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