Joint Committee on on Mental Health, Substance Use and Recovery
The Massachusetts Health & Hospital Association (MHA), on behalf of our member hospitals, health systems, physician organizations, and allied healthcare providers, appreciates the opportunity to submit comments in support of a number of bills that increase access and reimbursement for mental health and substance use disorder services.
MHA strongly supports SB1148 and legislation with a similar intent, HB1723, which seek to ensure that medical necessity is determined by the treating provider and not the insurer. Chapter 258 of the Acts of 2014 established an important precedent by requiring that medical necessity determinations for substance use diagnoses be solely within the province of treating clinicians. SB1148 and HB1723 would extend the same Chapter 258 principle to mental health services by ensuring that all determinations of medical necessity for mental health services are made by the treating clinician. This is an important standard as it ensures coverage decisions and access to services will be based upon a patient’s medical condition as documented in the medical chart. This will facilitate timely access to needed services and minimize the potential for unwarranted coverage denials resulting from subjective insurer decisions that have been based historically on discharge diagnoses instead of medical determinations made at the time of admission. SB1148 would also extend these coverage protections to community-based acute treatment and intensive community-based acute treatment services, which are critical mental health services for children at a time when the commonwealth is experiencing an unprecedented need for child and adolescent psychiatric services. (Please note that the Center for Health Information & Analysis (CHIA) is conducting a mandated benefit review of SB1148 that is due to be released this year.)
MHA supports HB1697, which seeks to expand coverage for MassHealth patients’ behavioral health services to licensed psychologists. The report from the Task Force on Behavioral Health Data Policies and Long Term Stays outlined the need to develop policies that support the expansion and reimbursement of evidence-based group psychotherapy treatment for behavioral health. MassHealth currently limits members’ ability to access certain therapeutic services offered by psychologists and independently licensed behavioral health providers. Specifically, 130 CMR 411.406 states that MassHealth “does not pay a psychologist for diagnostic (other than by testing) or treatment services, including services the psychologist performs when working under the supervision of a psychiatrist or when responding to a referral from a psychiatrist.” Removing these barriers will allow greater use of community-based services that will benefit patient care and may reduce the number patients in need of acute care services, while better facilitating timely access to appropriately sited services for all patients.
MHA also supports HB1699. This bill requires MassHealth to ensure network hospitals are compensated at their full negotiated rate for behavioral health services provided to MassHealth patients who are also clients of agencies within the Executive Office of Health and Human Services (EOHHS), and for whom no appropriate alternative placement is available. Hospitals would be required to document that they have engaged in good faith efforts to place these EOHHS clients in appropriate alternative settings. There are numerous clients of state agencies who are being treated in hospitals due to a lack of suitable discharge alternatives. These "stuck patients” may be Department of Mental Health or Department of Children & Families clients who can’t be discharged due to the insufficient availability of long-term placements in the state. In order to remedy this situation, HB1699 increases the financial responsibility for the care of these patients by MassHealth and its managed care organizations and requires payment of the full negotiated reimbursement rate to hospitals for such services. By requiring reimbursement to hospitals for the full cost of care, HB1699 may serve as a further incentive for state agencies to work with hospitals and other behavioral health providers to accelerate alternative placements for stuck patients and to enhance access for patients who require acute care in hospitals. MHA believes hospitals should be reimbursed for the full cost of care for these patients as they await placement in alternative settings.
MHA supports HB1710, which sets forth important patient protections related to private health insurance coverage for medically necessary behavioral health services. HB1710 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 care and treatment. 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 until the patient has been discharged or is no longer receiving ongoing care, which results in added costs for the patient and significant bad debt for providers. This bill provides 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. HB1710 will also protect healthcare providers, who currently may not receive notice of a planned termination and are thus inhibited from securing reimbursement for the cost of care provided.
MHA supports HB1715, which amends Chapter 258 of the Acts of 2014 to require for patients in need of addiction treatment expanded insurance coverage for acute treatment services and clinical stabilization services for up to 30 days, so long as the service is medically necessary. By building upon the current 14 days of coverage required by Chapter 258, this bill will help ensure needed coverage for clinical services. Research indicates that longer stays in addiction treatment can be beneficial to those suffering from substance use disorder. Accordingly, this legislation ensures that patients will have coverage for up to 30 days of treatment if the treating clinician believes such a course is medically necessary. The treatment period is not mandated; under HB1715 the decision on whether to pursue 30 days of treatment remains with the treating clinician and patient.
MHA supports HB1735, which seeks to provide MassHealth members with access to and coverage for emergency and urgent behavioral health services that is comparable to patient access for other acute medical conditions. HB1735 supports the intent and requirements outlined in Sections 23 and 254 of Chapter 224 of the Acts of 2012, directing the implementation of the federal and state mental health parity laws. Stronger protections are needed to ensure that MassHealth and its contracted Managed Care Organizations and behavioral health carve-outs are providing equal coverage for behavioral health patients. HB1735 will help ensure that the MassHealth program adopts regulations, policies and procedures for behavioral health services that are on par with the rules adopted for patients with other acute medical conditions.
Thank you for the opportunity to offer testimony on this matter. If you have any questions regarding this testimony, or require further information, please contact Michael Sroczynski, MHA's Senior Vice President of Government Advocacy at (781) 262-6055 or
msroczynski@mhalink.org