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SENATE DOCKET, NO. 2229 FILED ON: 1/20/2023
SENATE . . . . . . . . . . . . . . No. 760
The Commonwealth of Massachusetts
_________________
PRESENTED BY:
John F. Keenan
_________________
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 relative to behavioral health clinic rates.
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PETITION OF:
NAME:DISTRICT/ADDRESS :John F. KeenanNorfolk and PlymouthMichael O. MooreSecond Worcester2/2/2023 1 of 4
SENATE DOCKET, NO. 2229 FILED ON: 1/20/2023
SENATE . . . . . . . . . . . . . . No. 760
By Mr. Keenan, a petition (accompanied by bill, Senate, No. 760) of John F. Keenan and
Michael O. Moore for legislation relative to behavioral health clinic rates. Health Care
Financing.
The Commonwealth of Massachusetts
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In the One Hundred and Ninety-Third General Court
(2023-2024)
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An Act relative to behavioral health clinic rates.
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. Chapter 118E of the general laws, as appearing in the 2020 official edition,
2is hereby amended by inserting after 13D the following section:-
3 Section 13D ½.
4 (a) For the purposes of this section, the following words shall have the following
5meanings:
6 “Behavioral health clinic”, a clinic licensed by the department of public health pursuant
7to section 3 and sections 51 through 56 of chapter 111 of the general laws, as appearing in the
82020 official edition, and regulated pursuant to title 130 of the code of Massachusetts regulations
9429.000. 2 of 4
10 “Behavioral health services”, evaluation, diagnosis, treatment, care coordination,
11management, or peer support of patients with mental health, developmental or substance use
12disorder.
13 “Independent practitioner”, an individual who is licensed by the board to practice
14independent clinical social work and who meets the qualifications set forth in section 131 of
15chapter 112 of the general laws, as appearing in the 2020 official edition, for an independent
16clinical social worker and is regulated pursuant to title 130 of the code of Massachusetts
17regulations 462.000.
18 “Minimum payment rates”, rates of payment for services below which managed care
19entities may not enter into provider agreements.
20 (b) The division shall increase minimum payment rates for behavioral health services by
215% per procedure code for rates of payment effective as of January 1, 2023.
22 (c) Pursuant to sections 13C and 13D, and notwithstanding applicable state and federal
23laws, the division shall ensure that each rate of payment or component payment in a bundled rate
24for behavioral health services delivered in behavioral health clinics are no less than 20% above
25comparable behavioral health services delivered by independent practitioners.
26 (d) The division shall review behavioral health service rates biennially. This review shall
27include, but not be limited to the following: (i) adoption of an inflationary adjustment factor no
28less than the total Medicare Economic Index percentage for the past two calendar years; (ii)
29where possible, comparison of the wage estimate for each classification of staff position to the
3075th percentile wage estate for that position as determined by the most current United States
31Bureau of Labor Statistics for the commonwealth; and (iii) consideration of the reasonable cost 3 of 4
32to providers of any existing or new governmental mandate that has been enacted, promulgated or
33imposed by any governmental unit or federal governmental authority.
34 SECTION 2. Said chapter 118E is hereby amended by inserting after section 13K the
35following new section:-
36 Section 13L.
37 (a) For the purposes of this section, the following words shall have the following
38meanings:
39 “Behavioral health clinic”, a clinic licensed by the department of public health pursuant
40to section 3 and sections 51 through 56 of chapter 111 of the general laws, as appearing in the
412020 official edition, and that is regulated pursuant to title 130 of the code of Massachusetts
42regulations 429.000.
43 “Behavioral health services”, evaluation, diagnosis, treatment, care coordination,
44management or peer support of patients with mental health, developmental or substance use
45disorder.
46 “Independent practitioner”, an individual who is licensed by the board to practice
47independent clinical social work and who meets the qualifications set forth in section 131 of
48chapter 112 of the general laws, as appearing in the 2020 official edition, and who is regulated
49pursuant to title 130 of the code of Massachusetts regulations 462.000.
50 “Managed care entity”, all contracted health insurers, health plans, health maintenance
51organizations, behavioral health management firms and third party administrators under contract 4 of 4
52to a Medicaid managed care organization or primary care clinician plan, and accountable care
53organizations.
54 “Minimum payment rates”, rates of payment for services below which managed care
55entities may not enter into provider agreements.
56 (b) Notwithstanding applicable state and federal laws, the division shall direct its
57managed care entities to increase minimum payment rates for behavioral health services by 5%
58per procedure code for rates of payment effective as of January 1, 2023.
59 (c) The division shall direct managed care entities to ensure that each rate of payment or
60component payment in a bundled rate for behavioral health services delivered in behavioral
61health clinics is no less than 20% above comparable behavioral health services delivered by
62independent practitioners.
63 (d) The division shall review rates of payment by managed care entities for behavioral
64health services biennially. This review shall include, but not be limited to the following: (i)
65adoption of an inflationary adjustment factor no less than the total Medicare Economic Index
66percentage for the past two calendar years; (ii) where possible, comparison of the wage estimate
67for each classification of staff position to the 75th percentile wage estate for that position as
68determined by the most current United States Bureau of Labor Statistics for the commonwealth;
69and (iii) consideration of the reasonable cost to providers of any existing or new governmental
70mandate that has been enacted, promulgated or imposed by any governmental unit or federal
71governmental authority.