HB1794, HB1799, HB1810, HB1814, HB1818, HB3459, SB1050, Mental Health, Telemedicine

Joint Committee on Mental Health

The Massachusetts Hospital Association (MHA), on behalf of its member hospitals and health systems, appreciates the opportunity to offer comments on the many bills highlighted below.

MHA strongly supports HB3459, which sets forth important patient protections related to private health insurance coverage for medically necessary behavioral health services. HB3459 is critical to ensuring continued access and coverage for care by preventing health insurers from rejecting ongoing treatment for a patient whose insurance might be cancelled or terminated while they are receiving active inpatient care. It is not unusual for an insurer to eliminate coverage for a patient without any advance notice to the patient or provider that the insurance coverage will be eliminated. This bill provides the necessary protections for patients at a critical time, when many are not in a position to handle the administrative bureaucracy of insurance coverage options or appeals of coverage termination. While establishing this protection for patients is essential, HB3459 will also bring equity to the system for healthcare providers who may not have notice of a planned termination and are thus inhibited from securing reimbursement for the cost of care provided.

MHA supports the principles outlined in HB1810 to require both MassHealth and commercial insurers to provide coverage for telemedicine behavioral health services in instances where geography, specialty or linguistic and cultural capacity dictates that in-person visits are not available within a reasonable distance. However, we would strongly urge the committee to instead the more comprehensive approach to telemedicine parity found in HB267, “An Act Advancing and Expanding Access to Telemedicine Services”, which has been referred to the Health Care Financing Committee. HB267 ensures coverage for telemedicine services across all payers (including the GIC and MassHealth) and would expand and streamline licensure and credentialing processes to align with national standards. While we strongly support the principles of HB1810, we believe the systemic approach to telemedicine coverage found in HB267 will best ensure patient access to needed care and services.

MHA strongly supports HB1799, which provides for a streamlined review process for forensic or court ordered commitment hearings to ensure that administrative delays in scheduling cases do not cause undue harm or delays in care for patients. Due to the significant shortage of resources in the judicial system, many courts are hampered by the inability to conduct timely on-site reviews of patient commitment hearings. In addition, current law also allows open-ended delays in the review of cases, thereby further delaying care and requiring the boarding of patients while awaiting a hearing to initiate care and treatment. Such administrative delays are not in the best interest of any patient, add unnecessary costs to the overall healthcare system, and should be streamlined in the manner outlined in HB1799. This bill also seeks to develop an expedited process for the appropriate regulatory agencies within the Child Advocate’s Office and the Department of Children and Families to determine the time frame for administering certain antipsychotic medications to youth hospitalized in inpatient mental health facilities. This authority is long overdue and the proposed facilitated process for reviewing the cases of these patients will best allow the timely treatment and care of all patients.

MHA strongly supports HB1794, which calls for a technical correction to the current law governing the emergency hospitalization of patients who are deemed a danger to themselves or others. HB1794 allows the treating physician to apply for a dangerous patient to be hospitalized when an examination is not possible due to either the emergency nature of the case or the refusal of the patient. Current law provides restricts involuntarily commitment of a patient who is a danger to themselves or another to only those instances when a physician has physically seen the patient. For example, there are many times where a family member is at home threatening themselves or another family member. The family will call the treating clinician (often times a psychiatrist) asking for help to commit the patient for their own safety. But the physician cannot make such an order unless the patient is brought into a local hospital. In such instances, the potentially dangerous individual can often be unnecessarily diverted into the criminal justice system. It is important to note that this bill does not automatically place patients into a locked unit or facility without further medical review and determinations. It would simply allow a physician to have a patient transported to a local facility to be examined, even though the patient refuses, in order for the physician to make a determination if an inpatient commitment is warranted. HB1794 removes legal barriers that were inadvertently developed and have caused substantial problems for the appropriate care and treatment of potentially dangerous patients.

MHA opposes HB1818. In cases where a treating healthcare provider believes, following an examination, that a person will be a serious harm to themselves or others without hospitalization, state law (M.G.L. c. 123 § 12) already allows the healthcare provider to restrain the person and apply for a 3-day inpatient hospitalization stay. The law also provides the treating healthcare provider with certain needed discretion as to the time-limit for restraints to be placed upon a person while awaiting authorization, based on the patient’s medical and mental health conditions. HB1818 would remove the healthcare provider’s discretion, impose a twelve hour time-limit on the use of restraints, and prohibit the ability of the healthcare provider to renew such authorizations. While well intentioned, this legislation may potentially create unsafe and dangerous situations for patients, providers, and others in the community. The imposition of an absolute twelve hour limit for the utilization of restraints does not reflect the current realities of needed coordination between health care providers and judiciary personnel to obtain approval for a three day inpatient hospital stay. The judicial process is often quite lengthy, involved and includes numerous parties. The inflexible twelve hour standard suggested by this bill could, in some instances, result in patients who are a danger to themselves and/or others leaving the
hospital. MHA acknowledges the importance of the issue of timing in this matter and, while we oppose HB1818, as drafted, we would respectfully request that the committee instead consider the development of a task force to give further consideration to appropriate timeframes and clinical considerations.

MHA opposes HB1814, as it creates a new layer of administrative review and costs on a system that is already managing the issues that HB1814 is trying to address. The bill seeks to require healthcare providers and the Department of Mental Health (DMH) to develop a new adjudicatory review for any patient complaint of an alleged violation of a patient right essential to those patients admitted to an inpatient mental health facility. DMH already has an established regulatory process to review any alleged complaint, which includes the authority to review facility operational records and policies, the patient’s medical information, and conduct on-site reviews. Layering on an additional adjudicatory review process would only delay necessary care for patients and force unnecessary costs onto an already challenged system.

MHA opposes SB1050. Currently, in criminal proceedings where a patient has been found incompetent to stand trial or not guilty by reason of mental illness or mental defect, a facility may ultimately remove restrictions on a patient’s movements if the facility communicates the intention to modify restrictions on the patient’s movements in writing to the court and the court does not make written objection thereto within fourteen days. SB1050 eliminates this important and established process and instead requires the insertion of the district attorney’s office – with no limitation on the timing of needed judicial response. As drafted, this bill will inappropriately restrict the appropriate care and treatment of patients.
Thank you for the opportunity to offer testimony on this important matter. If you have any questions regarding this testimony or require further information, please contact Michael Sroczynski, MHA’s Vice President of Government Advocacy, at (781) 262-6055 or msroczynski@mhalink.org.