Massachusetts 2023-2024 Regular Session

Massachusetts House Bill H4058 Compare Versions

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

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1	1	1 of 1
2	2	HOUSE DOCKET, NO. 4101 FILED ON: 1/24/2023
3	3	HOUSE . . . . . . . . . . . . . . . No. 4058
4	4	The Commonwealth of Massachusetts
5	5	_________________
6	6	PRESENTED BY:
7	7	Marjorie C. Decker
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 expanding access to mental health services.
13	13	_______________
14	14	PETITION OF:
15	15	NAME:DISTRICT/ADDRESS :DATE ADDED:Marjorie C. Decker25th Middlesex1/24/2023Russell E. Holmes6th Suffolk3/13/2023 1 of 22
16	16	HOUSE DOCKET, NO. 4101 FILED ON: 1/24/2023
17	17	HOUSE . . . . . . . . . . . . . . . No. 4058
18	18	By Representative Decker of Cambridge, a petition (subject to Joint Rule 12) of Marjorie C.
19	19	Decker and Russell E. Holmes relative to insurance coverage to expand access to mental health
20	20	services. Financial Services.
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 expanding access to mental health services.
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. Section 17S of chapter 32A of the General Laws, as inserted by chapter
30	30	2177 of the Acts of 2022, is hereby amended by striking subsection (b) and inserting in place
31	31	3thereof the following subsection:-
32	32	4 (b) The commission shall provide to any active or retired employee of the
33	33	5commonwealth who is insured under the group insurance commission coverage for medically
34	34	6necessary mental health acute treatment, community-based acute treatment and intensive
35	35	7community-based acute treatment and shall not require a preauthorization before obtaining
36	36	8treatment; provided, however, that the facility shall notify the carrier of the admission and the
37	37	9initial treatment plan within three business days of admission; and provided further that services
38	38	10administered prior to notification must be covered. Notification shall be limited to patient’s
39	39	11name, facility name, time of admission, diagnosis, and initial treatment plan. 2 of 22
40	40	12 SECTION 2. Section 25C ½ of chapter 111 of the General Laws, as appearing in the
41	41	132020 Official Edition, is hereby amended by inserting after subsection (a)(4) the following
42	42	14subsection:-
43	43	15 (5) A health facility if the facility plans to make a capital expenditure for the
44	44	16development of acute psychiatric services including, inpatient, community based acute treatment,
45	45	17intensive community based acute treatment, partial hospitalization program, and crisis
46	46	18stabilization services; provided that the health facility demonstrates the need for a license from
47	47	19the department of mental health pursuant to paragraph c of section 19 of chapter 19 of the
48	48	20general laws, as so appearing.
49	49	21 SECTION 3. Section 51 ½ of Chapter 111 of the General Laws, as so appearing, is
50	50	22hereby amended by striking out the definition of “licensed mental health professional” and
51	51	23inserting in place thereof the following:-
52	52	24 “Licensed mental health professional”, a: (i) licensed physician who specializes in the
53	53	25practice of psychiatry or addiction medicine; (ii) licensed psychologist; (iii) licensed independent
54	54	26clinical social worker; (iv) licensed certified social worker; (v) licensed mental health counselor;
55	55	27(vi) licensed mental health counselor; (vii) licensed physician assistant who practices in the field
56	56	28of psychiatry or addiction medicine; (viii) licensed psychiatric clinical nurse specialist; (ix)
57	57	29licensed psychiatric mental health nurse practitioner; (x) certified addictions registered nurse;
58	58	30(xi) licensed alcohol and drug counselor I as defined in section 1 of chapter 111J;(xii) healthcare
59	59	31provider, as defined in section 1, qualified within the scope of the individual's license to perform
60	60	32substance use disorder evaluations, including an intern, resident or fellow pursuant to the policies
61	61	33and practices of the hospital and medical staff; (xiv) other licensed master’s level mental health 3 of 22
62	62	34clinician, including but not limited to licensed alcohol and drug counselor and licensed marriage
63	63	35and family therapist; or (xv) individuals with a master’s degree in a clinical behavioral health
64	64	36practice pursuing licensure post master’s under the supervision of an appropriately licensed and
65	65	37credentialed clinician.
66	66	38 SECTION 4. Section 51 ¾ of Chapter 111 of the General Laws, as inserted by Chapter
67	67	39177 of the Acts of 2022, is hereby amended by striking out the second sentence and replacing it
68	68	40with the following sentence:
69	69	41 The regulations shall define “licensed mental health professional”, which shall include,
70	70	42but not be limited to, a: (i) licensed physician who specializes in the practice of psychiatry or
71	71	43addiction medicine; (ii) licensed psychologist; (iii) licensed independent clinical social worker;
72	72	44(iv) licensed certified social worker; (v) licensed mental health counselor; (vi) licensed
73	73	45supervised mental health counselor; (vii) licensed physician assistant who practices in the field
74	74	46of psychiatry; (viii) licensed psychiatric clinical nurse specialist; (ix) licensed psychiatric mental
75	75	47health nurse practitioner; (x) healthcare provider, as defined in section 1, qualified within the
76	76	48scope of the individual's license to conduct an evaluation of a mental health condition, including
77	77	49an intern, resident or fellow pursuant to the policies and practices of the hospital and medical
78	78	50staff; (xi) other licensed master’s level mental health clinician, including but not limited to
79	79	51licensed alcohol and drug counselor and licensed marriage and family therapist; or (x)
80	80	52individuals with a master’s degree in a clinical behavioral health practice pursuing licensure post
81	81	53master’s under the supervision of an appropriately licensed and credentialed clinician. 4 of 22
82	82	54 SECTION 5. Section 10O of chapter 118E of the General Laws, as inserted by chapter
83	83	55177 of the acts of 2022, is hereby amended by striking out the last paragraph and inserting in
84	84	56place thereof the following new paragraph:-
85	85	57 The division and its contracted health insurers, health plans, health maintenance
86	86	58organizations, behavioral health management firms and third-party administrators under contract
87	87	59to a Medicaid managed care organization or primary care clinician plan shall cover the cost of
88	88	60medically necessary mental health acute treatment, community-based acute treatment and
89	89	61intensive community-based acute treatment and shall not require a preauthorization before
90	90	62obtaining treatment; provided, however, that the facility shall notify the carrier of the admission
91	91	63and the initial treatment plan within three business days of admission; provided further that
92	92	64notification shall be limited to patient’s name, facility name, time of admission, diagnosis, and
93	93	65initial treatment plan; and provided further that services administered prior to notification must
94	94	66be covered.
95	95	67 SECTION 6. Chapter 123 of the General Laws, as appearing in the 2020 Official
96	96	68Edition, is hereby amended by striking out section 12, and inserting in place thereof the
97	97	69following section:-
98	98	70 Section 12. (a) A physician who is licensed pursuant to section 2 of chapter 112, an
99	99	71advanced practice registered nurse authorized to practice as such under regulations promulgated
100	100	72pursuant to section 80B of said chapter 112, a qualified psychologist licensed pursuant to
101	101	73sections 118 to 129, inclusive, of said chapter 112 or a licensed independent clinical social
102	102	74worker licensed pursuant to sections 130 to 137, inclusive, of said chapter 112 or a qualified
103	103	75physician assistant licensed pursuant to section 9(e) of chapter 112, who, after examining a 5 of 22
104	104	76person, has reason to believe that failure to hospitalize such person would create a likelihood of
105	105	77serious harm by reason of mental illness may restrain or authorize the restraint of such person
106	106	78and apply for the hospitalization of such person for a 3-day period at a public facility or at a
107	107	79private facility authorized for such purposes by the department. If an examination is not possible
108	108	80because of the emergency nature of the case and because of the refusal of the person to consent
109	109	81to such examination, the physician, qualified psychologist, qualified advanced practice registered
110	110	82nurse, qualified physician assistant, or licensed independent clinical social worker on the basis of
111	111	83the facts and circumstances may determine that hospitalization is necessary and may therefore
112	112	84apply. In an emergency situation, if a physician, qualified psychologist, qualified advanced
113	113	85practice registered nurse, qualified physician assistant or licensed independent clinical social
114	114	86worker is not available, a police officer who believes that failure to hospitalize a person would
115	115	87create a likelihood of serious harm by reason of mental illness may restrain such person and
116	116	88apply for the hospitalization of such person for a 3-day period at a public facility or a private
117	117	89facility authorized for such purpose by the department. An application for hospitalization shall
118	118	90state the reasons for the restraint of such person and any other relevant information that may
119	119	91assist the admitting physician or qualified advanced practice registered nurse or qualified
120	120	92physician assistant. Whenever practicable, prior to transporting such person, the applicant shall
121	121	93telephone or otherwise communicate with a facility to describe the circumstances and known
122	122	94clinical history and to determine whether the facility is the proper facility to receive such person
123	123	95and to give notice of any restraint to be used and to determine whether such restraint is
124	124	96necessary.
125	125	97 (b) Only if the application for hospitalization under this section is made by a physician, a
126	126	98qualified advanced practice registered nurse or qualified physician assistant specifically 6 of 22
127	127	99designated to have the authority to admit to a facility in accordance with the regulations of the
128	128	100department, shall such person be admitted to the facility immediately after reception. If the
129	129	101application is made by someone other than a designated physician, a qualified advanced practice
130	130	102registered nurse, or a qualified physician assistant such person shall be given a psychiatric
131	131	103examination by a designated physician, a qualified advanced practice registered nurse or
132	132	104qualified physician assistant immediately after reception at such facility. If the physician,
133	133	105qualified advanced practice registered nurse, or qualified physician assistant determines that
134	134	106failure to hospitalize such person would create a likelihood of serious harm by reason of mental
135	135	107illness, the physician or qualified advanced practice registered nurse or qualified physician
136	136	108assistant may admit such person to the facility for care and treatment. Upon admission of a
137	137	109person under this subsection, the facility shall inform the person that it shall, upon such person's
138	138	110request, notify the committee for public counsel services of the name and location of the person
139	139	111admitted. The committee for public counsel services shall immediately appoint an attorney who
140	140	112shall meet with the person. If the appointed attorney determines that the person voluntarily and
141	141	113knowingly waives the right to be represented, is presently represented or will be represented by
142	142	114another attorney, the appointed attorney shall so notify the committee for public counsel
143	143	115services, which shall withdraw the appointment.
144	144	116 Any person admitted under this subsection who has reason to believe that such admission
145	145	117is the result of an abuse or misuse of this subsection may request or request through counsel an
146	146	118emergency hearing in the district court in whose jurisdiction the facility is located and unless a
147	147	119delay is requested by the person or through counsel, the district court shall hold such hearing on
148	148	120the day the request is filed with the court or not later than the next business day. 7 of 22
149	149	121 (c) No person shall be admitted to a facility under this section unless the person, or the
150	150	122person’s parent or legal guardian on the person’s behalf, is given an opportunity to apply for
151	151	123voluntary admission under paragraph (a) of section 10 and unless the person, or the person’s
152	152	124parent or legal guardian, has been informed that: (i) the person has a right to such voluntary
153	153	125admission; and (ii) the period of hospitalization under this section cannot exceed 3 days. At any
154	154	126time during such period of hospitalization, the superintendent may discharge such person if the
155	155	127superintendent determines that such person is not in need of care and treatment.
156	156	128 (d) A person shall be discharged at the end of the 3-day period unless the superintendent
157	157	129applies for a commitment under sections 7 and 8 or the person remains on a voluntary status.
158	158	130 (e) Any person may make an application to a district court justice or a justice of the
159	159	131juvenile court department for a 3-day commitment to a facility of a person with a mental illness
160	160	132if the failure to confine said person would cause a likelihood of serious harm. The court shall
161	161	133appoint counsel to represent said person. After hearing such evidence as the court may consider
162	162	134sufficient, a district court justice or a justice of the juvenile court department may issue a warrant
163	163	135for the apprehension and appearance before the court of the alleged person with a mental illness
164	164	136if in the court’s judgment the condition or conduct of such person makes such action necessary
165	165	137or proper. Following apprehension, the court shall have the person examined by a physician, a
166	166	138qualified advanced practice registered nurse or a qualified physician assistant designated to have
167	167	139the authority to admit to a facility or examined by a qualified psychologist in accordance with the
168	168	140regulations of the department. If the physician, qualified advanced practice registered nurse,
169	169	141qualified physician assistant or qualified psychologist reports that the failure to hospitalize the
170	170	142person would create a likelihood of serious harm by reason of mental illness, the court may order
171	171	143the person committed to a facility for a period not to exceed 3 days; provided, however, that the 8 of 22
172	172	144superintendent may discharge said person at any time within the 3-day period. The periods of
173	173	145time prescribed or allowed under this section shall be computed pursuant to Rule 6 of the
174	174	146Massachusetts Rules of Civil Procedure.
175	175	147 SECTION 7. Said chapter 123 is hereby further amended by striking out section 21, as
176	176	148so appearing, and inserting in place thereof the following section:-
177	177	149 Section 21. Any person who transports a person with a mental illness to or from a facility
178	178	150for any purpose authorized under this chapter shall not use any restraint that is unnecessary for
179	179	151the safety of the person being transported or other persons likely to come in contact with the
180	180	152person.
181	181	153 In the case of persons being hospitalized under section 6, the applicant shall authorize
182	182	154practicable and safe means of transport including, where appropriate, departmental or police
183	183	155transport.
184	184	156 Restraint of a person with a mental illness may only be used in cases of emergency, such
185	185	157as the occurrence of, or serious threat of, extreme violence, personal injury or attempted suicide;
186	186	158provided, however, that written authorization for such restraint is given by the superintendent or
187	187	159director of the facility or by a physician, or by a qualified advanced practice registered nurse or
188	188	160qualified physician assistant designated by the superintendent or director for this purpose who is
189	189	161present at the time of the emergency or if the superintendent, director, designated physician,
190	190	162designated qualified advanced practice registered nurse or designated qualified physician
191	191	163assistant is not present at the time of the emergency, non-chemical means of restraint may be
192	192	164used for a period of not more than 1 hour; provided further, that within 1 hour the person in
193	193	165restraint shall be examined by the superintendent, director, designated physician, designated 9 of 22
194	194	166qualified advanced practice registered nurse, or designated qualified physician assistant,; and
195	195	167provided further, that if the examination has not occurred within 1 hour, the patient may be
196	196	168restrained for an additional period of not more than 1 hour until such examination is conducted
197	197	169and the superintendent, director, designated physician, designated qualified advanced practice
198	198	170registered nurse, or designated qualified physician assistant shall attach to the restraint form a
199	199	171written report as to why the examination was not completed by the end of the first hour of
200	200	172restraint.
201	201	173 Any minor placed in restraint shall be examined within 15 minutes of the order for
202	202	174restraint by a physician, qualified advanced practice registered nurse, or qualified physician
203	203	175assistant, or, if a physician, qualified advanced practice registered nurse or qualified physician
204	204	176assistant is not available, by a registered nurse; provided, however, that said minor shall be
205	205	177examined by a physician, qualified advanced practice registered nurse or qualified physician
206	206	178assistant within 1 hour of the order for restraint. A physician, qualified advanced practice
207	207	179registered nurse or qualified physician assistant, or, if a physician, qualified advanced practice
208	208	180registered nurse or qualified physician assistant are not available, a registered nurse shall review
209	209	181the restraint order by personal examination of the minor or consultation with ward staff attending
210	210	182the minor every hour thereafter.
211	211	183 No minor shall be secluded for more than 2 hours in any 24-hour period; provided,
212	212	184however, that no such seclusion of a minor may occur except in a facility with authority to use
213	213	185such seclusion after said facility has been inspected and specially certified by the department.
214	214	186The department shall issue regulations establishing procedures by which a facility may be
215	215	187specially certified with authority to seclude a minor. Such regulations shall provide for review
216	216	188and approval or disapproval by the commissioner of a biannual application by the facility, which 10 of 22
217	217	189shall include: (i) a comprehensive statement of the facility’s policies and procedures for the
218	218	190utilization and monitoring of restraint of minors including a statistical analysis of the facility’s
219	219	191actual use of such restraint; and (ii) a certification by the facility of its ability and intent to
220	220	192comply with all applicable statutes and regulations regarding physical space, staff training, staff
221	221	193authorization, record keeping, monitoring and other requirements for the use of restraints.
222	222	194 Any use of restraint on a minor exceeding 1 hour in any 24-hour period shall be reviewed
223	223	195within 2 working days by the director of the facility. The director shall forward a copy of the
224	224	196report on each such instance of restraint to the human rights committee of that facility and, if
225	225	197there is no human rights committee, to the appropriate body designated by the commissioner of
226	226	198mental health. The director shall also compile a record of every instance of restraint in the
227	227	199facility and shall forward a copy of said report on a monthly basis to the human rights committee
228	228	200or the body designated by the commissioner of mental health.
229	229	201 No order for restraint for an individual shall be valid for a period of more than 3 hours
230	230	202beyond which time it may be renewed upon personal examination by the superintendent,
231	231	203director, designated physician, designated qualified advanced practice registered nurse, or
232	232	204qualified physician assistant or, for adults, by a registered nurse; provided, however, that no adult
233	233	205shall be restrained for more than 6 hours beyond which time an order may be renewed only upon
234	234	206personal examination by a physician, qualified advanced practice registered nurse or qualified
235	235	207physician assistant. The reason for the original use of restraint, the reason for its continuation
236	236	208after each renewal and the reason for its cessation shall be noted upon the restraining form by the
237	237	209superintendent, director, designated physician, qualified physician assistant, or, when applicable,
238	238	210by the registered nurse, certified physician, qualified advanced practice registered nurse assistant
239	239	211at the time of each occurrence. 11 of 22
240	240	212 When a designated physician, qualified advanced practice registered nurse, or qualified
241	241	213physician assistant is not present at the time and site of the emergency, an order for chemical
242	242	214restraint may be issued by a designated physician, qualified advanced practice registered nurse,
243	243	215or qualified physician assistant who has determined, after telephone consultation with a
244	244	216physician, qualified advanced practice registered nurse, registered nurse, or qualified physician
245	245	217assistant, who is present at the time and site of the emergency and who has personally examined
246	246	218the patient, that such chemical restraint is the least restrictive, most appropriate alternative
247	247	219available; provided, however, that the medication so ordered has been previously authorized as
248	248	220part of the individual’s current treatment plan.
249	249	221 No person shall be kept in restraint without a person in attendance specially trained to
250	250	222understand, assist and afford therapy to the person in restraint. The person may be in attendance
251	251	223immediately outside the room in full view of the patient when an individual is being secluded
252	252	224without mechanical restraint; provided, however, that in emergency situations when a person
253	253	225specially trained is not available, an adult may be kept in restraint unattended for a period not to
254	254	226exceed 2 hours. In that event, the person kept in restraints shall be observed at least every 5
255	255	227minutes; provided, further, that the superintendent, director, designated physician, designated
256	256	228qualified advanced practice registered nurse or designated physician assistant shall attach to the
257	257	229restraint form a written report as to why the specially trained attendant was not available. The
258	258	230maintenance of any adult in restraint for more than 8 hours in any 24-hour period shall be
259	259	231authorized by the superintendent or director or the person specifically designated to act in the
260	260	232absence of the superintendent or director; provided, however, that when such restraint is
261	261	233authorized in the absence of the superintendent or director, such authorization shall be reviewed
262	262	234by the superintendent or director upon the return of the superintendent or director. 12 of 22
263	263	235 No “P.R.N.” or “as required” authorization of restraint may be written. No restraint is
264	264	236authorized except as specified in this section in any public or private facility for the care and
265	265	237treatment of mentally ill persons including Bridgewater state hospital.
266	266	238 Not later than 24 hours after the period of restraint, a copy of the restraint form shall be
267	267	239delivered to the person who was in restraint. A place shall be provided on the form or on
268	268	240attachments thereto for the person to comment on the circumstances leading to the use of
269	269	241restraint and on the manner of restraint used.
270	270	242 A copy of the restraint form and any such attachments shall become part of the chart of
271	271	243the patient. Copies of all restraint forms and attachments shall be sent to the commissioner of
272	272	244mental health, or, with respect to Bridgewater state hospital to the commissioner of correction,
273	273	245who shall review and sign them within 30 days and statistical records shall be kept thereof for
274	274	246each facility, including Bridgewater state hospital, and each designated physician, qualified
275	275	247advanced practice registered nurse or qualified physician assistant. Furthermore, such reports,
276	276	248excluding personally identifiable patient identification, shall be made available to the general
277	277	249public at the department’s central office, or, with respect to Bridgewater state hospital at the
278	278	250department of correction’s central office.
279	279	251 Responsibility and liability for the implementation of this section shall rest with the
280	280	252department, the superintendent or director of each facility or the physician, qualified advanced
281	281	253practice registered nurse or qualified physician assistant designated by such superintendent or
282	282	254director for this purpose.
283	283	255 SECTION 8. Said chapter 123 is hereby further amended by striking out section 22, as
284	284	256so appearing, and inserting in place thereof the following section:- 13 of 22
285	285	257 Section 22. Physicians, qualified advanced practice registered nurses, qualified physician
286	286	258assistant, qualified psychologists, qualified psychiatric nurse mental health clinical specialists,
287	287	259police officers and licensed independent clinical social workers shall be immune from civil suits
288	288	260for damages for restraining, transporting, applying for the admission of or admitting any person
289	289	261to a facility or Bridgewater state hospital if the physician, qualified advanced practice registered
290	290	262nurse, or qualified physician assistant, qualified psychologist, qualified psychiatric nurse mental
291	291	263health clinical specialist, police officer or licensed independent clinical social workers acts in
292	292	264accordance with this chapter.”
293	293	265 SECTION 9. Section 2 of Chapter 111O of the General Laws, as so appearing, is hereby
294	294	266amended by adding the following subsection:-
295	295	267 (c) MIH programs that are focused on behavioral health services shall not be subject to
296	296	268application and registration fees.
297	297	269 SECTION 10. Section 1 of chapter 175 of the General Laws, as amended by chapter 177
298	298	270of the acts of 2022, is hereby amended by inserting after the definition of “Domestic company”
299	299	271the following definition:-
300	300	272 “Emergency services programs”, all programs subject to contract between the
301	301	273Massachusetts Behavioral Health Partnership and provider organizations for the provision of
302	302	274acute care hospital and community-based emergency behavioral health services, including, but
303	303	275not limited to, behavioral health crisis assessment, intervention and stabilization services 24
304	304	276hours per day, 7 days per week, through: (i) mobile crisis intervention services for youth; (ii)
305	305	277mobile crisis intervention services for adults; (iii) emergency service provider community-based
306	306	278locations; (iv) emergency departments of acute care hospitals or satellite emergency facilities; 14 of 22
307	307	279(v) adult community crisis stabilization services; and (vi) youth community crisis stabilization
308	308	280services.
309	309	281 SECTION 11. Section 47B of chapter 175 of the General Laws, as so appearing, is
310	310	282hereby amended by striking out the second paragraph of subsection (i) and replacing it with the
311	311	283following paragraph:-
312	312	284 For the purposes of this section, ''licensed mental health professional'' shall mean a
313	313	285licensed physician who specializes in the practice of psychiatry or addiction medicine; a licensed
314	314	286psychologist; a licensed independent clinical social worker; a licensed mental health counselor; a
315	315	287licensed nurse mental health clinical specialist; a licensed physician assistant who practices in
316	316	288the field of psychiatry or addiction medicine; a licensed psychiatric mental health nurse
317	317	289practitioner, other licensed master’s level mental health clinician including but not limited to a
318	318	290licensed alcohol and drug counselor I, as defined in section 1 of chapter 111J, or a licensed
319	319	291marriage and family therapist within the lawful scope of practice for such therapist; or a clinician
320	320	292practicing under the supervision of a licensed professional, and working towards licensure, in a
321	321	293clinic or hospital licensed under chapter 111.
322	322	294 SECTION 12. Section 47SS of chapter 175 of the General Laws, as inserted by chapter
323	323	295177 of the acts of 2022, is hereby amended by striking subsection (b) and inserting in place
324	324	296thereof the following subsection:-
325	325	297 (b) A policy, contract, agreement, plan or certificate of insurance issued, delivered or
326	326	298renewed within or without the commonwealth, which is considered creditable coverage under
327	327	299section 1 of chapter 111M, shall provide coverage for medically necessary mental health acute
328	328	300treatment, community-based acute treatment and intensive community-based acute treatment and 15 of 22
329	329	301shall not require a preauthorization before the administration of such treatment; provided,
330	330	302however, that the facility shall notify the carrier of the admission and the initial treatment plan
331	331	303within three business days of admission; and provided further that services administered prior to
332	332	304notification must be covered. Notification shall be limited to patient’s name, facility name, time
333	333	305of admission, diagnosis, and initial treatment plan.
334	334	306 SECTION 1 3. Section 8A of chapter 176A of the General Laws, as amended by chapter
335	335	307177 of the acts of 2022, is hereby amended by striking out the second paragraph of subsection (i)
336	336	308and replacing it with the following paragraph:-
337	337	309 For the purposes of this section, ''licensed mental health professional'' shall mean a
338	338	310licensed physician who specializes in the practice of psychiatry or addiction medicine; a licensed
339	339	311psychologist; a licensed independent clinical social worker; a licensed mental health counselor; a
340	340	312licensed nurse mental health clinical specialist; a licensed physician assistant who practices in
341	341	313the field of psychiatry or addiction medicine; a licensed psychiatric mental health nurse
342	342	314practitioner, other licensed master’s level mental health clinician including but not limited to a
343	343	315licensed alcohol and drug counselor I, as defined in section 1 of chapter 111J, or a licensed
344	344	316marriage and family therapist within the lawful scope of practice for such therapist; or a clinician
345	345	317practicing under the supervision of a licensed professional, and working towards licensure, in a
346	346	318clinic or hospital licensed under chapter 111.
347	347	319 SECTION 14 . Section 8SS of chapter 176A of the General Laws, as inserted by chapter
348	348	320177 of the acts of 2022, is hereby amended by striking subsection (b) and inserting in place
349	349	321thereof the following subsection:- 16 of 22
350	350	322 (b) A contract between a subscriber and the corporation under an individual or group
351	351	323hospital service plan that is delivered, issued or renewed within the commonwealth shall provide
352	352	324coverage for medically necessary mental health acute treatment, community-based acute
353	353	325treatment and intensive community-based acute treatment and shall not require a
354	354	326preauthorization before the administration of any such treatment; provided, however, that the
355	355	327facility shall notify the carrier of the admission and the initial treatment plan within three
356	356	328business days of admission; and provided further that services administered prior to notification
357	357	329must be covered. Notification shall be limited to patient’s name, facility name, time of
358	358	330admission, diagnosis, and initial treatment plan.
359	359	331 SECTION 15 . Section 4A of chapter 176B of the General Laws, as amended by chapter
360	360	332177 of the acts of 2022, is hereby amended by striking out the second paragraph of subsection (i)
361	361	333and replacing it with the following paragraph:-
362	362	334 For the purposes of this section, ''licensed mental health professional'' shall mean a
363	363	335licensed physician who specializes in the practice of psychiatry or addiction medicine; a licensed
364	364	336psychologist; a licensed independent clinical social worker; a licensed mental health counselor; a
365	365	337licensed nurse mental health clinical specialist; a licensed physician assistant who practices in
366	366	338the field of psychiatry or addiction medicine; a licensed psychiatric mental health nurse
367	367	339practitioner, other licensed master’s level mental health clinician including but not limited to a
368	368	340licensed alcohol and drug counselor I, as defined in section 1 of chapter 111J, or a licensed
369	369	341marriage and family therapist within the lawful scope of practice for such therapist; or a clinician
370	370	342practicing under the supervision of a licensed professional, and working towards licensure, in a
371	371	343clinic or hospital licensed under chapter 111. 17 of 22
372	372	344 SECTION 16. Section 4SS of chapter 176B of the General Laws, as inserted by chapter
373	373	345177 of the acts of 2022, is hereby amended by striking subsection (b) and inserting in place
374	374	346thereof the following subsection:-
375	375	347 (b) A subscription certificate under an individual or group medical service agreement
376	376	348delivered, issued or renewed within the commonwealth shall provide coverage for medically
377	377	349necessary mental health acute treatment, community-based acute treatment, intensive
378	378	350community-based acute treatment and shall not require a preauthorization before obtaining
379	379	351treatment; provided, however, that the facility shall notify the carrier of the admission and the
380	380	352initial treatment plan within three business days of admission; and provided further that services
381	381	353administered prior to notification must be covered. Notification shall be limited to patient’s
382	382	354name, facility name, time of admission, diagnosis, and initial treatment plan.
383	383	355 SECTION 17 . Section 4M of chapter 176G of the General Laws, as amended by chapter
384	384	356177 of the acts of 2022, is hereby amended by striking out the second paragraph of subsection (i)
385	385	357and replacing it with the following paragraph:-
386	386	358 For the purposes of this section, ''licensed mental health professional'' shall mean a
387	387	359licensed physician who specializes in the practice of psychiatry or addiction medicine; a licensed
388	388	360psychologist; a licensed independent clinical social worker; a licensed mental health counselor; a
389	389	361licensed nurse mental health clinical specialist; a licensed physician assistant who practices in
390	390	362the field of psychiatry or addiction medicine; a licensed psychiatric mental health nurse
391	391	363practitioner, other licensed master’s level mental health clinician including but not limited to a
392	392	364licensed alcohol and drug counselor I, as defined in section 1 of chapter 111J, or a licensed
393	393	365marriage and family therapist within the lawful scope of practice for such therapist; or a clinician 18 of 22
394	394	366practicing under the supervision of a licensed professional, and working towards licensure, in a
395	395	367clinic or hospital licensed under chapter 111.
396	396	368 SECTION 18 . Section 4KK of chapter 176G of the General Laws, as inserted by chapter
397	397	369177 of the acts of 2022, is hereby amended by striking subsection (b) and inserting in place
398	398	370thereof the following subsection:_-
399	399	371 An individual or group health maintenance contract that is issued or renewed within or
400	400	372without the commonwealth shall provide coverage for medically necessary mental health acute
401	401	373treatment, community-based acute treatment and intensive community-based acute treatment and
402	402	374shall not require a preauthorization before the administration of such treatment; provided,
403	403	375however, that the facility shall notify the carrier of the admission and the initial treatment plan
404	404	376within three business days of admission; and provided further that services administered prior to
405	405	377notification must be covered. Notification shall be limited to patient’s name, facility name, time
406	406	378of admission, diagnosis, and initial treatment plan.
407	407	379 SECTION 19. (a) There shall be a task force to: (i) evaluate ways to ensure the financial
408	408	380stability of inpatient behavioral health units and facilities; (ii) consider the role of inpatient
409	409	381behavioral health units and facilities within the continuum of behavioral health services; and (iii)
410	410	382address current behavioral health workforce challenges. The task force shall consist of the
411	411	383following members: the executive director of the health policy commission, who shall serve as
412	412	384co-chair; the executive director of the center for health information and analysis, who shall serve
413	413	385as co-chair; the assistant secretary for MassHealth or his/her designee, the commissioner of the
414	414	386department of mental health or his/her designee, the commissioner of the department of public
415	415	387health or his/her designee, and 1 representative from each of the following organizations: the 19 of 22
416	416	388Massachusetts Health & Hospital Association; the Massachusetts Psychiatric Society; the
417	417	389Massachusetts Association of Behavioral Health Systems; the Massachusetts Psychological
418	418	390Association; the Massachusetts Association of Advanced Practice Psychiatric Nurses; the
419	419	391National Association of Social Workers-Massachusetts Chapter; and the Massachusetts
420	420	392Association for Mental Health.
421	421	393 (b) The task force shall conduct an analysis and issue a report which shall include but not
422	422	394be limited to: (i) a review of the methodologies used for determining reimbursement rates for
423	423	395inpatient hospital behavioral health services provided to MassHealth members including those by
424	424	396MassHealth’s contracted health insurers, health plans, behavioral health management firms, and
425	425	397third party administrators under contract to a Medicaid managed care organization or primary
426	426	398care clinician plan; (ii) an analysis of the estimated payment levels associated with MassHealth
427	427	399reimbursement relative to the cost of providing inpatient hospital behavioral health care in acute
428	428	400hospital units and freestanding facilities; (iii) recommended improvements to MassHealth
429	429	401reimbursement for care provided by inpatient behavioral health units and facilities to promote
430	430	402financial stability, including a review of a cost-based method for rate determination; (iv) an
431	431	403assessment of the utility and limitations of incorporating diagnosis-related group DRG
432	432	404classifications in said rate calculation; (v) industry-wide workforce initiatives including, but not
433	433	405limited to, ways to improve recruitment, training, including transitional training opportunities for
434	434	406employment in behavioral health units and facilities and training in new behavioral healthcare
435	435	407modalities including but not limited to telehealth, retention, rates of pay and other methods of
436	436	408ensuring a sustainable, culturally and linguistically-competent behavioral health workforce; and
437	437	409(vi) the role of external economic factors on the development and retention of the behavioral 20 of 22
438	438	410health workforce such as the increases in the minimum wage and competition from other
439	439	411industries.
440	440	412 (c) The task force shall convene its first meeting within 30 days after the effective date of
441	441	413this act. The task force shall submit its report, including any proposed legislation necessary to
442	442	414carry out its recommendations, by filing the same with the clerks of the house of representatives
443	443	415and senate, the joint committee on health care financing, the joint committee on mental health,
444	444	416substance use and recovery, the joint committee on labor and workforce development and the
445	445	417house and senate committees on ways and means not later than December 31, 2024.
446	446	418 SECTION 20. Notwithstanding any general or special law to the contrary, the health
447	447	419policy commission, the division of medical assistance, four representatives from academic
448	448	420medical centers currently rendering inpatient services in a patient’s home, the department of
449	449	421public health and the department of mental health, shall conduct a study and issue a report
450	450	422regarding the design of a behavioral health home hospital program, herein referred to as the
451	451	423program. The study shall include, but not be limited to: (i) the recommendation of patient
452	452	424populations who would be best served by the provision of behavioral healthcare in a home
453	453	425environment; (ii) the identification of healthcare providers who would make up the program care
454	454	426team; (iii) the projected impact of the program on the rate of psychiatric emergency department
455	455	427boarding statewide; (iv) the identification of safety concerns regarding the provision of
456	456	428behavioral healthcare in a home environment and recommendations to address said concerns; (v)
457	457	429the projected impact of the program on the availability of psychiatric hospital beds in the
458	458	430commonwealth; (vi) the projected cost estimates of the program; (vii) a comparison of cost
459	459	431estimates of providing behavioral healthcare in the home versus in a healthcare facility; (viii) an
460	460	432analysis of the quality of patient care received through the program; (ix) the identification of 21 of 22
461	461	433screening protocols before care at home begins to assess medical and non-medical factors,
462	462	434including working utilities, assessment of physical barriers and screenings for domestic violence
463	463	435concerns; (x) recommendations for minimum personnel visits, the provision of immediate, on-
464	464	436demand telehealth connections with program staff; and (xi) recommendations for minimum
465	465	437emergency response times. The report shall be submitted to the governor, the chairs of the joint
466	466	438committee on health care financing, the chairs of the joint committee on mental health, substance
467	467	439use and recovery and the house and senate committees on ways and means no later than July 31,
468	468	4402024.
469	469	441 SECTION 21. Notwithstanding any general or special law to the contrary, the division of
470	470	442insurance, in consultation with the division of medical assistance, shall promulgate regulations or
471	471	443issue sub-regulatory guidance, within 30 days of the effective date of this act, to require carriers
472	472	444reimburse acute care hospitals with emergency departments or satellite emergency facilities for
473	473	445the provision of emergency behavioral health services, including but not limited to, behavioral
474	474	446health crisis assessment, intervention, and stabilization services. The regulations or sub-
475	475	447regulatory guidance shall include reimbursement for the provision of emergency behavioral
476	476	448services via telemedicine, electronic or telephonic consultation, in accordance with section 51 ¾
477	477	449of chapter 111 of the General Laws. The contractual rate for these services may be no less than
478	478	450the prevailing MassHealth rate for behavioral health emergency department crisis evaluations.
479	479	451This does not preclude a hospital from billing for other medically necessary services traditionally
480	480	452reimbursed through an emergency department visit and is also in addition to required
481	481	453reimbursement by carriers for each day a member waits in an emergency department,
482	482	454observation unit or inpatient floor for placement in an appropriate inpatient psychiatric
483	483	455placement, as required by section 78 of chapter 177 of the acts of 2022. The insurer shall 22 of 22
484	484	456reimburse other medically necessary services and for patients awaiting an inpatient psychiatric
485	485	457placement in addition to payment for emergency behavioral health services. Behavioral health
486	486	458services provided in this setting under this section shall be deemed medically necessary and shall
487	487	459not require prior authorization by an insurer.