Massachusetts 2023-2024 Regular Session

Massachusetts House Bill H1963 Compare Versions

Only one version of the bill is available at this time.

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2	2	HOUSE DOCKET, NO. 731 FILED ON: 1/17/2023
3	3	HOUSE . . . . . . . . . . . . . . . No. 1963
4	4	The Commonwealth of Massachusetts
5	5	_________________
6	6	PRESENTED BY:
7	7	James Arciero
8	8	_________________
9	9	To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
10	10	Court assembled:
11	11	The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:
12	12	An Act to promote high value and evidence-based behavioral health care.
13	13	_______________
14	14	PETITION OF:
15	15	NAME:DISTRICT/ADDRESS :DATE ADDED:James Arciero2nd Middlesex1/11/2023 1 of 12
16	16	HOUSE DOCKET, NO. 731 FILED ON: 1/17/2023
17	17	HOUSE . . . . . . . . . . . . . . . No. 1963
18	18	By Representative Arciero of Westford, a petition (accompanied by bill, House, No. 1963) of
19	19	James Arciero for legislation to promote high value and evidence-based behavioral health care.
20	20	Mental Health, Substance Use and Recovery.
21	21	The Commonwealth of Massachusetts
22	22	_______________
23	23	In the One Hundred and Ninety-Third General Court
24	24	(2023-2024)
25	25	_______________
26	26	An Act to promote high value and evidence-based behavioral health care.
27	27	Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
28	28	of the same, as follows:
29	29	1 SECTION 1. Chapter 6A of the General Laws is hereby amended by inserting after
30	30	2Section 18Z the following new section:
31	31	3 Section 19. The executive office of health and human services shall coordinate an
32	32	4interagency statewide planning committee to annually study the need for behavioral health care
33	33	5services across the commonwealth, beginning with inpatient psychiatric units and department of
34	34	6mental health beds. The study shall utilize data collected from census reporting by inpatient
35	35	7facilities and data collected through the expedited psychiatric admissions process. The study
36	36	8shall identify the total number of units currently in operation in the commonwealth by
37	37	9geographic region, including capacity to serve special populations, which shall include but not be
38	38	10limited to: children; geriatric patients; individuals with autism spectrum disorder, intellectual
39	39	11disabilities, and developmental disabilities; individuals with co-occurring substance use disorder;
40	40	12individuals with co-occurring medical conditions; individuals who present with high level of 2 of 12
41	41	13acuity, including severe behavior and assault risk; and individuals with eating disorders. The
42	42	14study shall estimate the need for total units/beds by geographic region, estimate the need for
43	43	15special population capacity by geographic region, and estimate the cost to operate each unit at
44	44	16the needed capacity. The committee should consult with stakeholders on performing this analysis
45	45	17and on developing recommendations for how to achieve the needed services and capacity. The
46	46	18committee shall publish an annual report by December 31 of each year that includes
47	47	19recommendations for reducing boarding in the emergency departments, and any suggested
48	48	20legislation to implement those recommendations and shall submit a copy the to the joint
49	49	21committee on mental health, substance use and recovery and the joint committee on health care
50	50	22financing.
51	51	23 SECTION 2. Chapter 6A of the General Laws is hereby amended by inserting after
52	52	24Section 19 the following new section:
53	53	25 Section 19A. The executive office shall convene a special commission charged with
54	54	26expanding access to specialty behavioral health care inpatient beds for adults and youth,
55	55	27addressing funding for said beds and making recommendations for a potential rate structure to
56	56	28fund high intensity specialty behavioral health beds.
57	57	29 The commission shall consist of the following members or their designees: the
58	58	30commissioner of the department of mental health, who shall serve as chair; the commissioner of
59	59	31the department of public health; the commissioner of the division of insurance; the director of the
60	60	32bureau of substance addiction services within the department of public health; the assistant
61	61	33secretary for MassHealth; the executive director of the group insurance commission; the
62	62	34executive director of the health policy commission; the executive director of the center for health 3 of 12
63	63	35information and analysis; and 6 members to be appointed by the chair: 1 of whom shall be a
64	64	36representative of the Association for Behavioral Healthcare, Inc.; 1 of whom shall be a
65	65	37representative of the Massachusetts Association of Behavioral Health Systems, Inc.; 1 of whom
66	66	38shall be a representative of the Massachusetts Health and Hospital Association; 1 of whom shall
67	67	39be a representative of the Massachusetts Association for Mental Health, Inc.; 1 of whom shall be
68	68	40a representative of Blue Cross and Blue Shield of Massachusetts, Inc.; and 1 of whom shall be a
69	69	41representative of the Massachusetts Association of Health Plans, Inc..
70	70	42 The commission’s review shall include, but not be limited to: (i) data collected through
71	71	43the EPIA program, or other sources on the availability of specialty behavioral health inpatient
72	72	44beds; (ii) data on the populations that are more likely to face longer wait times, which may
73	73	45include but not be limited to specialty beds to treat adults and youth with autism spectrum
74	74	46disorder, specialty beds to treat adults and youth with higher levels of acuity, specialty beds to
75	75	47treat adults and youth with developmental disabilities, specialty beds to treat adults and youth
76	76	48with aggressive behavior, and specialty beds to treat adults and youth with complex medical
77	77	49needs; (iii) data on the number of beds to serve the populations listed in (ii), including the
78	78	50difference between the differences between licensed and operational beds and the reasons for any
79	79	51differences; (iv) how services are funded today, including payer mix and payment models
80	80	52utilized; (v) the feasibility of developing alternative payment models, including global payments,
81	81	53bundled payments, or payments based on risk adjustment and predictive modeling to ensure that
82	82	54services are funded based on the population served; and (vi) the feasibility of developing a multi-
83	83	55payer equitable rate structure designed to fund and ensure an adequate supply of high intensity
84	84	56specialty behavioral health beds in the commonwealth. 4 of 12
85	85	57 Not later than 1 year after the effective date of this act, the commission shall submit its
86	86	58findings and recommendations, together with drafts of legislation or regulations necessary to
87	87	59carry those recommendations into effect, to the clerks of the senate and house of representatives
88	88	60and the joint committee on mental health, substance use and recovery.
89	89	61 SECTION 3. Section 15 of Chapter 6D of the General Laws is hereby amended by
90	90	62striking paragraph (b) in its entirety and replace it with the following new language:-
91	91	63 (b) The commission shall establish minimum standards for certified ACOs. A certified
92	92	64ACO shall: (i) be organized or registered as a separate legal entity from its ACO participants; (ii)
93	93	65have a governance structure that includes an administrative officer, a medical officer, and patient
94	94	66or consumer representation; (iii) receive reimbursements or compensation from alternative
95	95	67payment methodologies; (iv) have functional capabilities to coordinate financial payments
96	96	68amongst its providers; (v) have significant implementation of interoperable health information
97	97	69technology, as determined by the commission, for the purposes of care delivery coordination and
98	98	70population management; (vi) develop and file an internal appeals plan as required for risk-
99	99	71bearing provider organizations under section 24 of chapter 176O; provided, that said plan shall
100	100	72be approved by the office of patient protection; provided further, that the plan shall be a part of a
101	101	73membership packet for newly enrolled individuals; (vii) provide medically necessary services
102	102	74across the care continuum including behavioral and physical health services, as determined by
103	103	75the commission through regulations, internally or through contractual agreements; provided, that
104	104	76any medically necessary service that is not internally available shall be provided to a patient
105	105	77through services outside the ACO; (viii) develop guidelines for the delivery of evidence-based
106	106	78delivery of behavioral health services, including but not limited to, 24/7 access to treatment and
107	107	79services, 24/7 admissions and discharges, treatment and discharge planning, adherence to 5 of 12
108	108	80evidence-based standards of care, compliance with quality and outcome measures, and
109	109	81communication and coordination with all treating providers and payers; (ix) implement systems
110	110	82that allow ACO participants to report the pricing of services, as defined by the commission
111	111	83through regulations; further provided that ACO participants shall have the ability to provide
112	112	84patients with relevant price information when contemplating their care and potential referrals; (x)
113	113	85submit a report to the commission detailing the percentage of total health care expenditures that
114	114	86are paid to behavioral health providers; (xi) obtain a risk certificate from the division of
115	115	87insurance under chapter 176U; and (xii) shall engage patients in shared decision-making,
116	116	88including, but not limited to, shared-decision making on palliative care and long-term care
117	117	89services and supports.
118	118	90 SECTION 4. Said Chapter 6D of the General Laws is hereby amended by inserting after
119	119	91Section 19 the following new section:-
120	120	92 Section 20. Study on Evidence-Based Practice.
121	121	93 The commission, in consultation with the center for health information and analysis, the
122	122	94department of public health, and the department of mental health, shall conduct a study on the
123	123	95variation of the practice of behavioral health providers in the commonwealth, across the full
124	124	96continuum of care, and shall issue a report, not later than December 31, 2018. The review shall
125	125	97be posted on the commission’s website and shall be filed with the clerks of the house of
126	126	98representatives and the senate, and the joint committee on mental health and substance abuse.
127	127	99 In measuring adherence to evidence-based standards, the analysis shall include, but not
128	128	100be limited to: (i) adherence to evidence-based standards of care, as appropriate for each level of
129	129	101care, (ii) performance on quality and outcome measures, and (iii) patient access to appropriate 6 of 12
130	130	102discharge planning and transitions throughout the full continuum of care. The report shall include
131	131	103an examination of any gaps in the availability of data, quality metrics, or other means of
132	132	104measuring provider performance related to outcomes and quality. The report shall make
133	133	105recommendations for improving the availability of data collection and the measurement of
134	134	106behavioral health quality and outcomes, and recommendations related to improving quality and
135	135	107outcomes for patients.
136	136	108 SECTION 5. Chapter 19 of the General Laws is hereby amended by inserting after
137	137	109section 19, the following new section:-
138	138	110 Section 19A. Requirements for licensed facilities
139	139	111 (a) The department shall establish clinical competencies and additional operational
140	140	112standards for care and treatment of patients admitted to facilities licensed pursuant to 104 CMR
141	141	11327.00, including for specialty populations identified by the department. Clinical competencies
142	142	114and operational standards established by the Department shall incorporate national and local
143	143	115standards of practice where such standards of practice exist, and to the extent deemed
144	144	116appropriate by the Department. In establishing the clinical competencies, the department shall
145	145	117utilize all data collected to identify the needs of the commonwealth and consult with relevant
146	146	118stakeholders, including but not limited to, inpatient psychiatric facilities, emergency
147	147	119departments, emergency service providers, Medicaid managed care organizations, and
148	148	120commercial carriers. The department shall update the clinical competencies on a biennial, or as
149	149	121needed basis.
150	150	122 (b) The department shall issue regulations requiring free-standing facilities licensed
151	151	123pursuant to 104 CMR 27.00 to have a clinical affiliation with a medical facility to ensure access 7 of 12
152	152	124by patients to medical services. Such affiliation shall include, but not be limited to patient care,
153	153	125testing, and patient diagnostics.
154	154	126 (c) The department shall develop requirements for reporting of quality and outcome
155	155	127measures by facilities to ensure compliance with this section.
156	156	128 (d) The department shall promulgate regulations to enforce the requirements of this
157	157	129section and shall require hospitals to provide remedies for any failure to meet the requirements of
158	158	130said regulations. Remedies may include remediation plans or financial penalties. The amount of
159	159	131any penalty imposed shall be $100 for each day in the noncompliance period with respect to each
160	160	132patient to whom such failure relates; provided however that the maximum annual penalty under
161	161	133this subsection shall be $500,000.
162	162	134 SECTION 6. Chapter 19 of the General Laws is hereby amended by inserting after
163	163	135section 19A, the following new section:-
164	164	136 Section 19B.
165	165	137 (a) The department shall promulgate regulations instituting a policy to prohibit a facility
166	166	138from refusing to admit a patient who meets the general admission criteria for the facility,
167	167	139including all clinical competencies, pursuant to Section 19A of this chapter, where such
168	168	140admission would not result in a census exceeding the facility’s operational capacity.
169	169	141 (b) The department shall require facilities to collect and report data to the department on
170	170	142the facility’s total number of admission requests, admissions, admission denials, and the reasons
171	171	143for the rejected admissions. 8 of 12
172	172	144 (c) A facility may deny admission to a patient whose needs have been determined by the
173	173	145facility medical director to exceed the facility's capability at the time admission is sought. The
174	174	146determination shall include the factors justifying denial of admission and why mitigating efforts,
175	175	147such as utilization of additional staff, would have been inadequate to admit the patient. This
176	176	148determination must be recorded in writing. The facility shall submit a monthly report to the
177	177	149Department detailing the number of admissions that have been denied by the facility and the
178	178	150reasons for such denials; provided however, that such written determination shall not contain
179	179	151patient-identifiable information.
180	180	152 (d) Facilities shall keep data on patients referred for admission in a form and format and
181	181	153containing data elements as determined by the Department; provided however, that facilities
182	182	154shall not be required to maintain patient-identifiable data on individuals not accepted for
183	183	155admission. The department shall require that facilities report said data to the department on a
184	184	156monthly basis.
185	185	157 (e) The department shall promulgate regulations to enforce the requirements of this
186	186	158section and shall require facilities to provide remedies for any failure to meet the requirements of
187	187	159said regulations. Remedies may include remediation plans or financial penalties. The amount of
188	188	160any penalty imposed shall be $100 for each day in the noncompliance period with respect to each
189	189	161patient to whom such failure relates; provided however that the maximum annual penalty under
190	190	162this subsection shall be $500,000.
191	191	163 SECTION 7. Section 25C of Chapter 111 is hereby amended by striking paragraph (k) in
192	192	164its entirety and replacing it with the following new language: 9 of 12
193	193	165 (k) Determinations of need shall be based on the written record compiled by the
194	194	166department during its review of the application and on such criteria consistent with sections 25B
195	195	167to 25G, inclusive, as were in effect on the date of filing of the application. In compiling such
196	196	168record the department shall confine its requests for information from the applicant to matters
197	197	169which shall be within the normal capacity of the applicant to provide. In reviewing an
198	198	170application, the department shall take into consideration the report of the statewide planning
199	199	171committee pursuant to section 19 of chapter 6A of the general laws. In each case the action by
200	200	172the department on the application shall be in writing and shall set forth the reasons for such
201	201	173action; and every such action and the reasons for such action shall constitute a public record and
202	202	174be filed in the department.
203	203	175 SECTION 8. Section 25C of Chapter 111 of the General Laws is amended by inserting
204	204	176after the first paragraph the following new paragraph:
205	205	177 The Department, working with the department of mental health, shall conduct a statewide
206	206	178planning initiative for the purposes of studying and coordinating the availability and delivery of
207	207	179acute inpatient psychiatric beds across the commonwealth. The initiative shall utilize data
208	208	180collected through the expedited psychiatric inpatient admissions program, from the department
209	209	181of mental health pursuant to section 19B of chapter 19 of the general laws, from the center for
210	210	182health information and analysis, and other data collected by the department. The department
211	211	183shall analyze the number of individuals who are waiting for placement, including the patient
212	212	184demographic information, geographic disparities, the diagnosis, the types of services that such
213	213	185patients need, and identify gaps in the supply of licensed and operational psychiatric beds. The
214	214	186department shall consider this analysis when making determinations of need pursuant to this
215	215	187section. 10 of 12
216	216	188 The department shall publish an annual acute psychiatric inpatient bed report by
217	217	189December 31 of each year that identifies the types of and location of services that are in need and
218	218	190where may be oversupply of services. A copy of the report shall be provided to the health policy
219	219	191commission, the joint committee on mental health substance use and recovery and the joint
220	220	192committee health care financing.
221	221	193 SECTION 9. Chapter 111 of the General Laws is hereby amended by adding after section
222	222	19451K the following new section:
223	223	195 Section 51L. Standards for Delivery of Behavioral Health Care in Hospitals
224	224	196 (a) For the purposes of this section, the following words shall have the following
225	225	197meanings: -
226	226	198 ''Acute-care hospital'', any hospital licensed under section 51 that contains a majority of
227	227	199medical-surgical, pediatric, obstetric, and maternity beds, as defined by the department, and the
228	228	200teaching hospital of the University of Massachusetts Medical School.
229	229	201 (b) An acute-care hospital or a satellite emergency facility (hereinafter “facility”) shall
230	230	202ensure that all policies and protocols developed by the facility shall be applied and implemented
231	231	203on a nondiscriminatory basis such that such policies and protocols do not discriminate between
232	232	204patients presenting with a mental health or substance use condition and those patients with
233	233	205presenting with a medical/surgical condition.
234	234	206 (c) An acute-care hospital or a satellite emergency facility shall annually review its
235	235	207policies and procedures to ensure that such policies and procedures do not discriminate between
236	236	208patients presenting with a mental health or substance use condition and those patients with 11 of 12
237	237	209presenting with a medical/surgical condition and are applied and implemented on a
238	238	210nondiscriminatory basis. Following the review, the acute-care hospital or a satellite emergency
239	239	211facility must submit a certification to the department of public health and the department of
240	240	212mental health signed by the hospital’s chief executive officer and chief medical officer that states
241	241	213that the hospital has completed a comprehensive review of the policies and procedures of the
242	242	214hospital for the preceding calendar year for compliance with this section and any accompanying
243	243	215regulations.
244	244	216 (d) As part of the review outlined in the preceding paragraph, an acute-care hospital or a
245	245	217satellite emergency facility shall review its policies and procedures in the following areas:
246	246	218 1. Administrative policies and procedures, which may include but not be limited to,
247	247	219acquiring and maintaining equipment, policies on vendor requirements, licensing and credentials,
248	248	220and records requirements.
249	249	221 2. Operational policies and procedures, which may include, but not be limited to,
250	250	222information technology, physical plant maintenance, safety and security, food preparation,
251	251	223emergency management/disaster plans, and milieu.
252	252	224 3. Patient care policies and procedures, which may include, but not be limited to,
253	253	225patient admission and discharge policies and decision-making, patient flow policies, patient
254	254	226discharge planning, consultation, clinical competencies, charting processes, and patient rights,
255	255	227patient and staff security, and infection prevention.
256	256	228 4. Medication policies and procedures, which may include, but not be limited to,
257	257	229paperwork requirements for medicine, inventory control, dose distribution systems, and
258	258	230disposing of expired drugs. 12 of 12
259	259	231 5. Human Resources and Staffing policies and procedures, which may include, but
260	260	232not be limited to, staff hiring decisions, training, patient care ratios, scheduling, staffing for
261	261	233emergency management/disaster plans
262	262	234 6. Payment and Financial policies and procedures, which may include, but not be
263	263	235limited to, investment and resource allocation, billing and payment policies, and staff salaries
264	264	236and reimbursement.
265	265	237 (e) The department, in conjunction with the department of mental health, shall establish a
266	266	238process by which complaints regarding alleged non-compliance with the requirements of this
267	267	239section may be submitted. The department must provide a telephone number and address to be
268	268	240used to submit complaints, a standard form that can be used to submit complaints, and timeline
269	269	241for resolving the complaints. The department shall publish the information on its website to
270	270	242notify individuals how to submit a complaint to the department.
271	271	243 (f) The department, in conjunction with the department of mental health, shall promulgate
272	272	244regulations necessary to carry out this section, including the development of reporting
273	273	245procedures and a standard format for facility self-reporting.