Massachusetts 2025-2026 Regular Session

Massachusetts House Bill H1396 Compare Versions

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

Old	New	Differences
1	1	1 of 2
2	2	HOUSE DOCKET, NO. 1867 FILED ON: 1/15/2025
3	3	HOUSE . . . . . . . . . . . . . . . No. 1396
4	4	The Commonwealth of Massachusetts
5	5	_________________
6	6	PRESENTED BY:
7	7	James J. O'Day
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 strengthening mental health centers.
13	13	_______________
14	14	PETITION OF:
15	15	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
16	16	Danillo A. Sena37th Middlesex3/11/2025 1 of 4
17	17	HOUSE DOCKET, NO. 1867 FILED ON: 1/15/2025
18	18	HOUSE . . . . . . . . . . . . . . . No. 1396
19	19	By Representative O'Day of West Boylston, a petition (accompanied by bill, House, No. 1396)
20	20	of James J. O'Day and others for legislation to increase minimum payment rates for certain
21	21	behavioral health services. Health Care Financing.
22	22	The Commonwealth of Massachusetts
23	23	_______________
24	24	In the One Hundred and Ninety-Fourth General Court
25	25	(2025-2026)
26	26	_______________
27	27	An Act strengthening mental health centers.
28	28	Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
29	29	of the same, as follows:
30	30	1 SECTION 1. Chapter 118E of the General Laws, as appearing in the 2022 official
31	31	2edition, is hereby amended by inserting after 13D½ the following section:-
32	32	3 Section 13D¾.
33	33	4 (a) For the purposes of this section, the following words shall have the following
34	34	5meanings:
35	35	6 “Behavioral health clinic”, a clinic licensed by the department of public health pursuant
36	36	7to section 3 and sections 51 through 56 of chapter 111 and regulated pursuant to 130 CMR
37	37	8429.000.
38	38	9 “Behavioral health services”, evaluation, diagnosis, treatment, care coordination,
39	39	10management or peer support of patients with mental health, developmental or substance use
40	40	11disorder. 2 of 4
41	41	12 “Independent practitioner”, an individual who is licensed by the board to practice
42	42	13independent clinical social work and who meets the qualifications set forth in section 131 of
43	43	14chapter 112 for an independent clinical social worker and is regulated pursuant to 130
44	44	15CMR462.000.
45	45	16 “Minimum payment rates”, rates of payment for services below which managed care
46	46	17entities may not enter into provider agreements.
47	47	18 (b) The division shall increase minimum payment rates for behavioral health services by
48	48	195% per procedure code for rates of payment effective as of January 1, 2027.
49	49	20 (c) Pursuant to sections 13C and 13D, and notwithstanding any general of special law to
50	50	21the contrary, the division shall ensure that each rate of payment or component payment in a
51	51	22bundled rate for behavioral health services delivered in behavioral health clinics are no less than
52	52	2320% above comparable behavioral health services delivered by independent practitioners.
53	53	24 (d) The division shall review behavioral health service rates biennially. This review shall
54	54	25include, but not be limited to, the following: (i) adoption of an inflationary adjustment factor no
55	55	26less than the total Medicare Economic Index percentage for the past two calendar years; (ii)
56	56	27where possible, comparison of the wage estimate for each classification of staff position to the
57	57	2875th percentile wage estate for that position as determined by the most current United States
58	58	29Bureau of Labor Statistics for the commonwealth; and (iii) consideration of the reasonable cost
59	59	30to providers of any existing or new governmental mandate that has been enacted, promulgated or
60	60	31imposed by any governmental unit or federal governmental authority.
61	61	32 SECTION 2. Said chapter 118E is hereby amended by inserting after section 13L the
62	62	33following new section:- 3 of 4
63	63	34 Section 13M.
64	64	35 (a) For the purposes of this section, the following words shall have the following
65	65	36meanings:
66	66	37 “Behavioral health clinic”, a clinic licensed by the department of public health pursuant
67	67	38to section 3 and sections 51 through 56 of chapter 111, and that is regulated pursuant to title 130
68	68	39CMR 429.000.
69	69	40 “Behavioral health services”, evaluation, diagnosis, treatment, care coordination,
70	70	41management or peer support of patients with mental health, developmental or substance use
71	71	42disorder.
72	72	43 “Independent practitioner”, an individual who is licensed by the board to practice
73	73	44independent clinical social work and who meets the qualifications set forth in section 131 of
74	74	45chapter 112 and who is regulated pursuant to 130 CMR462.000.
75	75	46 “Managed care entity”, all contracted health insurers, health plans, health maintenance
76	76	47organizations, behavioral health management firms and third-party administrators under contract
77	77	48to a Medicaid managed care organization or primary care clinician plan, and accountable care
78	78	49organizations.
79	79	50 “Minimum payment rates”, rates of payment for services below which managed care
80	80	51entities may not enter into provider agreements.
81	81	52 (b) Notwithstanding applicable state and federal laws, the division shall direct its
82	82	53managed care entities to increase minimum payment rates for behavioral health services by 5%
83	83	54per procedure code for rates of payment effective as of January 1, 2027. 4 of 4
84	84	55 (c) The division shall direct managed care entities to ensure that each rate of payment or
85	85	56component payment in a bundled rate for behavioral health services delivered in behavioral
86	86	57health clinics is no less than 20% above comparable behavioral health services delivered by
87	87	58independent practitioners.
88	88	59 (d) The division shall review rates of payment by managed care entities for behavioral
89	89	60health services biennially. This review shall include, but not be limited to, the following: (i)
90	90	61adoption of an inflationary adjustment factor no less than the total Medicare Economic Index
91	91	62percentage for the past two calendar years; (ii) where possible, comparison of the wage estimate
92	92	63for each classification of staff position to the 75th percentile wage estate for that position as
93	93	64determined by the most current United States Bureau of Labor Statistics for the commonwealth;
94	94	65and (iii) consideration of the reasonable cost to providers of any existing or new governmental
95	95	66mandate that has been enacted, promulgated or imposed by any governmental unit or federal
96	96	67governmental authority.