Testimony Relative to Legislation before the Joint Committee on Mental Health, Substance Use and Recovery

A longstanding priority of the Massachusetts Medical Society (MMS) is the enforcement of state and federal parity laws and reduction of behavioral health boarding in emergency departments. For many years, the MMS has worked cooperatively with state health care leaders, providers, advocates and other professional health care organizations on Committees, Commissions, Taskforces and Working Groups all seeking the same goal – equal coverage and access to care for mental health and substance use disorders as for physical health conditions.  

The lack of parity and inadequate resources especially for dual diagnosis and other difficulties placing patients leads to “boarding” of patients in emergency departments. Studies have shown that mental health patients stay in emergency departments awaiting appropriate placement and treatment approximately twice as long as medical/surgical patients.  This isn’t good clinical practice, nor is consistent with the humane intentions behind passage of state and federal mental health parity laws.

The MMS feels strongly that all patients – regardless of source of health insurance coverage - requiring mental health evaluations, treatment or emergency evaluations should not suffer greater impediments to the coverage of their medically necessary services than victims of an accident, patients with hypertension or patients with any other legitimate medical need.  

With these principles in mind, the MMS wishes to be recorded in support of the following bills that would help reduce emergency department boarding and ensure fairness and consistency with state and national mental health parity initiatives:

  • H.2404, An Act to Improve Access to Behavioral Health Services (Malia)

This bill would remove pre-authorization requirements for MassHealth patients seeking inpatient psychiatric care. Because all private and Medicare coverage options already allow inpatient behavioral health services without a prior authorization requirement, this provision would implement true mental health parity. H.2404 would also help reduce ED boarding by requiring EOHHS to create a streamlined process allowing inpatient admission from the community, rather than solely from emergency departments; and requiring the creation of a database of existing behavioral health services across Massachusetts, which will help identify resources and gaps in care.

  • H.2399, An Act Providing Equitable Access to Behavioral Health Services for Masshealth Consumers (Malia)

This bill would ensure parity for MassHealth patients.  The bill will ensure comparable access to behavioral health services and medications by all contracted health insurers, health plans, health maintenance organizations, and behavioral health management firms providing medical assistance to MassHealth recipients.  It will increase transparency, access to care and ensure consistancy among all contracted providers of MassHealth services and would be a significant step towards full parity.

  • H.1070/S.1093, An Act to further define medical necessity determinations (Khan/Flanagan)

This bill would require that all medically necessary services for MassHealth and private insurance mental health services must be determined by the treating clinician in consultation with the patient and noted in the patient's medical record.

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