HOUSE DOCKET, NO. 2023 FILED ON: 2/16/2021
HOUSE . . . . . . . . . . . . . . . No. 1302
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The Commonwealth of Massachusetts
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PRESENTED BY:
James J. O'Day
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To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
Court assembled:
The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:
An Act relative to applied behavioral health clinic rates.
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PETITION OF:
Name: | District/Address: | Date Added: |
James J. O'Day | 14th Worcester | 2/16/2021 |
HOUSE DOCKET, NO. 2023 FILED ON: 2/16/2021
HOUSE . . . . . . . . . . . . . . . No. 1302
By Mr. O'Day of West Boylston, a petition (accompanied by bill, House, No. 1302) of James J. O'Day relative to the rates of payment for mental health services. Health Care Financing. |
The Commonwealth of Massachusetts
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In the One Hundred and Ninety-Second General Court
(2021-2022)
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An Act relative to applied behavioral health clinic rates.
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 118E of the General Laws is hereby amended by inserting after 13D the following section:-
Section 13D ½.
(a) For the purposes of this section, the following words shall have the following meanings:
“Behavioral health services”, evaluation, diagnosis, treatment, care coordination, management, or peer support of patients with mental health, developmental or substance use disorders.
“Community behavioral health center”, a clinic licensed by the Department of Public Health pursuant to Sections 3 and 51 through 56 of Chapter 111 of the General Laws and regulated pursuant to title 130 of the code of Massachusetts regulations section 140, subsection E.
“Division”, Division of Medical Assistance.
“Minimum payment rates”, rates of payment for services below which managed care entities may not enter into provider agreements.
(b) The Division shall establish rates of payment for behavioral health services pursuant to Sections 13C and 13D that are at 120% of the rate schedule for non-community behavioral health centers for each service code for which the Division establishes a rate.
SECTION 2. Chapter 118E of the General Laws is hereby amended by inserting after 13K the following new section:-
Section 13L. (a) For the purposes of this section, the following words shall have the following meanings:
“Managed Care Entity”, all 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, and accountable care organizations.
“Behavioral health services”, evaluation, diagnosis, treatment, care coordination, management or peer support of patients with mental health, developmental or substance use disorders.
“Community behavioral health center”, a clinic licensed by the Department of Public Health pursuant to Sections 3 and 51 through 56 of Chapter 111 of the General Laws and regulated pursuant to title 130 of the code of Massachusetts regulations section 140, subsection E.
“Division”, Division of Medical Assistance.
“Minimum payment rates”, rates of payment for services below which managed care entities may not enter into provider agreements.
(b) The Division shall direct its Managed Care Entities to pay minimum payment rates for behavioral health services that are initially 105% per procedure code of the minimum rates of payment in place as of January 1, 2021. The Division shall review these minimum rates biennially.
(c) The Division shall direct its Managed Care Entities to pay minimum payment rates for behavioral health services delivered in community behavioral health centers at 120% of the minimum payment rates for non-community behavioral health centers for each service code which a rate is established pursuant to paragraph (b).