Amendment #1225 to H4600

Behavioral Health ED Crisis Evaluations

Ms. Decker of Cambridge moves to amend the bill by adding the following sections:

SECTION XXXX.

SECTION 1. Section 1 of chapter 175 of the General Laws, as amended by chapter 177 of the acts of 2022, is hereby amended by inserting after the definition of “Domestic company” the following definition:-

“Emergency services programs”, all programs subject to contract between the Massachusetts Behavioral Health Partnership and provider organizations for the provision of acute care hospital and community-based emergency behavioral health services, including, but not limited to, behavioral health crisis assessment, intervention and stabilization services 24 hours per day, 7 days per week, through: (i) mobile crisis intervention services for youth; (ii) mobile crisis intervention services for adults; (iii) emergency service provider community-based locations; (iv) emergency departments of acute care hospitals or satellite emergency facilities;  (v) adult community crisis stabilization services; and (vi) youth community crisis stabilization services.

SECTION 2. Notwithstanding any general or special law to the contrary, the division of insurance, in consultation with the division of medical assistance, shall promulgate regulations or issue sub-regulatory guidance, within 30 days of the effective date of this act, to require carriers reimburse acute care hospitals with emergency departments or satellite emergency facilities for the provision of emergency behavioral health services, including but not limited to, behavioral health crisis assessment, intervention, and stabilization services. The regulations or sub-regulatory guidance shall include reimbursement for the provision of emergency behavioral services via telemedicine, electronic or telephonic consultation, in accordance with section 51 ¾ of chapter 111 of the General Laws. The contractual rate for these services may be no less than the prevailing MassHealth rate for behavioral health emergency department crisis evaluations. This does not preclude a hospital from billing for other medically necessary services traditionally reimbursed through an emergency department visit and is also in addition to required reimbursement by carriers for each day a member waits in an emergency department, observation unit or inpatient floor for placement in an appropriate inpatient psychiatric placement, as required by section 78 of chapter 177 of the acts of 2022. The insurer shall reimburse other medically necessary services and for patients awaiting an inpatient psychiatric placement in addition to payment for emergency behavioral health services. Behavioral health services provided in this setting under this section shall be deemed medically necessary and shall not require prior authorization by an insurer.

Additional co-sponsor(s) added to Amendment #1225 to H4600

Behavioral Health ED Crisis Evaluations