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December 31, 2024 Clouds | 44°F
The 193rd General Court of the Commonwealth of Massachusetts
  1. General Laws
  2. Part I ADMINISTRATION OF THE GOVERNMENT
  3. Title XVII PUBLIC WELFARE
  4. Chapter 118E DIVISION OF MEDICAL ASSISTANCE
  5. Section 13D1/2 Minimum payment rates to be paid to providers of behavioral health services delivered in community behavioral health centers by managed care entities; annual review and reporting

Section 13D1/2

Section 13D1/2: Minimum payment rates to be paid to providers of behavioral health services delivered in community behavioral health centers by managed care entities; annual review and reporting

Section 13D1/2. (a) As used in this section, the following words shall, unless the context clearly requires otherwise, have the following meanings:-

''Behavioral health services'', the evaluation, diagnosis, treatment, care coordination, management or peer support of patients with mental health, developmental or substance use disorders.

''Community behavioral health center'', organizations that are designated by the executive office of health and human services, licensed clinics that hold a contract with the department of mental health to provide community-based mental health services and other licensed clinics designated by the department of public health.

''Division'', the division of medical assistance.

''Managed care entity'', health insurers, health plans, health maintenance organizations, behavioral health management firms and third party administrators under contract with a Medicaid managed care organization or primary care clinician plan; provided, however, that ''managed care entity'' shall also include accountable care organizations.

''Minimum payment rates'', rates of payment for services below which managed care entities shall not enter into provider agreements.

(b) Annually, not later than January 1, the division shall review the minimum payment rates to be paid to providers of behavioral health services delivered in community behavioral health centers by managed care entities and submit a report to the house and senate committees on ways and means, the joint committee on health care financing and the joint committee on mental health, substance use and recovery identifying the difference between the minimum payment rates decided by the division and the payment rates that managed care entities contractually agree to pay providers for all behavioral health services delivered in community behavioral health centers.