Amendment #66 to H4879
Aligning to Current Expedited Psychiatric Inpatient Admissions Policy
Miss Gregoire of Marlborough moves to amend the bill moves to amend the bill in section 17 by striking clause (d) of section 19A of chapter 19 of the General Laws.
and further moves to amend section 17 of the bill by inserting after the words “setting forth additional exceptions to this section” the following words:-
,including when a facility’s medical director or designee determines admitting such a patient exceed the facility’s capability at the time admission is sought as provided for in clause (c).
and further moves to amend section 17 of the bill by inserting after the words “determined by the facility’s medical director” the following words:-
or designee
and further moves to amend the bill by inserting after section 22 the following new section:
SECTION 22A. Chapter 32A of the General Laws is hereby amended by inserting after Section 17T the following new section:-
Section 17U. The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission any necessary authorization and reimbursement needed to admit a patient to an inpatient psychiatric unit or inpatient psychiatric facility if an inpatient psychiatric provider identifies a need for special supports or services such as 1:1 staffing, single rooms as clinically necessary, or other specific needs associated with medical comorbidity such as high-cost medications, special equipment, or other resources when such supports or resources are determined to be needed by the inpatient psychiatric provider who also has the capability to provide such specialized resources to allow for admission. Mechanisms to be reimbursed for such payment shall be incorporated into contracts between the inpatient psychiatric providers and the commission’s health benefit plans. The commission’s health benefit plans shall provide authorization of specialing as soon as the need is identified in order to reduce admissions wait time.
If an in-network bed is unavailable, the plan shall seek placement in appropriate out-of-network facilities. The plan shall actively seek to obtain admission of the individual until an inpatient bed has been secured.
and further moves to amend the bill by inserting after section 31 the following new section:-
SECTION 31A. Chapter 118E of the General Laws is hereby amended by inserting after Section 10Q the following section:-
Section 10R. 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 to any member of 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 any necessary authorization and reimbursement needed to admit a patient to an inpatient psychiatric unit or inpatient psychiatric facility if an inpatient psychiatric provider identifies a need for special supports or services such as 1:1 staffing, single rooms as clinically necessary, or other specific needs associated with medical comorbidity such as high-cost medications, special equipment, or other resources when such supports or resources are determined to be needed by the inpatient psychiatric provider who also has the capability to provide such specialized resources to allow for admission. Mechanisms to be reimbursed for such payment shall be incorporated into contracts between the inpatient psychiatric providers and 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. 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 plans shall provide authorization of specialing as soon as the need is identified in order to reduce admissions wait time.
If an in-network bed is unavailable, 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 seek placement in appropriate out-of-network facilities. 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 actively seeks to obtain admission of the individual until an inpatient bed has been secured.
and further moves to amend the bill by inserting after section 47 the following new section:-
SECTION 47A. Chapter 176O of the General Laws is hereby amended by inserting after Section 10Q the following section:-
Section 5E. A carrier shall provide to any insured any necessary authorization and reimbursement needed to admit a patient to an inpatient psychiatric unit or inpatient psychiatric facility if an inpatient psychiatric provider identifies a need for special supports or services such as 1:1 staffing, single rooms as clinically necessary, or other specific needs associated with medical comorbidity such as high-cost medications, special equipment, or other resources when such supports or resources are determined to be needed by the inpatient psychiatric provider who also has the capability to provide such specialized resources to allow for admission. Mechanisms to be reimbursed for such payment shall be incorporated into contracts between the inpatient psychiatric providers and the carrier. The carrier shall provide authorization of specialing as soon as the need is identified in order to reduce admissions wait time.
If an in-network bed is unavailable, the carrier shall seek placement in appropriate out-of-network facilities. The carrier shall actively seek to obtain admission of the individual until an inpatient bed has been secured.