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