Budget Amendment ID: FY2023-S4-574-R1

Redraft EHS 574

Behavioral Health Crisis Helpline

Messrs. Cyr, Eldridge, Keenan, Collins and Moore, Ms. Moran, Ms. Gobi, Ms. Rausch, Ms. Lovely and Messrs. Gomez, O'Connor and Timilty moved that the proposed new text be amended by inserting after proposed section 2VVVVV the following section:-

“Section 2WWWWW. There shall be a Behavioral Health Access and Crisis Intervention Trust Fund to be administered by the secretary of health and human services. The secretary may expend money from the fund, without further appropriation, to support a statewide, payor-agnostic community behavioral health crisis system, including, but not limited to, all necessary costs to support: (i) a behavioral health access line to connect individuals to behavioral health services, including clinical assessment and triage; and (ii) a statewide system to deliver behavioral health crisis intervention services 24 hours per day and 7 days per week in mobile and community-based settings, available to all residents without regard to insurance.

There shall be credited to the fund all monies paid to the commonwealth under section 69A of chapter 118E and any other federal reimbursements, grants, premiums, gifts, interest or other contributions from any source received that are specifically designated to be credited to the fund. In the discretion of the secretary of administration and finance, in consultation with the secretary of health and human services, revenues equal to the amount of federal financial participation received by the commonwealth's General Fund for expenditures for the behavioral health access line may also be credited to the fund.

The fund may incur expenses and the comptroller shall certify for payment amounts in anticipation of the most recent estimate of expected receipts, as certified by the secretary of health and human services. Any balance in the fund at the close of a fiscal year shall be available for expenditure in subsequent fiscal years and shall not be transferred to any other fund or revert to the General Fund. Annually, not later than August 1, the secretary shall report to the house and senate committees on ways and means and the joint committee on mental health, substance use and recovery on the revenue and expenditure activity within the fund.”; and

by inserting after section 21 the following section:-

“SECTION 21A. Section 2WWWWW of said chapter 29 is hereby repealed.”; and

by inserting after section 40 the following 2 sections:-

“SECTION 40A. Said chapter 118E of the General Laws is hereby further amended by inserting after section 69 the following section:-

Section 69A. (a) As used in this section, the following words shall have the following meaning unless the context clearly requires otherwise:

"Fund", the Behavioral Health Access and Crisis Intervention Trust Fund established under section 2WWWWW of chapter 29.

"Surcharge payors'', entities that: (i) are defined as surcharge payors pursuant to section 64; and (ii) made payments subject to surcharge in the amount of $1,000,000 or more during the most recent fiscal year for which data is available.

"Total behavioral health surcharge amount", an amount equal to $33,700,000.

(b) Each surcharge payor shall pay a behavioral health payor surcharge to the secretary of health and human services, for deposit in the fund. The secretary shall promulgate regulations for implementation of the surcharge and such regulations shall: (i) include a schedule for surcharge payment; and (ii) require each surcharge payor to pay a portion of the total behavioral health surcharge amount proportional to their payments subject to surcharge during the most recent period for which data is available.

(c) In the case of a transfer of ownership, a surcharge payor's liability to the fund shall be assumed by the successor in interest to the surcharge payor.

(d) The secretary shall establish by regulation an appropriate mechanism for enforcing a surcharge payor's liability to the fund if a surcharge payor does not make a scheduled payment to the fund; provided, however, that the secretary may establish threshold liability amounts below which enforcement may be modified or waived. Such enforcement mechanism may include assessment of interest on the unpaid liability at a rate not to exceed an annual percentage rate of 18 per cent and late fees or penalties at a rate not to exceed 5 per cent per month. Such enforcement mechanism may also include notification to the office of Medicaid requiring an offset of payments on the claims of the surcharge payor, any entity under common ownership or any successor in interest to the surcharge payor from the office of Medicaid in the amount of payment owed to the fund, including any interest and penalties, and transfer of the withheld amounts into the fund. If the office of Medicaid offsets claims payments as ordered by the secretary, the office of Medicaid shall be considered not to be in breach of contract or any other obligation for payment of non-contracted services and a surcharge payor whose payment is offset under an order of the secretary shall serve all recipients of assistance under Title XIX of the federal Social Security Act under the contract then in effect with the executive office. The secretary shall not direct the office of Medicaid to offset claims unless the surcharge payor has maintained an outstanding liability to the fund for a period longer than 45 days and has received proper notice that the secretary intends to initiate enforcement actions under regulations promulgated by the secretary.

SECTION 40B. Section 69A of said chapter 118E is hereby repealed.”; and

by inserting after section 56 the following section:-

“SECTION 56A. Notwithstanding any general or special law to the contrary, the health policy commission, in collaboration with the executive office of health and human services and the center for health information and analysis, shall conduct an analysis and report on the use of the behavioral health access line and behavioral health crisis intervention services, as described in section 2WWWWW of chapter 29 of the General Laws, which shall include an evaluation of and recommendations for developing an equitable and sustainable funding mechanism for the behavioral health access line and behavioral health crisis intervention services 24 hours per day and 7 days per week, available to all residents without regard to insurance.

The report shall include: (i) an analysis of the use of the behavioral health access line and behavioral health crisis intervention services by payer, including public and private payers, by insurance status, including the uninsured, and by aggregate patient demographics, including age, diagnosis and geographic region; (ii) the number of referrals, both direct and indirect, made by the behavioral health access line to a health care provider by provider type; (iii) the average length of interaction with a patient on the behavioral health access line; (iv) the average length of stay or interaction with the behavioral health crisis intervention services, including whether patients were admitted for care or referred to a new care setting following discharge; (v) the impact of the behavioral health access line and behavioral health crisis intervention services on emergency department wait times and utilization of inpatient psychiatric services by geographic region; (vi) any barriers to accessing the behavioral health access line and behavioral health crisis intervention services; (vii) an analysis of the use of the federally-designated 988 suicide prevention hotline including, but not limited to, call volume, abandoned call rate and number of referrals to other services by service type; (viii) recommendations on ways to expand access to the behavioral health access line and behavioral health crisis intervention services; (ix) an analysis and breakdown of the total annual cost of providing the behavioral health access line and behavioral health crisis intervention services 24 hours per day and 7 days per week, available to all residents without regard to insurance; (x) an examination of potential funding mechanisms for sustaining the behavioral health access line and behavioral health crisis intervention services, including, but not limited to, the behavioral health payor surcharge described in section 69A of chapter 118E of the General Laws, the General Fund, the Health Safety Net Trust Fund established by section 66 of said chapter 118E, an assessment on surcharge payors, any funds distributed through the federal 988 program and a surcharge on cell phone usage; and (xi) recommendations for an equitable and sustainable funding mechanism for the behavioral health access line and behavioral health crisis intervention services that takes into account utilization of such services by payer type and insurance status.

In developing the report, the commission shall seek input from relevant state agencies, the Massachusetts Association of Health Plans, Inc., Blue Cross and Blue Shield of Massachusetts, Inc., the Massachusetts Association of Mental Health, Inc., the Association for Behavioral Healthcare, Inc., the Massachusetts Health and Hospital Association, Inc., the Massachusetts Taxpayers Foundation, Inc., health care providers and payers, patients and any other interested stakeholder.

The commission shall submit its report and recommendations to the clerks of the senate and house of representatives, the senate and house committees on ways and means, the joint committee on health care financing and the joint committee on mental health, substance use and recovery not later than January 15, 2025.”; and

by inserting after section 74 the following section:-

“SECTION 74A. Sections 21A and 40B shall take effect on July 1, 2025.”.