Massachusetts 2023-2024 Regular Session

Massachusetts Senate Bill S760 Compare Versions

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

Old	New	Differences
1	1	1 of 1
2	2	SENATE DOCKET, NO. 2229 FILED ON: 1/20/2023
3	3	SENATE . . . . . . . . . . . . . . No. 760
4	4	The Commonwealth of Massachusetts
5	5	_________________
6	6	PRESENTED BY:
7	7	John F. Keenan
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 relative to behavioral health clinic rates.
13	13	_______________
14	14	PETITION OF:
15	15	NAME:DISTRICT/ADDRESS :John F. KeenanNorfolk and PlymouthMichael O. MooreSecond Worcester2/2/2023 1 of 4
16	16	SENATE DOCKET, NO. 2229 FILED ON: 1/20/2023
17	17	SENATE . . . . . . . . . . . . . . No. 760
18	18	By Mr. Keenan, a petition (accompanied by bill, Senate, No. 760) of John F. Keenan and
19	19	Michael O. Moore for legislation relative to behavioral health clinic rates. Health Care
20	20	Financing.
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 relative to behavioral health clinic rates.
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 118E of the general laws, as appearing in the 2020 official edition,
30	30	2is hereby amended by inserting after 13D the following section:-
31	31	3 Section 13D ½.
32	32	4 (a) For the purposes of this section, the following words shall have the following
33	33	5meanings:
34	34	6 “Behavioral health clinic”, a clinic licensed by the department of public health pursuant
35	35	7to section 3 and sections 51 through 56 of chapter 111 of the general laws, as appearing in the
36	36	82020 official edition, and regulated pursuant to title 130 of the code of Massachusetts regulations
37	37	9429.000. 2 of 4
38	38	10 “Behavioral health services”, evaluation, diagnosis, treatment, care coordination,
39	39	11management, or peer support of patients with mental health, developmental or substance use
40	40	12disorder.
41	41	13 “Independent practitioner”, an individual who is licensed by the board to practice
42	42	14independent clinical social work and who meets the qualifications set forth in section 131 of
43	43	15chapter 112 of the general laws, as appearing in the 2020 official edition, for an independent
44	44	16clinical social worker and is regulated pursuant to title 130 of the code of Massachusetts
45	45	17regulations 462.000.
46	46	18 “Minimum payment rates”, rates of payment for services below which managed care
47	47	19entities may not enter into provider agreements.
48	48	20 (b) The division shall increase minimum payment rates for behavioral health services by
49	49	215% per procedure code for rates of payment effective as of January 1, 2023.
50	50	22 (c) Pursuant to sections 13C and 13D, and notwithstanding applicable state and federal
51	51	23laws, the division shall ensure that each rate of payment or component payment in a bundled rate
52	52	24for behavioral health services delivered in behavioral health clinics are no less than 20% above
53	53	25comparable behavioral health services delivered by independent practitioners.
54	54	26 (d) The division shall review behavioral health service rates biennially. This review shall
55	55	27include, but not be limited to the following: (i) adoption of an inflationary adjustment factor no
56	56	28less than the total Medicare Economic Index percentage for the past two calendar years; (ii)
57	57	29where possible, comparison of the wage estimate for each classification of staff position to the
58	58	3075th percentile wage estate for that position as determined by the most current United States
59	59	31Bureau of Labor Statistics for the commonwealth; and (iii) consideration of the reasonable cost 3 of 4
60	60	32to providers of any existing or new governmental mandate that has been enacted, promulgated or
61	61	33imposed by any governmental unit or federal governmental authority.
62	62	34 SECTION 2. Said chapter 118E is hereby amended by inserting after section 13K the
63	63	35following new section:-
64	64	36 Section 13L.
65	65	37 (a) For the purposes of this section, the following words shall have the following
66	66	38meanings:
67	67	39 “Behavioral health clinic”, a clinic licensed by the department of public health pursuant
68	68	40to section 3 and sections 51 through 56 of chapter 111 of the general laws, as appearing in the
69	69	412020 official edition, and that is regulated pursuant to title 130 of the code of Massachusetts
70	70	42regulations 429.000.
71	71	43 “Behavioral health services”, evaluation, diagnosis, treatment, care coordination,
72	72	44management or peer support of patients with mental health, developmental or substance use
73	73	45disorder.
74	74	46 “Independent practitioner”, an individual who is licensed by the board to practice
75	75	47independent clinical social work and who meets the qualifications set forth in section 131 of
76	76	48chapter 112 of the general laws, as appearing in the 2020 official edition, and who is regulated
77	77	49pursuant to title 130 of the code of Massachusetts regulations 462.000.
78	78	50 “Managed care entity”, all contracted health insurers, health plans, health maintenance
79	79	51organizations, behavioral health management firms and third party administrators under contract 4 of 4
80	80	52to a Medicaid managed care organization or primary care clinician plan, and accountable care
81	81	53organizations.
82	82	54 “Minimum payment rates”, rates of payment for services below which managed care
83	83	55entities may not enter into provider agreements.
84	84	56 (b) Notwithstanding applicable state and federal laws, the division shall direct its
85	85	57managed care entities to increase minimum payment rates for behavioral health services by 5%
86	86	58per procedure code for rates of payment effective as of January 1, 2023.
87	87	59 (c) The division shall direct managed care entities to ensure that each rate of payment or
88	88	60component payment in a bundled rate for behavioral health services delivered in behavioral
89	89	61health clinics is no less than 20% above comparable behavioral health services delivered by
90	90	62independent practitioners.
91	91	63 (d) The division shall review rates of payment by managed care entities for behavioral
92	92	64health services biennially. This review shall include, but not be limited to the following: (i)
93	93	65adoption of an inflationary adjustment factor no less than the total Medicare Economic Index
94	94	66percentage for the past two calendar years; (ii) where possible, comparison of the wage estimate
95	95	67for each classification of staff position to the 75th percentile wage estate for that position as
96	96	68determined by the most current United States Bureau of Labor Statistics for the commonwealth;
97	97	69and (iii) consideration of the reasonable cost to providers of any existing or new governmental
98	98	70mandate that has been enacted, promulgated or imposed by any governmental unit or federal
99	99	71governmental authority.