Amendment ID: S2871-8

Amendment 8

Community Behavioral Health Centers

Mr. Cyr moves that the proposed new text be amended by adding the following sections:-

"SECTION X. Section 1 of chapter 175 of the General Laws is hereby amended by striking the definition of 'Emergency services programs' and replacing it with the following definition:-

'Emergency services programs', community-based organizations providing emergency psychiatric 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) youth community crisis stabilization services; (vi) adult community crisis stabilization services; and (vii) MassHealth-designated community behavioral health centers, including outpatient behavioral health bundled services delivered by these centers.

SECTION X. Chapter 32A of the General Laws is hereby amended by striking section 31, as appearing in the 2022 Official Edition, and inserting in place thereof the following section:-

Section 31. The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission benefits on a nondiscriminatory basis for medically necessary emergency services programs, as defined in section 1 of chapter 175. Services delivered by emergency services programs shall be deemed medically necessary and shall not require prior authorization. Services delivered by emergency service programs shall be covered with no patient cost-sharing; provided, however, that cost-sharing shall be required if the applicable plan is governed by the Federal Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on cost-sharing for this service.

The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for emergency services programs delivered by MassHealth-designated community behavioral health centers. Reimbursement for outpatient services delivered by emergency services programs through MassHealth-designated community behavioral health centers shall be structured as a bundled rate per encounter at a rate not less than the corresponding bundled encounter rate paid by MassHealth.

SECTION X. Chapter 175 of the General Laws is hereby amended by striking section 47RR, as appearing in the 2022 Official Edition, and inserting in place thereof the following section:-

Section 47RR. An individual policy of accident and sickness insurance issued under section 108 that provides hospital expense and surgical expense insurance or a group blanket or general policy of accident and sickness insurance issued under section 110 that provides hospital expense and surgical expense insurance that is issued or renewed within or without the commonwealth shall provide benefits on a nondiscriminatory basis for medically necessary emergency services programs. Services delivered by emergency services programs shall be deemed medically necessary and shall not require prior authorization. Services delivered by emergency service programs shall be covered with no patient cost-sharing; provided, however, that cost-sharing shall be required if the applicable plan is governed by the Federal Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on cost-sharing for this service.

An individual policy of accident and sickness insurance issued pursuant to section 108 that provides hospital expense and surgical expense insurance or a group blanket or general policy of accident and sickness insurance issued pursuant to section 110 that provides hospital expense and surgical expense insurance that is issued or renewed within or without the commonwealth shall provide coverage for emergency services programs delivered by MassHealth-designated community behavioral health centers. Reimbursement for outpatient services delivered by emergency services programs through MassHealth-designated community behavioral health centers shall be structured as a bundled rate per encounter at a rate not less than the corresponding bundled encounter rate paid by MassHealth.

SECTION X. Chapter 176A of the General Laws is hereby amended by striking section 8TT, as appearing in the 2022 Official Edition, and inserting in place thereof the following section:-

Section 8TT. A contract between a subscriber and the corporation under an individual or group hospital service plan that is delivered, issued or renewed within or without the commonwealth shall provide benefits on a nondiscriminatory basis for medically necessary emergency services programs, as defined in section 1 of chapter 175. Services delivered by emergency services programs shall be deemed medically necessary and shall not require prior authorization. Services delivered by emergency service programs shall be covered with no patient cost-sharing; provided, however, that cost-sharing shall be required if the applicable plan is governed by the Federal Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on cost-sharing for this service.

A contract between a subscriber and the corporation under an individual or group hospital service plan that is delivered, issued or renewed within or without the commonwealth shall provide coverage for emergency services programs delivered by MassHealth-designated community behavioral health centers. Reimbursement for outpatient services delivered by emergency services programs through MassHealth-designated community behavioral health centers shall be structured as a bundled rate per encounter at a rate not less than the corresponding bundled encounter rate paid by MassHealth.

SECTION X. Chapter 176B of the General Laws in hereby amended by striking section 4TT, as appearing in the 2022 Official Edition, and inserting in place thereof the following section:-

Section 4TT. A subscription certificate under an individual or group medical service agreement that is issued or renewed shall provide benefits on a nondiscriminatory basis for medically necessary emergency services programs, as defined in section 1 of chapter 175. Services delivered by emergency services programs shall be deemed medically necessary and shall not require prior authorization. Services delivered by emergency service programs shall be covered with no patient cost-sharing; provided, however, that cost-sharing shall be required if the applicable plan is governed by the Federal Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on cost-sharing for this service.

A subscription certificate under an individual or group medical service agreement that is issued or renewed within or without the commonwealth shall provide coverage for emergency services programs delivered by MassHealth-designated community behavioral health centers. Reimbursement for outpatient services delivered by emergency services programs through MassHealth-designated community behavioral health centers shall be structured as a bundled rate per encounter at a rate not less than the corresponding bundled encounter rate paid by MassHealth.

SECTION X. Chapter 176G of the General Laws is hereby amended by striking section 4LL, as appearing in the 2022 Official Edition, and inserting in place thereof the following section:-

Section 4LL. An individual or group health maintenance contract that is issued or renewed within or without the commonwealth shall provide benefits on a nondiscriminatory basis for medically necessary emergency services programs, as defined in section 1 of chapter 175. Services delivered by emergency services programs shall be deemed medically necessary and shall not require prior authorization. Services delivered by emergency service programs shall be covered with no patient cost-sharing; provided, however, that cost-sharing shall be required if the applicable plan is governed by the Federal Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on cost-sharing for this service.

An individual or group health maintenance contract that is issued or renewed within or without the commonwealth shall provide coverage for emergency services programs delivered by MassHealth-designated community behavioral health centers. Reimbursement for outpatient services delivered by emergency services programs through MassHealth-designated community behavioral health centers shall be structured as a bundled rate per encounter at a rate not less than the corresponding bundled encounter rate paid by MassHealth."