Amendment #328 to H4000

Relative to Mental Health Access

Mr. Markey of Dartmouth moves to amend the bill by inserting at the end thereof the following:

SECTION X: Notwithstanding any general or special law, rule or regulation to the contrary, no Carrier as defined under section 1 of chapter 176O and their respective contractors, nor any 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 a primary care clinician plan, shall require a prior authorization or a prior approval requirement related to the coverage of inpatient level mental health and substance abuse services of a patient with a mental health condition or a substance abuse disorder where the patient is determined to have an emergency medical condition by the treating healthcare provider, as emergency medical condition is so defined in Chapter 141 of the Acts of 2000. Any such prior authorization or prior approval requirements shall be prohibited and shall be considered violations of the requirements for coverage of emergency services as provided in Chapter 141 of the Acts of 2000 and the mental health parity provisions required in chapter 224 of the Acts of 2012.

SECTION X: Notwithstanding any general or special law to the contrary, the Office of Medicaid and the Commissioner of Insurance shall develop regulations by January 1, 2015 requiring: 1) Carriers, as defined under section 1 of chapter 176O and their contractors, and 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 a primary care clinician plan to conduct searches for inpatient or community based mental health or substance abuse placements for their members or insured if the individuals suffering from a mental health or substance abuse condition remain in a hospital’s emergency department two hours after the decision to admit has been made by the emergency department physician or psychiatric physician; and 2) the development of a payment rate by Carriers and their contractors, as well as 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 primary care clinician plan which shall not be less than twice the contracted rate of an inpatient hospital per diem, the physician fee schedule, and the behavioral health screening teams fee for the services provided for each calendar day that a patient remains continuously boarded in a hospital’s emergency department for over 24 hours from the decision to admit.  Any aforementioned regulations adopted pursuant to this section must be utilized and included by the Office of Medicaid and a Carrier with a contracted entity in developing future payment reform and alternative contract arrangements.

SECTION X: Notwithstanding any general or special law, rule or regulation to the contrary, a Carrier, as defined under Section 1 of Chapter 176O and their contractors, and 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 a primary care clinician plan shall implement all Current Procedural Terminology, or CPT, as well as evaluation and management codes for behavioral health services in accordance with the new CPT evaluation and management codes as most recently adopted by the American Medical Association and the Centers for Medicare and Medicaid Services, or CMS; provided further, that if a code is covered under a Carrier or Medicaid fee schedule and paid on the medical surgical benefit, then the code shall reimburse providers the same rate as provided in facility and non-facility settings on the behavioral health and substance abuse benefit; provided further, that the Carrier and office of Medicaid shall work with its actuary to ensure that capitation rates appropriately account for changes in provider rates for all rate changes associated with incremental increases for behavioral health services; provided further, that any integrated care organization, managed care entity or behavioral health carve-out entity that manages behavioral health services on behalf of the Carrier or Medicaid shall implement all CPT evaluation and management codes for behavioral health services in accordance with the new CPT codes for evaluation and management services as well as psychopharmacological services and neuropsychological assessment services as most recently adopted by the American Medical Association and CMS; provided further, that any integrated care organization, managed care entity or behavioral health carve-out entity that manages behavioral health services on behalf of a Carrier or Medicaid shall be required to pay, at a minimum, the Carrier’s or Medicaid’s rates of payment for all CPT evaluation and management codes for behavioral health services by October 1, 2014; and provided further, that the Carrier and Medicaid shall review and adjust all rates of payment accordingly for mental health services provided in hospitals, hospital clinics, outpatient clinics, private practice offices, community health centers and mental health centers by October 1, 2014.