Massachusetts 2025-2026 Regular Session

Massachusetts Senate Bill S1399 Compare Versions

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

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2	2	SENATE DOCKET, NO. 1197 FILED ON: 1/15/2025
3	3	SENATE . . . . . . . . . . . . . . No. 1399
4	4	The Commonwealth of Massachusetts
5	5	_________________
6	6	PRESENTED BY:
7	7	Cindy F. Friedman
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 to increase investment in behavioral health care in the Commonwealth.
13	13	_______________
14	14	PETITION OF:
15	15	NAME:DISTRICT/ADDRESS :Cindy F. FriedmanFourth Middlesex 1 of 15
16	16	SENATE DOCKET, NO. 1197 FILED ON: 1/15/2025
17	17	SENATE . . . . . . . . . . . . . . No. 1399
18	18	By Ms. Friedman, a petition (accompanied by bill, Senate, No. 1399) of Cindy F. Friedman for
19	19	legislation to increase investment in behavioral health care in the Commonwealth. Mental
20	20	Health, Substance Use and Recovery.
21	21	[SIMILAR MATTER FILED IN PREVIOUS SESSION
22	22	SEE SENATE, NO. 1248 OF 2023-2024.]
23	23	The Commonwealth of Massachusetts
24	24	_______________
25	25	In the One Hundred and Ninety-Fourth General Court
26	26	(2025-2026)
27	27	_______________
28	28	An Act to increase investment in behavioral health care in the Commonwealth.
29	29	Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
30	30	of the same, as follows:
31	31	1 SECTION 1. Section 1 of chapter 6D of the General Laws, as appearing in the 2022
32	32	2Official Edition, is hereby amended by inserting after the definition of “After-hours care” the
33	33	3following definitions:-
34	34	4 “Aggregate behavioral health baseline expenditures”, the sum of all behavioral health
35	35	5expenditures, as defined by the center, in the commonwealth in the calendar year preceding the
36	36	63-year period to which the aggregate behavioral health expenditure target applies; provided,
37	37	7however, that aggregate behavioral health baseline expenditures shall initially be calculated
38	38	8using calendar year 2025. 2 of 15
39	39	9 “Aggregate behavioral health expenditure target”, the targeted rate of growth for
40	40	10aggregate behavioral health baseline expenditures for a particular calendar year, as a percentage
41	41	11established by the board.
42	42	12 SECTION 2. Said section 1 of said chapter 6D, as so appearing, is hereby further
43	43	13amended by inserting after the definition of “Alternative payment methodologies or methods”
44	44	14the following definitions:-
45	45	15 “Behavioral health baseline expenditures”, the sum of all behavioral health expenditures,
46	46	16as defined by the center, by or attributed to an individual health care entity in the calendar year
47	47	17preceding the 3-year period to which the behavioral health expenditure target applies; provided,
48	48	18however, that behavioral health baseline expenditures shall initially be calculated using calendar
49	49	19year 2025.
50	50	20 “Behavioral health expenditure target”, the targeted rate of growth for behavioral health
51	51	21baseline expenditures for a particular calendar year, as a percentage established by the board.
52	52	22 SECTION 3. Section 8 of said chapter 6D, as so appearing, is hereby amended by
53	53	23striking out subsection (a), as amended by section 6 of chapter 342 and section 16 of chapter 343
54	54	24of the acts of 2024, and inserting in place thereof the following subsection:-
55	55	25 (a) Not later than October 1 of every year, the commission shall hold public hearings
56	56	26based on the report submitted by the center under section 16 of chapter 12C comparing the
57	57	27growth in total health care expenditures to the health care cost growth benchmark for the
58	58	28previous calendar year and comparing the growth in actual aggregate behavioral health
59	59	29expenditures for the previous calendar year to the aggregate behavioral health expenditure target.
60	60	30The hearings shall examine the costs, prices and cost trends of health care providers, provider 3 of 15
61	61	31organizations, private and public health care payers, pharmaceutical manufacturing companies
62	62	32and pharmacy benefit managers and any relevant impact of significant equity investors, health
63	63	33care real estate investment trusts, management services organizations on such costs, prices and
64	64	34cost trends, with particular attention to factors that contribute to cost growth within the
65	65	35commonwealth's health care system, and trends in annual primary care and behavioral health
66	66	36expenditures, and factors that challenge the ability of the commonwealth’s health care system to
67	67	37meet the benchmark or the aggregate behavioral health expenditure target established under
68	68	38section 9A.
69	69	39 SECTION 4. Said section 8 of said chapter 6D, as so appearing, is hereby further
70	70	40amended by striking out subsection (g), as amended by section 6 of chapter 342 and section 16 of
71	71	41chapter 343 of the acts of 2024, and inserting in place thereof the following subsection:-
72	72	42 (g) The commission shall compile an annual report concerning spending trends, including
73	73	43primary care and behavioral health expenditures, and the underlying factors influencing said
74	74	44spending trends. The report shall be based on the commission’s analysis of information provided
75	75	45at the hearings by witnesses, providers, provider organizations and payers, registration data
76	76	46collected pursuant to section 11, data collected or analyzed by the center pursuant to sections 8 to
77	77	4710A, inclusive, of chapter 12C and any other available information that the commission
78	78	48considers necessary to fulfill its duties under this section, as defined in regulations promulgated
79	79	49by the commission. The report shall be submitted to the house and senate committees on ways
80	80	50and means and the joint committee on health care financing and shall be published and available
81	81	51to the public not later than December 31 of each year. The report shall include recommendations
82	82	52for strategies to increase the efficiency of the health care system and promote affordability for
83	83	53individuals and families, recommendations on the specific spending trends that impede the 4 of 15
84	84	54commonwealth’s ability to meet the health care cost growth benchmark and the aggregate
85	85	55behavioral health expenditure target, and draft legislation necessary to implement said
86	86	56recommendations.
87	87	57 SECTION 5. Said chapter 6D is hereby further amended by inserting after section 9 the
88	88	58following section:-
89	89	59 Section 9A. (a) The board shall establish an aggregate behavioral health expenditure
90	90	60target for the commonwealth, which the commission shall prominently publish on its website.
91	91	61 (b) The commission shall establish the aggregate behavioral health expenditure target as
92	92	62follows:
93	93	63 (1) For the 3-year period ending with calendar year 2028, the aggregate behavioral health
94	94	64expenditure target in year 1, in year 2, and in year 3 shall be 30 per cent higher than aggregate
95	95	65behavioral health baseline expenditures, and the behavioral health expenditure target in year 1, in
96	96	66year 2, and in year 3 shall be 30 per cent higher than behavioral health baseline expenditures.
97	97	67 (2) For calendar years 2029 and beyond, the commission may modify the behavioral
98	98	68health expenditure target and aggregate behavioral health expenditure target, to be effective for
99	99	69each year of a 3-year period, provided that the behavioral health expenditure target and aggregate
100	100	70behavioral health expenditure target shall be approved by a two-thirds vote of the board not later
101	101	71than December 31 of the final calendar year of the preceding 3-year period. If the commission
102	102	72does not act to establish an updated behavioral health expenditure target and aggregate
103	103	73behavioral health expenditure target pursuant to this subsection, the behavioral health
104	104	74expenditure target for each of the 3 years shall be 30 per cent higher than behavioral health
105	105	75baseline expenditures, and the aggregate behavioral health expenditure target for each of the 3 5 of 15
106	106	76years shall be 30 per cent higher than aggregate behavioral health baseline expenditures, until
107	107	77such time as the commission acts to modify the behavioral health expenditure target and
108	108	78aggregate behavioral health expenditure target. If the commission modifies the behavioral health
109	109	79expenditure target and aggregate behavioral health expenditure target, the modification shall not
110	110	80take effect until the 3-year period beginning with the next full calendar year.
111	111	81 (c) Prior to establishing the behavioral health expenditure target and aggregate behavioral
112	112	82health expenditure target, the commission shall hold a public hearing. The public hearing shall be
113	113	83based on the report submitted by the center under section 16 of chapter 12C, comparing the
114	114	84actual aggregate expenditures on behavioral health services to the aggregate behavioral health
115	115	85expenditure target, any other data submitted by the center and such other pertinent information or
116	116	86data as may be available to the commission The hearings shall examine the performance of
117	117	87health care entities in meeting the behavioral health expenditure target and the commonwealth’s
118	118	88health care system in meeting the aggregate behavioral health expenditure target. The
119	119	89commission shall provide public notice of the hearing at least 45 days prior to the date of the
120	120	90hearing, including notice to the joint committee on health care financing. The joint committee on
121	121	91health care financing may participate in the hearing. The commission shall identify as witnesses
122	122	92for the public hearing a representative sample of providers, provider organizations, payers and
123	123	93such other interested parties as the commission may determine. Any other interested parties may
124	124	94testify at the hearing.
125	125	95 SECTION 6. Said chapter 6D is hereby further amended by inserting after section 10 the
126	126	96following section:- 6 of 15
127	127	97 Section 10A. (a) For the purposes of this section, “health care entity” shall mean any
128	128	98entity identified by the center under section 18 of chapter 12C.
129	129	99 (b) The commission shall provide notice to all health care entities that have been
130	130	100identified by the center under section 18 of chapter 12C for failure to meet the behavioral health
131	131	101expenditure target. Such notice shall state that the center may analyze the performance of
132	132	102individual health care entities in meeting the behavioral health expenditure target and, beginning
133	133	103in calendar year 2029, the commission may require certain actions, as established in this section,
134	134	104from health care entities so identified.
135	135	105 (c) In addition to the notice provided under subsection (b), the commission may require
136	136	106any health care entity that is identified by the center under section 18 of chapter 12C for failure
137	137	107to meet the behavioral health expenditure target to file and implement a performance
138	138	108improvement plan. The commission shall provide written notice to such health care entity that
139	139	109they are required to file a performance improvement plan. Within 45 days of receipt of such
140	140	110written notice, the health care entity shall either:
141	141	111 (1) file a performance improvement plan with the commission; or
142	142	112 (2) file an application with the commission to waive or extend the requirement to file a
143	143	113performance improvement plan.
144	144	114 (d) The health care entity may file any documentation or supporting evidence with the
145	145	115commission to support the health care entity’s application to waive or extend the requirement to
146	146	116file a performance improvement plan. The commission shall require the health care entity to
147	147	117submit any other relevant information it deems necessary in considering the waiver or extension 7 of 15
148	148	118application; provided, however, that such information shall be made public at the discretion of
149	149	119the commission.
150	150	120 (e) The commission may waive or delay the requirement for a health care entity to file a
151	151	121performance improvement plan in response to a waiver or extension request filed under
152	152	122subsection (c) in light of all information received from the health care entity, based on a
153	153	123consideration of the following factors: (1) the behavioral health baseline expenditures, costs,
154	154	124price and utilization trends of the health care entity over time, and any demonstrated
155	155	125improvement to increase the proportion of behavioral health expenditures; (2) any ongoing
156	156	126strategies or investments that the health care entity is implementing to invest in or expand access
157	157	127to behavioral health services; (3) whether the factors that led to the inability of the health care
158	158	128entity to meet the behavioral health expenditure target can reasonably be considered to be
159	159	129unanticipated and outside of the control of the entity; provided, that such factors may include,
160	160	130but shall not be limited to, market dynamics, technological changes and other drivers of non-
161	161	131behavioral health spending such as pharmaceutical and medical devices expenses; (4) the overall
162	162	132financial condition of the health care entity; and (5) any other factors the commission considers
163	163	133relevant.
164	164	134 (f) If the commission declines to waive or extend the requirement for the health care
165	165	135entity to file a performance improvement plan, the commission shall provide written notice to the
166	166	136health care entity that its application for a waiver or extension was denied and the health care
167	167	137entity shall file a performance improvement plan.
168	168	138 (g) The commission shall provide the department of public health any notice requiring a
169	169	139health care entity to file and implement a performance improvement plan pursuant to this 8 of 15
170	170	140section. In the event a health care entity required to file a performance improvement plan under
171	171	141this section submits an application for a notice of determination of need under section 25C or 51
172	172	142of chapter 111, the notice of the commission requiring the health care entity to file and
173	173	143implement a performance improvement plan pursuant to this section shall be considered part of
174	174	144the written record pursuant to said section 25C of chapter 111.
175	175	145 (h) A health care entity shall file a performance improvement plan: (1) within 45 days of
176	176	146receipt of a notice under subsection (c); (2) if the health care entity has requested a waiver or
177	177	147extension, within 45 days of receipt of a notice that such waiver or extension has been denied; or
178	178	148(3) if the health care entity is granted an extension, on the date given on such extension. The
179	179	149performance improvement plan shall identify specific strategies, adjustments and action steps the
180	180	150entity proposes to implement to increase the proportion of behavioral health expenditures. The
181	181	151proposed performance improvement plan shall include specific identifiable and measurable
182	182	152expected outcomes and a timetable for implementation.
183	183	153 (i) The commission shall approve any performance improvement plan that it determines
184	184	154is reasonably likely to address the underlying cause of the entity’s inability to meet the
185	185	155behavioral health expenditure target and has a reasonable expectation for successful
186	186	156implementation.
187	187	157 (j) If the board determines that the performance improvement plan is unacceptable or
188	188	158incomplete, the commission may provide consultation on the criteria that have not been met and
189	189	159may allow an additional time period, up to 30 calendar days, for resubmission.
190	190	160 (k) Upon approval of the proposed performance improvement plan, the commission shall
191	191	161notify the health care entity to begin immediate implementation of the performance improvement 9 of 15
192	192	162plan. Public notice shall be provided by the commission on its website, identifying that the health
193	193	163care entity is implementing a performance improvement plan. All health care entities
194	194	164implementing an approved performance improvement plan shall be subject to additional
195	195	165reporting requirements and compliance monitoring, as determined by the commission. The
196	196	166commission shall provide assistance to the health care entity in the successful implementation of
197	197	167the performance improvement plan.
198	198	168 (l) All health care entities shall, in good faith, work to implement the performance
199	199	169improvement plan. At any point during the implementation of the performance improvement
200	200	170plan the health care entity may file amendments to the performance improvement plan, subject to
201	201	171approval of the commission.
202	202	172 (m) At the conclusion of the timetable established in the performance improvement plan,
203	203	173the health care entity shall report to the commission regarding the outcome of the performance
204	204	174improvement plan. If the performance improvement plan was found to be unsuccessful, the
205	205	175commission shall either: (1) extend the implementation timetable of the existing performance
206	206	176improvement plan; (2) approve amendments to the performance improvement plan as proposed
207	207	177by the health care entity; (3) require the health care entity to submit a new performance
208	208	178improvement plan under subsection (c); or (4) waive or delay the requirement to file any
209	209	179additional performance improvement plans.
210	210	180 (n) Upon the successful completion of the performance improvement plan, the identity of
211	211	181the health care entity shall be removed from the commission’s website.
212	212	182 (o) The commission may submit a recommendation for proposed legislation to the joint
213	213	183committee on health care financing if the commission determines that further legislative 10 of 15
214	214	184authority is needed to achieve the health care quality and spending sustainability objectives of
215	215	185section 9A, assist health care entities with the implementation of performance improvement
216	216	186plans or otherwise ensure compliance with the provisions of this section.
217	217	187 (p) If the commission determines that a health care entity has: (1) willfully neglected to
218	218	188file a performance improvement plan with the commission by the time required in subsection (h);
219	219	189(2) failed to file an acceptable performance improvement plan in good faith with the
220	220	190commission; (3) failed to implement the performance improvement plan in good faith; or (4)
221	221	191knowingly failed to provide information required by this section to the commission or that
222	222	192knowingly falsifies the same, the commission may assess a civil penalty to the health care entity
223	223	193of not more than $500,000. The commission shall seek to promote compliance with this section
224	224	194and shall only impose a civil penalty as a last resort.
225	225	195 (q) The commission shall promulgate regulations necessary to implement this section.
226	226	196 (r) Nothing in this section shall be construed as affecting or limiting the applicability of
227	227	197the health care cost growth benchmark established under section 9, and the obligations of a
228	228	198health care entity thereto.
229	229	199 SECTION 7. Subsection (a) of section 16 of chapter 12C of the General Laws, as
230	230	200appearing in the 2022 Official Edition, is hereby amended by striking out the first paragraph, as
231	231	201amended by section 25 of chapter 342 of the acts of 2024, and inserting in place thereof the
232	232	202following paragraph:-
233	233	203 (a) The center shall publish an annual report based on the information submitted under:
234	234	204(i) sections 8 to 10A, inclusive, concerning health care provider, provider organization, private
235	235	205and public health care payer, pharmaceutical manufacturing company and pharmacy benefit 11 of 15
236	236	206manager costs and cost and price trends; (ii) section 13 of chapter 6D relative to cost and market
237	237	207impact reviews; and (iii) section 15 relative to quality data. The center shall compare the costs
238	238	208and cost trends with the health care cost growth benchmark established by the health policy
239	239	209commission under section 9 of chapter 6D, analyzed by regions of the commonwealth, and shall
240	240	210compare the costs, cost trends, and expenditures with the aggregate behavioral health
241	241	211expenditure target established under section 9A of chapter 6D, and shall detail: (1) baseline
242	242	212information about cost, price, quality, utilization and market power in the commonwealth's
243	243	213health care system; (2) cost growth trends for care provided within and outside of accountable
244	244	214care organizations and patient-centered medical homes; (3) cost growth trends by provider
245	245	215sector, including but not limited to, hospitals, hospital systems, non-acute providers,
246	246	216pharmaceuticals, medical devices and durable medical equipment; provided, however, that any
247	247	217detailed cost growth trend in the pharmaceutical sector shall consider the effect of drug rebates
248	248	218and other price concessions in the aggregate without disclosure of any product or manufacturer-
249	249	219specific rebate or price concession information, and without limiting or otherwise affecting the
250	250	220confidential or proprietary nature of any rebate or price concession agreement; (4) factors that
251	251	221contribute to cost growth within the commonwealth's health care system and to the relationship
252	252	222between provider costs and payer premium rates; (5) behavioral health expenditure trends as
253	253	223compared to the aggregate behavioral health baseline expenditures, as defined in section 1 of
254	254	224chapter 6D; (6) the proportion of health care expenditures reimbursed under fee-for-service and
255	255	225alternative payment methodologies; (7) the impact of health care payment and delivery reform
256	256	226efforts on health care costs including, but not limited to, the development of limited and tiered
257	257	227networks, increased price transparency, increased utilization of electronic medical records and
258	258	228other health technology; (8) the impact of any assessments including, but not limited to, the 12 of 15
259	259	229health system benefit surcharge collected under section 68 of chapter 118E, on health insurance
260	260	230premiums; (9) trends in utilization of unnecessary or duplicative services, with particular
261	261	231emphasis on imaging and other high-cost services; (10) the prevalence and trends in adoption of
262	262	232alternative payment methodologies and impact of alternative payment methodologies on overall
263	263	233health care spending, insurance premiums and provider rates; (11) the development and status of
264	264	234provider organizations in the commonwealth including, but not limited to, acquisitions, mergers,
265	265	235consolidations and any evidence of excess consolidation or anti-competitive behavior by
266	266	236provider organizations; (12) the impact of health care payment and delivery reform on the quality
267	267	237of care delivered in the commonwealth; and (13) costs, cost trends, price, quality, utilization and
268	268	238patient outcomes related to behavioral health service subcategories, as described in section 21A.
269	269	239 SECTION 8. Said section 16 of said chapter 12C, as so appearing, is hereby further
270	270	240amended by adding the following subsections:-
271	271	241 (d) The center shall publish the aggregate behavioral health baseline expenditures in its
272	272	242annual report, beginning in the center’s 2026 annual report.
273	273	243 (e) The center, in consultation with the commission, shall determine the behavioral health
274	274	244baseline expenditures for individual health care entities and shall report to each health care entity
275	275	245its respective baseline expenditures annually, by October 1.
276	276	246 SECTION 9. Said chapter 12C, as so appearing, is hereby further amended by striking
277	277	247out section 18 and inserting in place thereof the following section:-
278	278	248 Section 18. The center shall perform ongoing analysis of data it receives under this
279	279	249chapter to identify any payers, providers or provider organizations whose: (i) increase in health
280	280	250status adjusted total medical expense is considered excessive and who threaten the ability of the 13 of 15
281	281	251state to meet the health care cost growth benchmark established by the commission under section
282	282	25210 of chapter 6D; or (ii) expenditures fail to meet the behavioral health expenditure target under
283	283	253section 9A of chapter 6D. The center shall confidentially provide a list of the payers, providers
284	284	254and provider organizations to the commission such that the commission may pursue further
285	285	255action under sections 10 and 10A of chapter 6D.
286	286	256 SECTION 10. Notwithstanding any general or special law to the contrary, there shall be a
287	287	257special task force to develop guiding principles and practice specifications that will assist health
288	288	258care entities in meeting their annual behavioral health expenditure target, as established by
289	289	259section 9A of chapter 6D of the General Laws.
290	290	260 The task force shall consist of 21 individuals: the executive director of the health policy
291	291	261commission or a designee, who shall serve as chair; the secretary of health and human services
292	292	262or a designee; the executive director of the center for health information and analysis or a
293	293	263designee; the senate chair of the joint committee on health care financing or a designee; the
294	294	264house chair of the joint committee on health care financing or a designee; and 16 members to be
295	295	265appointed by the chair, 1 of whom shall be a representative of the Association for Behavioral
296	296	266Healthcare, 1 of whom shall be a representative of Blue Cross Blue Shield of Massachusetts,
297	297	267Inc., 1 of whom shall be a representative of the Children’s Mental Health Campaign, 1 of whom
298	298	268shall be a representative from Health Care For All, 1 of whom shall be a representative of the
299	299	269Massachusetts Association for Mental Health, Inc., 1 of whom shall be a representative of
300	300	270Massachusetts Association of Behavioral Health Systems, 1 of whom shall be a representative of
301	301	271the Massachusetts Association of Health Plans, Inc., 1 of whom shall be a representative of the
302	302	272Massachusetts Health and Hospital Association, Inc., 1 of whom shall be a representative of the
303	303	273Massachusetts League of Community Health Centers, 1 of whom shall be from a healthcare 14 of 15
304	304	274consumer organization that advocates on behalf of adults who receive behavioral health care
305	305	275services, 1 of whom shall be from a healthcare consumer organization that advocates on behalf
306	306	276of children who receive behavioral health services, 1 of whom shall be a representative from a
307	307	277behavioral health provider group, 1 of whom shall have expertise in the behavioral health
308	308	278treatment of Black, Indigenous, and People of Color, 1 of whom shall have expertise in the
309	309	279behavioral health treatment of the lesbian, gay, bisexual, transgender, and queer community, 1 of
310	310	280whom shall have expertise in the treatment of individuals with a mental health condition, and 1
311	311	281of whom shall have expertise in the treatment of individuals with a substance use disorder.
312	312	282 The task force shall make recommendations on the guiding principles and practice
313	313	283specifications by which health care entities are required to meet their annual behavioral health
314	314	284expenditure target, as established by section 9A of chapter 6D of the General Laws. The guiding
315	315	285principles and practice specifications may include, but are not limited to: (i) the adoption and
316	316	286dissemination of practices that promote health; (ii) person-centered and whole person care
317	317	287delivery; (iii) early intervention and urgent care services that mitigate morbidity and mortality
318	318	288risks; (iv) integrated behavioral health and primary care, including the psychiatric collaborative
319	319	289care model; (v) non-medical supports such a recovery coaches and peer specialists in care
320	320	290transformation efforts; and (vi) emphasis on ambulatory and community-based services.
321	321	291 The task force shall submit a report and recommendations to the clerks of the senate and
322	322	292house of representatives not later than 6 months after passage of this legislation. The executive
323	323	293director of the health policy commission shall also make the report and recommendations
324	324	294publicly available on the commission’s website. 15 of 15
325	325	295 SECTION 11. Subsection (e) of section 16 of chapter 12C of the General Laws shall take
326	326	296effect October 1, 2026.