SB1103, HB2394, SB1097, SB1096, HB2402, HB2397, SB1101, SB1094, HB2269, Access and Treatment Legislation

Joint Committee on Consumer Protection and Professional Licensure

The Massachusetts Health and Hospital Association (MHA), on behalf of our member hospitals, health systems, physician organizations, and allied health care providers, appreciates the opportunity to submit comments on legislation related to improving access and treatment for behavioral health services.

MHA supports SB1103, which amends Chapter 258 of the Acts of 2014 to require expanded insurance coverage for acute treatment services, clinical stabilization services, and residential treatment services for up to 30 days for patients in need of addiction treatment, so long as the service is medically necessary. By building upon the period of 14 days of coverage for acute treatment and clinical stabilization services that are currently required by Chapter 258, this bill will help ensure needed coverage for clinical services. Research indicates that longer stays in addiction treatment can be beneficial to those suffering from substance use disorder. Accordingly, this legislation ensures that willing patients will have coverage for up to 30 days of treatment if the treating clinician believes such a course is medically necessary. The treatment period is not mandated – under SB1103 the decision on whether to pursue 30 days of treatment remains with the doctor and patient.

SB1103 also expands coverage for residential treatment services that was limited by a recent Division of Insurance (DOI) interpretive bulletin. The DOI bulletin states that residential substance use disorder treatment services that fall within the American Society of Addiction Medicine (ASAM) Level 3 service category should be covered by the health insurers, but only requires such coverage for in-network providers and only if an insurer chooses to include this benefit. Residential rehabilitation treatment settings are a necessary option for patients who must develop, practice, and/or demonstrate the recovery skills necessary to avoid immediate relapse and continued substance abuse. SB1103 ensures there will be appropriate insurer coverage for residential treatments settings (defined as transitional support services or TSS) for a period of up to 30 days, provided that the service is medically necessary. Last session, a CHIA “mandated benefit” analysis of the premium cost impact of requiring coverage by fully-insured health plans for TSS indicated that such a mandate from the state would result in an average annual increase, over five years, to the typical member’s monthly health insurance premiums of one to three cents per month, or less than 0.01 % of premium.

The bill additionally directs a review of statewide access to these services for patients who may not have a residential service provider in their local community or within their insurer’s provider network. MHA believes all of the provisions contained in SB1103 will advance patient care and help the Commonwealth fully realize the promise and goals initially set forth by Chapter 258. We urge the
committee to issue SB1103 a favorable report. MHA also supports HB2394 as it seeks to extend the coverage period for these critical services to 30 days.

MHA supports SB1097. This bill will establish an adolescent substance use prevention and early intervention trust fund and allocate 3% of the excise taxes from the sale of commercial marijuana to support evidence-based adolescent substance use prevention programs. Prior to commercial legalization, the Centers for Disease Control and Prevention indicated that adolescent marijuana use in Massachusetts was already higher than national averages. Forty-one percent of teens in Massachusetts have tried marijuana (3% higher than national averages) and 25% are current users (again, 3% higher than the national average). The National Center on Addiction and Substance Abuse at Columbia University has indicated that teen substance users are at significantly higher risk of developing an addictive disorder compared to adults and the earlier that they begin using, the higher their risk. The adolescent brain is in the process of active development and regular youth use of marijuana may lead to lower academic performance and increased risk for mental health problems. The advent of commercial marijuana legalization has been demonstrated to decrease youth perception of the risks perception of marijuana use. Because of this, MHA believes it is essential that the commonwealth bolster evidence-based adolescent substance use prevention programs, and the dedication of taxes associated with the sale of recreational marijuana is a prudent use of these funds.

MHA generally supports the principles of SB1096, HB2402, and HB2397, which would require the state to develop a voluntary process for providers to be trained in the use of naltrexone to help care and treat patients suffering from an opioid overdose. HB2397, in particular, looks at methods to expand access to naloxone outside of a prescription. MHA supports the state in its efforts to develop ongoing provider education for addressing opiate overdoses and other statewide efforts that seek to address the opioid overdose epidemic. Additionally, MHA also supports SB1101, which seeks to limit the out-of-pocket costs for consumers seeking to purchase naloxone.

While MHA may agree with the intent of SB1094, we are opposed to the bill, as drafted. In particular, the bill directs a statewide study of the provider community to determine what operational and clinical changes should be mandated through the Accountable Care Organization (ACO) certification process at the Health Policy Commission (HPC) to improve access to evidence-based behavioral healthcare. Recently, the Executive Office of Health and Human Services (EOHHS) issued a work plan that was developed over the last year with stakeholders, including hospitals and insurers, which outlines several specific recommendations aimed at opening up access to, and insurance coverage for, behavioral health services. One of the key recommendations is a study by the Division of Insurance (DOI) to determine the gaps in coverage and payment by insurers to determine if insurers have appropriately addressed the issue of “mental health parity” for those accessing behavioral health services in the state. Another EOHHS recommendation is for a joint workgroup of payers and providers and other stakeholders to improve the overall communication and care coordination between behavioral health care providers and insurers in an attempt to break through barriers that have impacted the ability to move patients effectively and efficiently through the behavioral health continuum to ensure all patients receive timely care in the most appropriate setting. Because of the many ongoing initiatives in this area, we believe the study directed at the provider community in SB1094 is unnecessary and would be redundant in nature. Even more concerning is the recommended mandate on ACOs sought by this bill. In the absence of further directives requiring that insurers offer adequate payment for behavioral services, or improving access to community-based services outside of an ACO, this mandate sought by this legislation would likely force an increase in costs and, perhaps, endanger the maintenance of needed services for behavioral health patients.

MHA is also very concerned with HB2269, which establishes a psychiatric advanced care directive within the health care proxy laws. It is important to note that the healthcare proxy provides patients with stronger patient rights to determine appropriate care, whereas the psychiatric advanced directive as outlined in HB2269 would be limited to specific care and treatment that may change depending on the needs of the patient over the course of treatment. For this reason, we urge the joint committee to carefully consider the necessity of advancing HB2269.

Thank you for the opportunity to offer testimony on these issues. If you have any questions or require further information, please contact MHA’s Vice President of Government Advocacy, Michael Sroczynski, at (781) 262-6055 or msroczynski@mhalink.org.