Budget Amendment ID: FY2014-S3-627

EHS 627

Outpatient Rates for Mental Health Services

Mr. Rodrigues and Ms. Lovely and Mr. Keenan moved that the proposed new text be amended in section 2, in item 4000-0500, by adding at the end thereof the following:-

“provided further, that MassHealth shall, retroactive to January 1, 2013, implement all Current Procedural Terminology (CPT) evaluation and management codes for behavioral health services in accordance with new Current Procedural Terminology (CPT) as most recently adopted by the American Medical Association and Centers for Medicare and Medicaid  Services (CMS); provided further that if a code is covered and paid on the medical surgical benefit then the code shall  reimburse providers the same rate as provided in non-facility settings on the behavioral health and substance abuse benefit; 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 commonwealth shall retroactive to January 1, 2013, implement all Current Procedural Terminology (CPT) evaluation and management codes for behavioral health services in accordance with new Current Procedural Terminology (CPT) as most recently adopted by the American Medical Association and Centers for Medicare and Medicaid  Services (CMS); provided further, that if a code is covered and paid on the medical surgical benefit then the code shall  reimburse providers the same rate as provided in non-facility settings on the behavioral health and substance abuse benefit; provided further, that said codes shall be available and paid in the same manner and value for psychiatric services as for any other medical or surgical service and be required to pay, at a minimum, the MassHealth rates of payment for all evaluation and management psychiatric services, and, provided further that MassHealth shall review and adjust all Relative Value Units (RVU) in the same manner as RVU’s paid on the medical surgical benefit and that MassHealth shall review and adjust all rates of payment for mental health services provided in community health centers and mental health centers by September 1, 2013”