Behavioral Health & Substance Abuse Services: Massachusetts Proposal Reflects Focus on Expanding Access and Coverage

Click HERE to read about the Proposed Facility Fee Ban.
Click HERE to read about the Proposed Massachusetts Primary and Behavioral Health Care Spending Requirement.
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Massachusetts House Bill 4134 includes several provisions aimed at expanding access to treatment for mental health and substance use conditions in the Massachusetts Commonwealth. Most notably, the Bill would require providers and payers to increase spending on behavioral healthcare by 30% over the next three years. As described in a previous Healthcare Law Today post, Governor Baker proposed this spending provision in order to address the increasingly challenging nature of addiction and behavioral health issues.

In addition to this 30% increased spending requirement, the Bill includes a variety of provisions which appear intended to broaden the mental health parity laws that are already applicable in the Commonwealth and to ensure that Commonwealth residents facing a substance use disorder or mental health issue receive the most appropriate care on a timely and cost-efficient basis.

Mental Health Parity

The Bill would require insurers, non-profit hospital service corporations, medical service corporations, and health maintenance organizations (HMOs) to submit utilization reports to the oversight agency in order to demonstrate compliance with existing mental health parity laws. These utilization reports would include the number of requests, approvals, denials, denial appeals, and approved out-of-network services for behavioral health and non-behavioral health services. The Division of Insurance would use these utilization repots to determine whether each carriers’ network provides adequate access to covered behavioral health services.

Further, the Bill would require the Commissioner of Insurance to promulgate regulations requiring reimbursement rates be the same for evaluation and management services whether provided by licensed mental health professionals or primary care providers.

Behavioral Health Provider Availability

The Bill includes several provisions that would have the effect of increasing availability of mental and behavioral health providers. First, the Bill would require the Department of Public Health (DPH) to promulgate regulations requiring acute care hospitals to provide qualified behavioral health clinicians to evaluate, stabilize, and refer for appropriate treatment or admission, all patients admitted to the emergency department with a behavioral health presentation. 

Moreover, the Bill would require DPH to promulgate regulations regarding licensure of urgent care clinics. These regulations would include requirements that urgent care clinics provide behavioral healthcare services.

Increased Behavioral Health Coverage

The Bill proposes requirements regarding insurance coverage of behavioral health services. Under the Bill, insurers, non-profit hospital service corporations, medical service corporations, and HMOs would be prohibited from denying coverage for any behavioral healthcare or any evaluation and management office visit solely because the two services are delivered on the same day in the same practice or facility. However, the Bill does reserve for insurers the right to deny coverage if the two services are provided on the same day by the same provider—or providers—of the same specialty.

Admission to Mental Health Facilities

The Bill would grant advanced practice registered nurses (APRNs) authority with regards to voluntary and involuntary admission to mental health facilities. First, an APRN would have the authority to determine whether patients have the capacity to voluntarily admit themselves to a facility. Second, APRNs would, like physicians, have the authority to require the restraint of patients for involuntary admission to a mental health facility under Massachusetts General Laws chapter 123, section 12 (a).

Addiction Recovery Coaches

Finally, the Bill would establish a board of registration of “Recovery Coaches” within the Department of Public Health to license and regulate recovery coaches. The Bill defines a “Recovery Coach” as an individual who has “lived experience” of addiction and recovery from a substance use disorder, with at least two years of sustained recovery, who uses shared understanding, respect and mutual empowerment to help others become and stay engaged in the process of recovery from a substance use disorder. It remains to be seen to what extent payers will cover the services of these “Recovery Coaches,” but the creation of a regulatory regime governing “Recovery Coaches” seems like an important first step in recognizing that successful, long-term recovery from a substance use disorder often requires community support at a lower level of clinical care.

With the Bill, the Baker Administration clearly demonstrates its commitment to increasing access to behavioral health care and substance use services through enforcement of mental health parity, increased access to providers, and coverage of behavioral health services.