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HOUSE DOCKET, NO. 1867 FILED ON: 1/15/2025
HOUSE . . . . . . . . . . . . . . . No. 1396
The Commonwealth of Massachusetts
_________________
PRESENTED BY:
James J. O'Day
_________________
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 strengthening mental health centers.
_______________
PETITION OF:
NAME:DISTRICT/ADDRESS :DATE ADDED:James J. O'Day14th Worcester1/15/2025David Paul Linsky5th Middlesex2/5/2025Carmine Lawrence Gentile13th Middlesex2/6/2025Paul McMurtry11th Norfolk2/10/2025Brian W. Murray10th Worcester2/10/2025James B. EldridgeMiddlesex and Worcester2/10/2025Daniel Cahill10th Essex2/10/2025James K. Hawkins2nd Bristol2/12/2025James C. Arena-DeRosa8th Middlesex2/13/2025Marjorie C. Decker25th Middlesex2/18/2025John H. Rogers12th Norfolk2/24/2025James Arciero2nd Middlesex2/24/2025Natalie M. Higgins4th Worcester2/24/2025Manny Cruz7th Essex2/25/2025Samantha Montaño15th Suffolk2/27/2025Rodney M. Elliott16th Middlesex3/3/2025Daniel M. Donahue16th Worcester3/7/2025Tara T. Hong18th Middlesex3/7/2025 2 of 2
Danillo A. Sena37th Middlesex3/11/2025 1 of 4
HOUSE DOCKET, NO. 1867 FILED ON: 1/15/2025
HOUSE . . . . . . . . . . . . . . . No. 1396
By Representative O'Day of West Boylston, a petition (accompanied by bill, House, No. 1396)
of James J. O'Day and others for legislation to increase minimum payment rates for certain
behavioral health services. Health Care Financing.
The Commonwealth of Massachusetts
_______________
In the One Hundred and Ninety-Fourth General Court
(2025-2026)
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An Act strengthening mental health centers.
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 2022 official
2edition, is hereby amended by inserting after 13D½ the following section:-
3 Section 13D¾.
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 and regulated pursuant to 130 CMR
8429.000.
9 “Behavioral health services”, evaluation, diagnosis, treatment, care coordination,
10management or peer support of patients with mental health, developmental or substance use
11disorder. 2 of 4
12 “Independent practitioner”, an individual who is licensed by the board to practice
13independent clinical social work and who meets the qualifications set forth in section 131 of
14chapter 112 for an independent clinical social worker and is regulated pursuant to 130
15CMR462.000.
16 “Minimum payment rates”, rates of payment for services below which managed care
17entities may not enter into provider agreements.
18 (b) The division shall increase minimum payment rates for behavioral health services by
195% per procedure code for rates of payment effective as of January 1, 2027.
20 (c) Pursuant to sections 13C and 13D, and notwithstanding any general of special law to
21the contrary, the division shall ensure that each rate of payment or component payment in a
22bundled rate for behavioral health services delivered in behavioral health clinics are no less than
2320% above comparable behavioral health services delivered by independent practitioners.
24 (d) The division shall review behavioral health service rates biennially. This review shall
25include, but not be limited to, the following: (i) adoption of an inflationary adjustment factor no
26less than the total Medicare Economic Index percentage for the past two calendar years; (ii)
27where possible, comparison of the wage estimate for each classification of staff position to the
2875th percentile wage estate for that position as determined by the most current United States
29Bureau of Labor Statistics for the commonwealth; and (iii) consideration of the reasonable cost
30to providers of any existing or new governmental mandate that has been enacted, promulgated or
31imposed by any governmental unit or federal governmental authority.
32 SECTION 2. Said chapter 118E is hereby amended by inserting after section 13L the
33following new section:- 3 of 4
34 Section 13M.
35 (a) For the purposes of this section, the following words shall have the following
36meanings:
37 “Behavioral health clinic”, a clinic licensed by the department of public health pursuant
38to section 3 and sections 51 through 56 of chapter 111, and that is regulated pursuant to title 130
39CMR 429.000.
40 “Behavioral health services”, evaluation, diagnosis, treatment, care coordination,
41management or peer support of patients with mental health, developmental or substance use
42disorder.
43 “Independent practitioner”, an individual who is licensed by the board to practice
44independent clinical social work and who meets the qualifications set forth in section 131 of
45chapter 112 and who is regulated pursuant to 130 CMR462.000.
46 “Managed care entity”, all contracted health insurers, health plans, health maintenance
47organizations, behavioral health management firms and third-party administrators under contract
48to a Medicaid managed care organization or primary care clinician plan, and accountable care
49organizations.
50 “Minimum payment rates”, rates of payment for services below which managed care
51entities may not enter into provider agreements.
52 (b) Notwithstanding applicable state and federal laws, the division shall direct its
53managed care entities to increase minimum payment rates for behavioral health services by 5%
54per procedure code for rates of payment effective as of January 1, 2027. 4 of 4
55 (c) The division shall direct managed care entities to ensure that each rate of payment or
56component payment in a bundled rate for behavioral health services delivered in behavioral
57health clinics is no less than 20% above comparable behavioral health services delivered by
58independent practitioners.
59 (d) The division shall review rates of payment by managed care entities for behavioral
60health services biennially. This review shall include, but not be limited to, the following: (i)
61adoption of an inflationary adjustment factor no less than the total Medicare Economic Index
62percentage for the past two calendar years; (ii) where possible, comparison of the wage estimate
63for each classification of staff position to the 75th percentile wage estate for that position as
64determined by the most current United States Bureau of Labor Statistics for the commonwealth;
65and (iii) consideration of the reasonable cost to providers of any existing or new governmental
66mandate that has been enacted, promulgated or imposed by any governmental unit or federal
67governmental authority.