floor, who have been subsequently medically cleared and are boarding on a medical-surgical floor for an inpatient psychiatric placement.

SECTION 36. Notwithstanding any general or special law to the contrary, the health policy commission, the division of medical assistance, four representatives from academic medical centers currently rendering inpatient services in a patient’s home, the department of public health and the department of mental health, shall conduct a study and issue a report regarding the design of a behavioral health home hospital program, herein referred to as the program. The study shall include, but not be limited to: (i) the recommendation of patient populations who would be best served by the provision of behavioral healthcare in a home environment; (ii) the identification of healthcare providers who would make up the program care team; (iii) the projected impact of the program on the rate of psychiatric emergency department boarding statewide; (iv) the identification of safety concerns regarding the provision of behavioral healthcare in a home environment and recommendations to address said concerns; (v) the projected impact of the program on the availability of psychiatric hospital beds in the commonwealth; (vi) the projected cost estimates of the program; (vii) a comparison of cost estimates of providing behavioral healthcare in the home versus in a healthcare facility; (viii) an analysis of the quality of patient care received through the program; (ix) the identification of screening protocols before care at home begins to assess medical and non-medical factors, including working utilities, assessment of physical barriers and screenings for domestic violence concerns; (x) recommendations for minimum personnel visits, the provision of immediate, on-demand telehealth connections with program staff; and (xi) recommendations for minimum emergency response times. The report shall be submitted to the governor, the chairs of the joint committee on health care financing, the chairs of the joint committee on mental health, substance use and recovery and the house and senate committees on ways and means no later than July 31, 2022.

SECTION 37. (a) There shall be a task force to: (i) evaluate ways to ensure the financial stability of inpatient behavioral health units and facilities; (ii) consider the role of inpatient behavioral health units and facilities within the continuum of behavioral health services; and (iii) address current behavioral health workforce challenges. The task force shall consist of the following members: the executive director of the health policy commission, who shall serve as co-chair; the executive director of the center for health information and analysis, who shall serve as co-chair; the assistant secretary for MassHealth or his/her designee, the commissioner of the department of mental health or his/her designee, the commissioner of the department of public health or his/her designee, and 1 representative from each of the following organizations: the Massachusetts Health & Hospital Association; the Massachusetts Psychiatric Society; the Massachusetts Association of Behavioral Health Systems; the Massachusetts Psychological Association; the Massachusetts Association of Advanced Practice Psychiatric Nurses; the National Association of Social Workers-Massachusetts Chapter; and the Massachusetts Association for Mental Health.

(b) The task force shall conduct an analysis and issue a report which shall include but not be limited to: (i) a review of the methodologies used for determining reimbursement rates for inpatient hospital behavioral health services provided to MassHealth members including those by MassHealth’s contracted health insurers, health plans, behavioral health management firms, and third party administrators under contract to a Medicaid managed care organization or primary care clinician plan; (ii) an analysis of the estimated payment levels associated with MassHealth reimbursement relative to the cost of providing inpatient hospital behavioral health care in acute hospital units and freestanding facilities; (iii) recommended improvements to MassHealth reimbursement for care provided by inpatient behavioral health units and facilities to promote financial stability, including a review of a cost-based method for rate determination; (iv) an assessment of the utility and limitations of incorporating diagnosis-related group DRG classifications in said rate calculation; (v) industry-wide workforce initiatives including, but not limited to, ways to improve recruitment, training, including transitional training opportunities for employment in behavioral health units and facilities and training in new behavioral healthcare modalities including but not limited to telehealth, retention, rates of pay and other methods of ensuring a sustainable, culturally and linguistically-competent behavioral health workforce; and (vi) the role of external economic factors on the development and retention of the behavioral health workforce such as the increases in the minimum wage and competition from other industries.

(c) The task force shall convene its first meeting within 30 days after the effective date of this act. The task force shall submit its report, including any proposed legislation necessary to carry out its recommendations, by filing the same with the clerks of the house of representatives and senate, the joint committee on health care financing, the joint committee on mental health, substance use and recovery, the joint committee on labor and workforce development and the house and senate committees on ways and means not later than December 31, 2021.

Name:	District/Address:	Date Added:
Marjorie C. Decker	25th Middlesex	2/18/2021
Lindsay N. Sabadosa	1st Hampshire	2/18/2021
Christina A. Minicucci	14th Essex	2/26/2021
Susannah M. Whipps	2nd Franklin	3/9/2021
Mathew J. Muratore	1st Plymouth	3/15/2021
Sean Garballey	23rd Middlesex	3/31/2021
Michelle L. Ciccolo	15th Middlesex	5/10/2021
Jack Patrick Lewis	7th Middlesex	7/22/2021