Testimony in Support of House 1070/Senate 1093 before the Joint Committee on Mental Health, Substance Use and Recovery

The Massachusetts Medical Society wishes to be recorded in support of SB1093/HB1070, An Act to further define medical necessity determinations. The Medical Society believes all patients should have ready access to appropriate mental and behavioral health care. This bill supports that goal by ensuring that determinations of medical necessity in mental health care will be made by physicians in consultation with patients. Medical necessity is, as the name suggests, a medical determination, which ought to be made through the shared decision making model of clinician-patient collaboration, and without intrusion by the health insurance companies.

The Medical Society’s policy particularly emphasizes the importance of ensuring access to mental health services given the stigma and burdens often associated with seeking mental health care. Our policy states that “all insurers offering mental health services [ought to] adhere to the following principles”:

“Maintain an acute awareness that patients often feel stigma in seeking mental health services. Because of this, there must be…active efforts to insure patient dignity and elimination of potential barriers to service, such as voice mail mazes, unnecessary intake questions and difficulty accessing providers…Eliminate burdensome, redundant, and not clinically useful paperwork.”

This bill supports insurer compliance with the above guidelines; therefore, the Medical Society views this legislation as important advocacy for this vulnerable patient population.

We wish to state, however, that this bill ought to be expanded to apply to all health services, and not only to mental health, for reasons of both parity and justice. Our policy states that insurers offering mental health services ought to adhere to the principle of parity, such that “review and authorization processes should be no different than those for physical illness.” We therefore urge that, in accordance with that principle and with our points above, medical necessity across both physical and mental health care services ought to be determined exclusively by physicians, in consultation with patients.

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