Amendment ID: S2202-48-R1

Redraft Amendment 48

Behavioral Health Services Cost Study

Ms. Friedman, Messrs. Cyr and O'Connor move to amend the bill by inserting after section 145 the following section:-

“SECTION 145A. Notwithstanding any general or special law to the contrary, MassHealth, in consultation with the center for health information and analysis, shall report on the costs incurred by efficiently and economically operated outpatient and diversionary behavioral health providers in providing outpatient and diversionary behavioral health services. MassHealth may contract with an independent research entity with experience in determining the costs of providing outpatient and diversionary behavioral health services.

The report shall analyze the cost of efficiently and economically operating outpatient and diversionary behavioral health providers by examining the 20 highest volume outpatient and diversionary billing codes utilized in providing services to MassHealth members, including services administered by MassHealth managed care organizations, accountable care organizations, managed behavioral health organizations with whom MassHealth may contract for management of behavioral health benefits, the managed behavioral health organization for the primary care clinician plan and MassHealth fee for service.  The report’s analysis shall be based on data from not less than 15 outpatient and diversionary behavioral health providers representing the diversity of providers across the commonwealth with consideration given to, but not limited to: (i) geographic location; (ii) whether the provider serves adults and children; (iii) providers serving racial and ethnic minority groups, including those for whom English is not a primary language; and (iv) the overall size of the outpatient and diversionary behavioral health providers in terms of annual revenues.

MassHealth, or the independent research entity if contracted, shall recommend an appropriate methodology for determining the true cost of providing the services identified as the 20 highest volume outpatient and diversionary billing codes; provided, however, that the methodology may be developed through on-site interviews with organizations participating in the project.

MassHealth shall submit its findings and recommendations, together with drafts of legislation necessary to carry those recommendations into effect, by filing the same with the clerks of the senate and house of representatives, the joint committee on mental health, substance use and recovery, the joint committee on health care financing and the joint committee on financial services not later than March 1, 2018.”.