Massachusetts 2025-2026 Regular Session

Massachusetts Senate Bill S898 Compare Versions

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

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1	1	1 of 1
2	2	SENATE DOCKET, NO. 95 FILED ON: 1/7/2025
3	3	SENATE . . . . . . . . . . . . . . No. 898
4	4	The Commonwealth of Massachusetts
5	5	_________________
6	6	PRESENTED BY:
7	7	Michael O. Moore
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 patient centered access to behavioral health services in accountable care
13	13	organizations.
14	14	_______________
15	15	PETITION OF:
16	16	NAME:DISTRICT/ADDRESS :Michael O. MooreSecond Worcester 1 of 6
17	17	SENATE DOCKET, NO. 95 FILED ON: 1/7/2025
18	18	SENATE . . . . . . . . . . . . . . No. 898
19	19	By Mr. Moore, a petition (accompanied by bill, Senate, No. 898) of Michael O. Moore relative to
20	20	patient centered access to behavioral health services in accountable care organizations. Health
21	21	Care Financing.
22	22	[SIMILAR MATTER FILED IN PREVIOUS SESSION
23	23	SEE HOUSE, NO. 1167 OF 2023-2024.]
24	24	The Commonwealth of Massachusetts
25	25	_______________
26	26	In the One Hundred and Ninety-Fourth General Court
27	27	(2025-2026)
28	28	_______________
29	29	An Act relative to patient centered access to behavioral health services in accountable care
30	30	organizations.
31	31	Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
32	32	of the same, as follows:
33	33	1 Chapter 6D of the General Laws, as appearing in the 2022 Official Edition, is hereby
34	34	2amended by inserting after section 15 the following new section:
35	35	3 Section 15A. Patient Centered Access to Behavioral Health Services in Accountable Care
36	36	4Organizations
37	37	5 Section 1. Definitions. As used in this chapter, the following words shall, unless the
38	38	6context clearly requires otherwise, have the following meanings:--
39	39	7 (a) Behavioral health specialist- a licensed physician who specializes in the practice of
40	40	8psychiatry, a licensed psychologist, a licensed independent clinical social worker, a licensed 2 of 6
41	41	9mental health counselor, a licensed nurse mental health clinical specialist or a licensed marriage
42	42	10and family therapist within the lawful scope of practice for such therapist.
43	43	11 (b) Patient Engagement Advocate- a licensed social worker; a certified nursing aide; a
44	44	12community health worker or peer recovery coach certified by the department of public health; or
45	45	13a peer support specialist certified by the department of mental health, who provides patient
46	46	14navigation and care coordination services throughout the continuum of care. Advocates shall
47	47	15achieve such certification within two years of hiring, and meet a standard of minimum skills and
48	48	16competencies as determined by the health policy commission.
49	49	17 (c) Continuum of care- a system that guides and tracks patients over time through a
50	50	18comprehensive array of health services spanning all levels and intensity of care throughout the
51	51	19treatment process and into post-recovery follow-up to prevent relapse.
52	52	20 (d) Patient navigation and care coordination services- services offered by an ACO
53	53	21through Patient Engagement Advocates with the goal of removing barriers that prevent patients
54	54	22from seeking care, helping a patient follow through with a recommended course of treatment,
55	55	23and maintaining their gains after treatment:
56	56	24 Section 2. (a) All Accountable Care Organizations (ACOs) in the Commonwealth
57	57	25certified by the Health Policy Commission shall offer patient navigation and care coordination
58	58	26services as defined below for patients with a diagnosed mental illness or substance use disorder
59	59	27and for patients with symptoms that suggest a possible mental illness or substance use disorder
60	60	28as determined by a licensed health care provider. These services shall constitute a requirement
61	61	29for the certification of new ACOs by the Health Policy Commission and shall constitute a new
62	62	30requirement for existing ACOs six months following the effective date of this act. The services 3 of 6
63	63	31are to be offered by Patient Engagement Advocates with the consent of the patient. One Patient
64	64	32Engagement Advocate may be assigned to multiple patients, but each patient must be assigned to
65	65	33a primary Patient Engagement Advocate. In ACOs where multiple navigators are managing
66	66	34different components of a patient’s care, the Patient Engagement Advocate will serve as the lead
67	67	35navigator that coordinates care among the other navigators. The services provided as part of the
68	68	36Patient Engagement Advocate Program shall include, but not be limited to the following:
69	69	37 i. Performing an initial intake to assess the patient’s needs. If the patient does not have a
70	70	38diagnosis, the Advocate shall refer the patient to a clinician who can determine their condition
71	71	39and recommend a plan of action/course of treatment. This may involve referral to additional
72	72	40specialists. Once a diagnosis has been obtained, the Advocate, with the patient’s consent, shall
73	73	41help the patient follow through with the plan of action set forth by the diagnosing clinician;
74	74	42 ii. Finding an appropriate provider to treat the condition(s) if outside the expertise of the
75	75	43clinician who provided the initial diagnosis, including contacting and screening providers on the
76	76	44patient’s behalf;
77	77	45 iii. Assisting with navigating health insurance; including but not limited to, helping the
78	78	46patient understand cost-sharing, finding in-network providers, assisting with referrals, assisting
79	79	47with appeals, explaining benefits and helping the patient find new insurance during open
80	80	48enrollment periods or due to a qualifying life event if their current insurance plan does not meet
81	81	49their needs.
82	82	50 iv. Finding alternative sources of support if a patient is put on a waiting list, including,
83	83	51but not limited to, coordinating with the patient’s primary care provider, exploring
84	84	52complementary therapies that could offer relief, online counseling and peer-to-peer support; 4 of 6
85	85	53 v. Scheduling initial appointments for patients and reminding them to go to their
86	86	54appointments.
87	87	55 vi. Providing or coordinating transportation to appointments if this is a potential barrier to
88	88	56care;
89	89	57 vii. Providing support with medication adherence to ensure patients take the medications
90	90	58prescribed by their clinician.
91	91	59 viii. Provider-matching follow-up to see if the current provider is a good match and if
92	92	60not, finding a different provider. Patient Engagement Advocates will continue to check up on
93	93	61patients as they receive treatment as an additional source of support;
94	94	62 ix. Coordinating care between the patient’s PCP and different specialists treating the
95	95	63same patient to ensure they are communicating with each other;
96	96	64 x. Post-treatment follow-up to ensure that patients are maintaining their gains and do not
97	97	65relapse; and
98	98	66 xi. Additional duties may be designated by the commission in consultation with ACOs,
99	99	67health plans and patient advocates.
100	100	68 (b) All primary care providers within an ACO shall directly connect patients with a
101	101	69diagnosed mental illness or substance use disorder, or with symptoms suggesting a possible
102	102	70mental illness or substance use disorder to the Patient Engagement Advocates prior to discharge
103	103	71or within 7 calendar days following a discharge by the primary care provider. With the patient’s
104	104	72consent, such Advocate shall work with the patient to identify an appropriate behavioral health
105	105	73specialist for the patient’s needs and shall work with the patient to eliminate all barriers to 5 of 6
106	106	74accessing such specialist. The Patient Engagement Advocates shall follow up to ensure the
107	107	75patient gets an appointment.
108	108	76 (c) If a patient diagnosed with a mental illness or substance use disorder in an acute care
109	109	77hospital or emergency facilities affiliated with an ACO refuses further treatment after the
110	110	78evaluation is complete, and is otherwise medically stable, the acute care hospital or emergency
111	111	79facility may initiate discharge proceedings; provided, however, that if the patient is in need of
112	112	80and agrees to further treatment following discharge and pursuant to the mental health or
113	113	81substance use disorder evaluation, then the acute care hospital or satellite emergency facility
114	114	82shall directly connect the patient with a patient engagement advocate prior to discharge or within
115	115	83seven calendar days following discharge, and shall notify the patient’s primary care provider if
116	116	84applicable.
117	117	85 (d) ACOs shall not restrict referrals to only behavioral health specialists who are part of
118	118	86the ACO.
119	119	87 (e) Non-behavioral health specialists within the same ACO whose patients also present
120	120	88with symptoms of mental illness or substance use disorder shall inform the patient’s PCP of a
121	121	89possible behavioral health issue within 7 days of identifying non-emergency symptoms. With the
122	122	90patient’s consent, the PCP shall then refer the patient to a Patient Engagement Advocate, as
123	123	91described in paragraph (a). For all emergency symptoms, the patient shall be referred to the
124	124	92nearest emergency room.
125	125	93 (f) ACOs that already offer the above services described in subsections (i) through (x) for
126	126	94all patients diagnosed with or presenting symptoms of mental health and substance use disorders
127	127	95shall not be required to hire additional staff to comply with this section. Employees of ACOs that 6 of 6
128	128	96currently offer these services shall be exempted from certification requirements in subsection (b)
129	129	97of section 1.
130	130	98 Section 3. The Secretary of Health and Human Services shall provide funding for at least
131	131	99one pilot program with a community-based organization that offers the services described above,
132	132	100and in addition, offers the following:
133	133	101 (a) Patient, caregiver and survivor services, including the Patient Engagement Advocates
134	134	102defined in Section 1; e-support networks; financial counseling; referrals to online Cognitive
135	135	103Behavioral Therapy (CBT) and for complementary, integrative therapies; and an evidence-based
136	136	104patient empowerment program, designed to give patients the tools to improve their self-concept,
137	137	105develop the confidence to seek treatment, and maintain their gains following treatment; and
138	138	106 (b) Patient empowerment, information and communication initiatives through a blog,
139	139	107public service announcements, patient stories, utilization of social media, videos and educational
140	140	108campaigns; and
141	141	109 (c) Provider education on the effects of stigma on patient engagement in treatment; on
142	142	110best practices for reducing stigma in clinical settings; strategies for integrating behavioral health
143	143	111into primary care; and strategies to maximize patient engagement in their own treatment.
144	144	112 Section 4. The Health Policy Commission shall promulgate regulations to implement the
145	145	113provisions of Sections 1 and 2 within 3 months of the effective date of this law.