2023-12-04 00:00:00 - Joint Committee on Mental Health, Substance Use and Recovery
2023-12-04 00:00:00 - Joint Committee on Mental Health, Substance Use and Recovery
SHOW NON-ESSENTIAL DIALOGUE
SPEAKER1 - Late. But a busy day for us
SPEAKER2 - at the state house as I'm sure
SPEAKER1 - you all heard. But thank you for your patience, and thank you for being here today. Good afternoon. My name is Adrian Modroad, chair of the, mental health Constitution recovery committee on the house side. We, will be joined, I believe, by, my senate co chair senator John Vilas. Like, the house had to tackle the sub budget earlier. I believe they are27 also informal in informal session trying to get that done. So, he should be joining soon.
Today, we are, hearing testimony on 20 bills, before us concerning studies and commissions and health plan requirements. We'll start with the 12 bills related to studies and commissions and then move on to the remaining 8 bills related to health plan requirements. I don't wanna take up too much time, but I wanna just quickly review, the process before we begin. Please be aware that today's hearing is being recorded and streamed live. There will be an archived copy made available on legislature's website. Due to the hybrid nature of this hearing, those wishing to provide testimony, virtually were required to sign up in Vance, if you are not able to testify today, you can submit written testimony at any time. Also, we do limit testimony to 3 minutes. So if you have longer testimony, please77 feel free, to send us that, in an email. Due to their schedules, it is our policy to take elected officials out of turn to testify. All other speakers will be test at the call to testify in the order of the bills being heard. Again, testimony, is limited to 3 minutes. You'll hear a timer go off, at At the 3 minute mark. So once you hear that timer, please, wrap up your testimony. Again, if you have longer comments, you can submit that via written testimony. After each speaker, committee members will be given the chance to ask questions. Speaking of our committee members, we're joined by representative Tram Nguyen, representative Donahue, Representative Exaros I saw somewhere. I'm sure he114 will be back momentarily. I don't think anyone else is online. Right? No. Okay.
I wanna thank, LIS and the assistant sergeant of arms for facilitating the hybrid hearing as well as our amazing committee staff for their diligent work in preparing for today. And finally, I wanna thank all of you for taking time out of your busy lives and schedules to be here, to share your important perspectives136 on the issues She's before us. So without further ado, we will, call out of turn leader O'Day, who will be on a panel with Lydia Conley, from ABH, and they're here to testify on h 2006.
SPEAKER3 - Lydia, mister Leiter, welcome.
REP O'DAY - HB 2006 - Mr. Chairman, thanks so much for taking this out of And it's great to be in the State House today taking care of business, so thank you very much. And to the committee members, thank you so much. And as you've mentioned, I do have CEO of the American Association of Behavioral Health. We're here today to speak on House bill 2006 and that is a bill relative to rates of service. And as we know here in the House that we hear almost daily from families and from clinicians the struggles193 that we are having with so many families, so many young children, and from clinicians who are trying to provide services to these families and to these children that, you know, it has been a very difficult road, over the last handful of years.
Certainly, prior to the pandemic, which has certainly thrown a number of our children off their path, and prior to that, we were already dealing with the opioid epidemic. And regrettably, those matters still, greatly, are in front of us. And so, you236 know, those who treat individuals with behavioral health and mental health issues have a very, very difficult job. And so this particular bill is an effort to try to help, encourage more clinicians to come253 into this field. And as you may or may not know that, you know, clinics, are really a training ground for burgeoning clinicians. So in order to really get all of your licensure, you need to be able to say that you were supervised by a more senior clinician. And those individuals are located in our mental health clinics. So in order to get the training, we need to have clinicians of supervisory status who can provide those services. This bill attempts to address those needs along with, you290 know, speaking about the actual cost of the amount of money that they are reimbursed.
And this bill asks that for all mental health services that we provide a 5% Increase, and to those that run the clinics a 20% increase. I think by doing that we will continue to encourage more clinicians to come and provide the services that we hear about daily from our constituents and from the clinicians themselves that we are not being able to reach everyone we need to reach. And I guess329 the last point that I will make that, 1983, I began my career as a social worker for the335 Department of Social Services. And even back then, we had waiting lists. Even back then we had a little bit of a shortage of clinicians. Today, it's far greater and much more of a unilateral problem. So with that, I hope that the committee can look favorably upon this bill and give it a nod to pass. And with that, I will pass the microphone to the microphone to Miss Conley.
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Thank you, representative.
SPEAKER4 - Can you hear me? Yes. Yep. Okay.
LYDIA367 CONLEY367 -367 ABH367 -367 HB367 2006367 -367 Mr.367 Chair,367 committee,367 thank you very much. I'm Lydia Conley from the Association for Behavioral Healthcare. I'm president and CEO. I'm here today in support of House 2006, which as the representative indicated, would require378 a 5% rate increase for all outpatient services and then a greater increase for services delivered via mental health clinics. ABH is a statewide association, we represent more than 80 behavioral health provider organizations, and three quarters of our members operate state licensed mental health clinics that contract with MassHealth. Clinics are important to MassHealth members and to the larger community for a variety of reasons.
Clinics offer therapy services to individuals with MassHealth and private health insurance at a time when many therapists don't take insurance anymore. They offer psychiatric prescribing for anxiety, depression, and other illnesses at a time when psychiatrists often don't take insurance anymore. And as Representative O'Day indicated, they also train the future workforce. So clinics really are the training setting where new therapists gain required experience in order to practice on their own. Basically, clinics are the state's behavioral health workforce engine. The therapists that train in clinics go on to work in schools, they work in health systems, hospitals, primary care practices and private practices. But whether they remain the state's behavioral health workforce engine is really questionable.
In 2022, ABH released a summary of a survey that we did, and the findings were very alarming. So in addition to the things that Representative O'Day talked about, so there's wait times of 13 to 16 weeks to get into services. At that time, there were 14,000 people on wait lists amongst our members. But what was really stunning to us was that for every 10465 therapists that clinics hired, 13 left. So this is troubling not just for clinics but for all of us. So if we're not training sufficient new staff to meet with this rising demand for behavioral healthcare, the stories that we see every single day in the papers are only gonna get worse. Under MassHealth rules, clinics have to offer, they have to have a psychiatrist, they have to have different types of therapists, they have to have a medical director. They have to have a mandatory range of therapy services, staffed after hours coverage, and minimum operating hours.
And private practices don't have those same requirements but in setting rates, MassHealth pays the same502 rates for services delivered in a clinic versus the private that doesn't have those same requirements. So you're gonna hear later in the afternoon from a panel of providers that are gonna talk about the state of their clinics and the role that rates play in increasing access and quality under516 the MassHealth framework. Investment in mental health is really the solution to the dual problem of access delays and insufficient workforce across our delivery system. And so I join the representative in asking respectfully that the committee report the bill out favorably. I'd also just like to briefly add that in addition to House 2006, we strongly support Senate 1248, which is an act to increase investment in behavioral healthcare in the commonwealth, which would rebalance expenditure towards behavioral health. And so what this really would do is a really required remedy to address the structural under resourcing of behavioral health access shortages. And so thank you for your consideration. SHOW NON-ESSENTIAL DIALOGUE
SPEAKER1 - Thank you, leader of555 all day. Do we have questions from committee members?
Alright. Here we're done.561 Thank you. That's wonderful. Thank you.
Are you ready? Are you ready? You still I'm away. Okay. Next, we will hear from representative Adam Scanlon, who is here to testify on s 1253. Welcome, representative.
REP SCANLON - SB 1253 - Good afternoon Mr. Chair. So good afternoon. I come before you to express my strong support of S 1253, an act to remove administrative barriers to behavioral health services filed by Senator Keenan in the Senate and filed in House by Rep Donaghue and myself who has been staunch advocate on many of these issues for a lifetime and thank her for her service. I filed the House version with her that was referred to Financial Services, and the senator's bill is in this committee, but we wanted to lend support for it as well. I am glad to have the expertise of both community members at work in considering its importance.
This bill would amend the current law to expand the number of behavioral health settings in which care must be covered without prior authorization. It would require determination of a treatment being of medical necessity be made by a patient's trained treating clinician. These reforms would return decision making power back to doctors and patients and limit the power of insurance companies to deny or delay the provision of necessary care. Currently, the law requires coverage without prior authorization only for various acute forms of mental and behavioral health treatment. The timely access to treatment with as few barriers as possible is just as needed when it comes to non acute treatment in inpatient psychiatric facilities and outpatient substance use disorder facilities. And the barriers that currently exist can be684 extra difficult to navigate when under distress of a mental health issue and trying to navigate the requirements to access treatment.
This bill would also impose more restrictions on denials of claims and more limits on when insurers were allowed to recoup payments already made requiring them to provide a detailed written explanation for doing so when allowed. These708 provisions would further ensure that treatment decisions are made by medical experts rather than the agents of insurance companies concerned only about the bottom line. I urge any interested legislators in getting in touch with either myself, Rep Donaghue,723 or723 Senator Keenan to discuss this technical but very critical legislation to ensure that residents of the commonwealth are able to get the mental and behavioral health treatments they need.
Mental health is often considered secondary to physical wellness by some who maintain positive mental health is vital to our overall health.741 This is clear from witnessing how the opioid epidemic has affected so many families and communities, but it applies even748 more broadly. Too many of us have known someone that had fallen victim to the opioid crisis and addiction in general. And it's time we actually get serious and pass meaningful and very important Legislation. I think we all agree that enough is enough, and the addiction crisis doesn't discriminate against any person, political party, class, or any sort of, background. We can get something done in this session, and775 I hope we do. And thank you Senator Velis for joining us. Thank you. SHOW NON-ESSENTIAL DIALOGUE
SPEAKER1 - Thank you, representative. Yes. Wanna wanna acknowledge that, my wonderful co chair, senator Villas, is with us. Any questions Committee members. Please. Go ahead, professor.
REP DONAGHUE - Thank you.791 Thank you, rep. I just want to lift up what the representative said. And in addition to the fact that decisions would be being made by, instead of decisions being made by, insurance folks, decisions would be made by providers. And the providers would be able to spend more time in direct care812 and less time spending all of their time working to get817 approvals. So I just wanted to add that testimony to821 yours. Thank you. SHOW NON-ESSENTIAL DIALOGUE
SPEAKER1 - Thank you. Any other823 comments your questions?
SPEAKER9 - Mister chairman, just be briefly, if I may, just apologizing to everyone. We are taking up a supplemental budget bill today. Certainly, no disrespect intended wait for this hearing today. Happy to be here with folks. I will likely have to get up again shortly, but just happy to be here. Thank you.
SCANLON - HB 2004 - One more thing, Mr. Chairman. I just wanted to lift up the legislation brought forward by845 Rep Nguyen regarding the sober homes. I think that's a very important issue849 and I'm glad that she filed that and I hope we can get that approved. SHOW NON-ESSENTIAL DIALOGUE
SPEAKER1 - Thank you.
Alright. We are now gonna go in the order of the bills that860 were listed in the hearing notice. First up, we're gonna hear h 2004, an act to Establish a special task force on the869 best practices for silver I'm speaking of representatives.871 In Winsville. We873 have a panel, consisting of Kristen Long and Don Roach,
welcome.
You'll get 3 minutes on each.
SPEAKER7 - Aren't you guys late?
SPEAKER1 - Sorry. 3 minutes total.
SPEAKER10 - That's not a problem.896
SPEAKER1 - Yep. I was a lot of minutes. I was I was being directed by my staff.
SPEAKER10 - So what do I do?
SPEAKER11 - So you902 could submit
SPEAKER1 - You could submit the rest of your written904 testimony. Oh. Okay.
SPEAKER7 - Okay. Alright.
KRISTEN WONG - CONCERNED CITIZEN - HB 2004 - HB 2012 - Good afternoon and thank you for having us. My name is Kristen Wong, I'm a mom of five beautiful children, two who are in Recovery today. I have been working in the field, boots on the ground, for over 17 years. I currently work for a company that is a not for profit and only deals with MassHealth and it has been very eye opening. As far as sober homes go,934 well, this is a great idea, but who's gonna follow-up, on it? Who's gonna, like, actually implement any changes, or guidelines, or anything like that and actually follow-up on it?
Because we have MASH, and MASH is supposed to have all these guidelines and everything else, and we know how that's been turning out. There needs to be supportive services for the sober home employees, from the house managers to the owners. There needs to be reinforcement and support around what's going on. A lot of these people have firsthand experience. Their managers are maybe two, three months sober, and, you983 know, I could probably985 rattle off a couple dozen house managers that have died from overdoses while being managers of sober homes. So there needs to be a lot of reinforcement and support around that.
BHJI uses MASH certified housing in their guidelines, but a lot of these houses do not have support around the prison population. I know this firsthand because we are plugging and playing people that are getting out jail, long stents of1015 jail, and putting them in sober homes where there are people that are less than 30 days sober. And we're putting them into houses where they have years of sobriety, and it's just a stipulation. And there needs to be a better definition as to where you are plugging in people that are, you know, BHJI. That's really all I have to say. SHOW NON-ESSENTIAL DIALOGUE
SPEAKER8 - You can talk about your other what? You can talk about your other1043 bills in here.
SPEAKER7 - You have time.
WONG - 2012, this one is an act creating a commission to reform Section 12. In that committee, there needs to be suggest, there should be people that have firsthand knowledge and firsthand lived experience on the Section 12. It's a great bill but it's not long enough. 72 hour hold with somebody who has dual diagnosis, they sober up and they can talk themselves out of, you know, a Section 12. Or you have the other people that hurt themselves to get the help because there's no substance use help available to them currently, and then they're discharged from the hospital when they're asking for help. So firsthand lived experience will give you a lot of insight as to what is wrong with Section 12. SHOW NON-ESSENTIAL DIALOGUE
Can I keep going? No.
SPEAKER1 - But you can submit everything via written testimony, and it will be reviewed. Okay?
DAWN ROCHE - YSAC - HB 2004 - So thank you for allowing me to speak today. My name is Dawn. I'm from Yarmouth, Mass. I'm a board member of the Yarmouth Substance Awareness Committee and also Parents Supporting Parents, which is an all volunteer nonprofit organization peer group that offers resources and hope, sober living scholarships for those to continue their road to recovery. Also, I began the Cape's first overdose awareness events, August 31st, in memory of my child, Trevor. So most importantly, I'm a mother of two. I speak today as a mother of a wonderful young man who1146 did everything1148 possible, he did, and we did to help save him. My son was murdered by fentanyl, July 6th, 2018.
We need to fix the system sectioning across the board. On the cape alone, since November 20th, which was just 13 days ago, five parents have lost a child to drugs and substances. Our kids matter at any age. On the average one person passes every eight minutes, which I'm sure you guys are all aware of. We need to get tougher on the career criminals and the drug dealers. We need to stop the plea bargaining of repeat offenders, secure the border, which we all know, increase detox and rehab facilities. On the Cape, we have very few. We need to stop letting the broken walk out of hospitals after sectioning and being released. This is the exact timing for the medical professionals to provide a mandatory hold on those who need further treatment.
I know I'd rather have my son in a locked down facility, getting the resources and the professional help that he needs, than to have his remains at home with me today. We need to enforce the laws that we have in existence to save our children. These laws were established for a purpose and a reason. Nothing changes if nothing changes, and when is enough enough? We must do better as Americans. Please support the bills that we all have brought forward with you today. Thank you, and have a blessed holiday with your families.
DONAGHUE - I just wanted to say thank you for your courage in testifying and sharing your stories. And to echo what Miss Wong was saying about the lack of training of house managers. I think it's an area where a lot could be done and it would make a difference in people's lives.
SEN VELIS - And then just briefly, I share your concerns about sober homes. I1280 spend a good amount of time at them. And, obviously, I wanna clearly distinguish between those that are MASH certified and not. But in many respects I feel like there are some homes that are the wild west. In fact, I am, well, I've got a situation right now. I'm from the western part of the state where there's a home in question. And I just find it, you know, a lot of times folks are going into they might go in from a detox, they might be coming from some type of inpatient treatment, and then they get put into a home without knowing much about it. There's active using going on, whether it's the manager or others. And I don't know what the answer is because I don't want to, you know, the proverbial, throwing out the baby with the bathwater because I know there are a lot of homes that are not1335 MASH certified that are doing good things. So I don't
WONG - And they're being penalized because they're not MASH certified.
VELIS - So, I think exploring sober homes and doing a deep dive on what works and what doesn't is an incredibly worthwhile endeavor. So, I appreciate your your testimony today and very sorry about Trevor.
DONAGHUE - Can I just ask you to talk about, you were starting to tell me about your concerns about administrative discharge, your experience with that.1369
WONG - So, firsthand, I'll speak about an individual who's already lost a brother and a sister, the family's lost a brother and a sister. And this individual had to say goodbye to his brother while he was in MASAC, on the telephone, and missed the call from his sister. So there's a lot of PTSD around what happened to him. And he's a great kid, when he's sober, he's great. And he can be five minutes sober and he can be great. But what has happened is he self sabotages. He blames himself for the death of his brother and his sister for not being available for them. So he has self sabotaged in all of the programs in the state of Massachusetts, private and, now because he's 26, MassHealth, and he has been administratively discharged.
The reason being is he'll get three or four days of sobriety, and his depression, anxiety, and PTSD will kick in. And it won't be addressed, so he turns to where It is addressed, and that's to using. To1434 going1434 back out to the street and numbing that feeling, numbing that guilt, numbing1438 all of it. So across the board in the1440 state of Massachusetts, he has a very difficult time getting into treatment and staying in treatment because his mental health part of it is not being addressed. Most recently, he was at BMC Hospital. He had slashed his wrist. He was on Mass and Cas. Slashed his wrist, went in, and asked for help. He wanted help, he wanted to be sectioned. And the doctor said, you know, you're just coming out of being high, and you're miserable, and we're not gonna section you, and they cut him loose. And for the family, like, to think, you know, okay, he's gone in the hospital, he's asking for help, he's willing and to just be dismissed it's unacceptable. It really is unacceptable. And the administrative discharge has a huge definition. It can be whatever they decide is their administrative discharge. SHOW NON-ESSENTIAL DIALOGUE
Thank you. Thank you.
SPEAKER9 - Thank you. Thank you for your time.
SPEAKER14 - Thank you.
SPEAKER1 - Next, we're gonna hear from, senator Cindy Freedman, who's here to testify on s 1248 and s 1249. Welcome, senator.
SEN FRIEDMAN - SB 1248 - SB 1249 - Thank you so1524 much for allowing me to testify Mr. Chairs and members of the committee. I'm gonna first briefly talk about S 1248 which is an act to increase investment in behavioral healthcare in the commonwealth. This1538 is a bill that would direct that 30% of healthcare dollars go toward behavioral health. And we all know what the situation is, we all know what's happening out there, we all know how difficult it is to get access to treatment, we all know how difficult is to keep people in the workforce, and we know that care isn't being given, although the state has done a lot to try and address those issues. This bill simply says that we will increase the spending on healthcare over 2023 baseline for behavioral health. And that it further just defines that we can't increase the actual healthcare dollars.
So what we're trying to do with this bill is to shift the dollars, not increase the dollars. I'll be really honest, I think this bill is really important. And I think we need to continue to figure out how we monitor and oversee that those dollars are actually getting shifted to the places that we're directing them, and I think we need some more discussion around that. So, I wanna put that out there honestly because that's something that I think we're all working to try and figure out. What I'm really here to talk about is an act relative to reduce administrative burden. So, again, we all know that our healthcare providers are spending more time on administrative tasks and less time with patients. And this is leading to lower level of career satisfaction and incredibly high burnout rates for people in the profession, especially primary care.
We have got to reduce the administrivia in our healthcare system and support our health care providers, especially those in primary care. Most of the administrative costs and workload in our healthcare system can be attributed to one major area, billing and insurance related activities, one of them being prior authorization. So, at the risk of telling you what you already1680 know, we know the prior authorization is a healthcare insurance policy where providers1686 have to obtain approval for health insurance for certain services, treatments, and medications before they're able to deliver the care. Essentially, it is insurers, not healthcare providers, who are determining what care patients receive. And when insurers deny prior authorization requests, providers have to spend more time appealing the decision, and many providers do not have the extra capacity to do so.
So not only is it difficult for providers, but it's especially difficult and becomes a health equity issue when you're running a practice where the majority of your people are on Medicaid and Medicare.1731 This bill, and let me be clear because you'll hear from people, this bill is not to eliminate prior authorization. Prior authorization started for a very good reason, it goes in the 60s. And it was to cap unneeded and unnecessary care and treatment. But1752 what's happened over the course of the years, like so many things in healthcare, it's become about the money. And it's become now something that we need to bring way back in line with what the original purpose of prior authorization was. Now prior authorization is just an expensive and labor intensive process for providers.
And a lot of this comes from different criteria and forms across insurers for the same service, vendor carve outs and limited support from insurers. So one insurer can say this is a perfectly good medical reason for providing the service and another insurer can say, no, it's not. Well, how can that be? Who's making those decisions? In the survey conducted by the American Medical Association, physicians reported an average of 14 hours per week spent on completing prior authorization. And McKinsey estimated $35 billion is spent annually on prior authorization at the national level, which relates to about $2.5 billion1817 in1817 Massachusetts. Each prior authorization request can cost providers, providers, and insurers between $4.87 and $10.80. So that's money going from healthcare into anything but care.
Prior authorization has also become an impediment to care for patients. In a study on Medicare Advantage Plans and Medicaid managed care organizations, prior authorization denial rates ranged from 2% to 41%. Again, this is where our healthcare dollars are going. 94% physician surveyed by the MA reported delays in necessary care due to prior authorization. You will hear a lot today about automating prior authorization. It's important, it's gonna be helpful, but it is not gonna be the panacea that is being discussed and that you will hear from many of the insurers. We need to address the sheer volume of services and medications that require prior authorization and the lack of standards across the1889 insurers.
S 1249 would reduce prior authorization for services, treatments, and medications that have low variation and utilization across providers, low denial rates across carriers, and are considered evidence based for the treatment of management of certain chronic diseases. It would standardize the electronic prior authorization process. There is currently very, very little state level data on prior authorization, so it will require reporting by carriers. And most importantly, and I cannot stress this enough, it will remove the burden from providers and patients to solve issues with prior authorization. The patient, the patient, the patient should not be the one on the hook for trying to get care that they need. This bill would ensure continuity of care and require prior authorization approvals to be valid for the duration of the course of treatment or at least for one year.
It would also prohibit denying payment for medically necessary covered services on the basis of an administrative or technical defect in the claim unless the claim was submitted fraudulently. I want to eliminate, once again, it does not eliminate prior authorization. It simply removes the unnecessary and no longer effective barriers that are not only preventing care, but they are preventing people from doing their jobs. And I cannot stress this enough. One of the most important parts this bill is it will not solve the administrivia problem that is being inflicted in health care, but it sends a message to our providers that we are paying attention and that it really matters to us to make their jobs easier, to focus on actually delivering healthcare, and to stop being the gatherers of data for insurance companies to spend money. So I urge you, I urge you, I urge you to report this bill out favorably. SHOW NON-ESSENTIAL DIALOGUE
Thank you, senator. Thank you.
SPEAKER1 - Questions or Committee members.
VELIS - Senator, you mentioned just, and I think you referenced that already, the time period. So provider requesting that authorization some type of course of treatment. So talk to me a little bit about that time frame, how long it takes to get that authorization. And if it's denied and there's an appeal, how long that process plays out.
FRIEDMAN - So it really varies. I mean, sometimes you can wait a week, right? Especially if you hit a Friday for a weekend, you now have to wait to get an answer. And there's several steps to an appeal. So you send the documentation or you call up and somebody denies it, and usually that person is somebody on the customer service desk, right? And then you appeal it, and then you have to wait for a response. And then, ultimately, what will happen is that a provider is supposed to talk to a provider in the insurance space that is of your practice. So if it's OB/GYN, you talk to an OB/GYN doctor. But that doesn't always happen. That's what's supposed to happen, but I have had many doctors come to me and say, I just talked to a OB/GYN to try and get authorization for behavioral health med.
So it really varies and you can't be sure. What it does mean is that there's somebody in that office that's constantly having to follow-up to get that prior authorization. And it may be okay for Blue Cross Blue Shield, but it's not okay for Point32. And you're the provider, you don't know that. Even if one of the insurers says, hey, listen, we're gonna cut out 300 drugs from prior authorization. Well, that may be great, but you're at the doc, and you're sitting there, and you serve patients that have many different insurers. How do you know? You just go through the process, you have to go through the process. So, those are some of the impediments. SHOW NON-ESSENTIAL DIALOGUE
SPEAKER3 - Etcetera.
SPEAKER1 - Thank you. Any further questions or comments? Alright. Thank you, senator.
SPEAKER15 - Thank you. Thank you for keeping
SPEAKER1 - Certainly. And I'm gonna Go, back to testimony on h 2004. We have another panel signed up consisting of Eva and Ellen.
Welcome.
SPEAKER16 - So was hoping Helen would be here, but she had a medical emergency. So she'll be missing.
SPEAKER1 - Is okay.
SPEAKER16 - Yeah. Thank you. My name is thank you.
EVA MONTIBELLO - EAMMON'S HEART FOUNDATION - HB 2004 - First off, thank you so much to the committee for hearing my testimony. My name is Eva Montibello from Haverhill, Massachusetts, and I'm part of Eammon's Heart Foundation. Helen, is a woman in our community, one of my friends who lost her son to an opioid addiction. And she has created a2191 organization called the Eammon's Heart Foundation to help others in the community. We work on Narcan trainings, we work with Mass General Brigham, we work with Trinity Ambulance, we work with the Haverhill police and fire. So we're starting to really pull together all of the resources to help folks. And what we are testifying or what I'm testifying on2209 is House bill 2004.
2213 You2213 know, we're looking for guidelines for sober housing not regulations. But one of our opinions is that with public private partnerships, we can provide 360 degree wraparound services to support folks that may not have the skills that are needed to live a thriving life. One of the things that we constantly look at is adverse childhood experiences. And when you look at folks that are going into the prison system, or using substances, you know, one of the things that you can assume is that there is an issue2244 with coping. There's some type of mental health issue, some type of familial issue that is missing. So, you know, among the services that we think should be offered at sober homes are, you know, job support and training and career prep, including technology, skills, entrepreneurship, you know, dress, you know, all the way across the board.
Mental wellness, you know, in my dream, like, sober home, they would all have a mental health professional. They would have a doctor. I know that it's a little bit crazy to ask for, but, you know, it's my hope someday, financial literacy, and then also looking at the epidemic of loneliness and emotional support. How can we get people connected to their community with community support, whether that's volunteering or other things. And then, you know, the basics, you know, when you look at the pyramid, you know, health, food, medical care, make sure that all of their basics are handled as well as, you know, access to, like, lifelong learning and making sure that these folks have a future that they can live into.
When we have spoken to folks that have suffered from substance use and have recovered, one of the things that they say is that their future is brighter than what they go back to substances. So also thinking about how can we create, like, vision statements, mission statements, really help these folks, you know, find their own purpose in life. And then have everyone in the community, whether it be private public partnerships and really have them all be supported. You know, from the basic side, have an Excel spreadsheet with all of these things with two or three organizations in every city. In Haverhill, we're getting really close to knocking off all the boxes and we're working really hard to get it2349 done. SHOW NON-ESSENTIAL DIALOGUE
SPEAKER1 - Thank you for sharing that, and congrats on all your work in April.
SPEAKER16 - Thank you.
SPEAKER3 - Do
SPEAKER1 - we have any questions or comments from committee members?
SPEAKER17 - Thank you for
SPEAKER16 - your time.
SPEAKER1 - Again, whole public is okay.
Next, we're shifting to testimony on age 2012, a Creating a commission to reform section 12. 1st, we will hear from, Duncan, Dav, Sorry. Davia?
I'm not sure how to pronounce the last name. Sorry, Duncan. But, immediate past president of the Massachusetts Association of Physician Assistants.
Duncan, are you with us?
Okay. Well, while we wait on Duncan, I did just see, senator Keenan step in. So we will just, come back to you, Duncan, and we'll senator Keenan up here to testify on s 1253.
SEN KEENAN - SB 1253 - Thank you Mr. Chairman and Mr. Chairman, and members of the committee. I appreciate you taking me out of order, so I will be brief and reflect that appreciation. I'm here to testify on Senate 1253 which is an act to remove administrative barriers to behavioral health services. Currently, when in need of inpatient mental health services, MassHealth members face a long lengthy period of time before that authorization comes through. They face time where they are boarded in emergency departments, which I know is not news to you folks, and I appreciate the work that you're doing in all that. It's become pretty clear that if you have a behavioral health issue, particularly mental health issue, you're treated quite differently when you show up in an emergency department versus if you show up with a medical condition.
And just by way of quick anecdote, a while ago, when looking at this issue as it related in my home city of Quincy, we had asked at the time when the hospital was open for them to gather some data for us. And they gave us some information that showed quite strikingly the difference in how people are treated. On one particular day somebody appeared at the emergency department with a heart attack. The person came by ambulance, was brought in, brought into a room, stabilized, and within 45 minutes was transferred to a downtown Boston hospital. There's no issues routed to insurance, no questions about prior authorization. Person was stabilized and moved. That same day somebody appeared in the emergency department with an acute mental health situation.
The person was asked about insurance, the person was asked to wait, prior authorization calls went out, and the person waited and waited. Same day, two people in acute situations, one medical, one behavioral health. Medical, stabilized and moved in 45 minutes and the other person essentially boarding the emergency department. So it's something that's definitely in need of being addressed. And we know that many commercial insurers in Massachusetts have lessened the hurdles relative to getting treatment quickly. But MassHealth, believe it or not, lags a little bit in terms of doing away with prior authorization.
So this bill would ensure timely treatment for MassHealth members in need of behavioral health services by removing the prior authorization requirements. It would help address disparities in accessing care2540 between lower income and moderate to higher income individuals, it would also reduce the gap between behavioral and physical health patients, as I mentioned, who seek care sometimes at the same time. So we've made a lot of progress on this issue over the years, recent years in particular. And the legislation before you today represents an additional step in that direction. So I want to thank you for your time and consideration, and I'd be happy to answer any questions that you may have. SHOW NON-ESSENTIAL DIALOGUE
SPEAKER1 - Senator, questions or comments from committee members? You're done.
SPEAKER18 - Thank you. Have a great day.
SPEAKER1 - You too. Thank you. Alright. So going back to testimony on aims 2012. Duncan, are you with us?
SPEAKER6 - Hi. I'm here. I'm sorry. I'm Hey, doctor. Running late step away for a second.
SPEAKER1 - Worries. No worries. Please take it away.
SPEAKER6 - Perfect.
DUNCAN DAVIAU - TRININTY HEALTH OF NEW ENGLAND - SB 1267 - So hi, everyone. My name is Duncan Daviau. I'm a clinically practicing physician assistant within the Springfield and Worcester areas. I've worked in emergency medicine for the past seven years. And I'm here today to talk about how PAs can help our mental healthcare crisis within the Commonwealth of Massachusetts. So I wanna talk about being in support of Senator Oliveira's Section 12 Commission. So PAs are licensed medical professionals that practice medicine as part of collaborative based teams. We have the ability to diagnose illnesses, prescribe medications, assist in surgery, and order diagnostic and therapeutic interventions, and we often serve as patients' primary care providers.
There are over 4500 clinically practicing PAs within the Commonwealth of Massachusetts, and that number is expected to rise in particular with the number of programs we have opening up across the state. PAs are trained at the master's level and increasingly at the doctoral level. Coming out of an entry level PA program, a newly minted PA will have thousands of hours worth of classroom didactic instruction as well as over 2,000 hours worth of Clinical rotations, which will include internal medicine, emergency medicine, women's health, pediatrics rotations, elective rotations in psychiatry. In every single one of those circumstances, PA students will be learning how to treat patients and address their mental health conditions.
During the last Session, the Legislature recognized the contributions PAs provide to our health care system and in particular, our mental healthcare system by recognizing us as qualified mental healthcare providers. However, we lack the regulatory tools we need in order to care for this underserved population. These tools include the ability to sign Section 12 orders, perform restraints when a patient may be at severe harm to themselves or others, and the ability to sign admission reports for patients who need inpatient level care. This is why I urge the committee to vote favorably on Senator Oliveira's bill, S 1267, an act expanding access to mental healthcare services. And why I think it's important that the PAs' voices are heard within the section Commission in the event that piece of legislation passes.
I currently work in emergency medicine where we have significant issues in our ability to connect patients to inpatient care when they have acute mental healthcare cases. Depending on their past medical history and past psych history, sometimes they have to wait days or even weeks to connect to the care that they need. I want everyone to imagine what it's like sitting in a busy emergency department in the throes of an acute mental healthcare crisis being anxious, potentially being suicidal, and hearing voices. If you're lucky, you may be in a small mental health room with a television, but often they're boarding in hallways. Allowing PAs to sign Section 12 due admission orders will allow PAs to enter mental healthcare settings more readily, because we'll have the tools we need to address this patient population and care for them. And we can increase the speed at which patients boarding in the emergency department are able to connect with care. So I wanna thank you all for your time. SHOW NON-ESSENTIAL DIALOGUE
SPEAKER1 - Questions or comments from committee members? Alright. Thank you for testimony. Next, we'll hear from Jana Apologies in advance if you got it. I mispronounced any last names.
SPEAKER12 - It's Fikey.
SPEAKER1 - Fikey. Sorry.
SPEAKER20 - It's alright.
JONA FEIKE - CONCERNED CITIZEN - HB 2012 - Good afternoon. I'm Jona Feike and I appreciate the opportunity to be here today. So I'm here for 2012, an act creating commission to reform Section 12, which I agree definitely needs to be looked at and reformed. However, there's information in here that feels unclear to me. It talks about, it feels like it's gonna be made harder to section someone based on the verbiage here. Maybe I'm misunderstanding it. There's information about substance use disorder which we know most people with substance use disorder also also have mental illness. So, I'd like to kind of, if I may, put Section 35 with this 12 because the shortcoming of this is we cannot section someone unless it's 9 to 5. And when someone is in a crisis, it's not necessarily Monday through Friday, 9 to 5.
I did section my son, it was a weekday. I got him into treatment. He was doing great. He was in sober living, life was wonderful. And he said, mom, thank God you sectioned me because what, he was only 22 years old. He said, when I'm high, I cannot think for myself. I cannot think for myself, I don't make good decisions, I would be dead if you had not sectioned me. If I ever act like that again, that's what you have to do. Fast forward, he relapses, he's in Cape Cod hospital, he's in a medically induced coma. He wakes up from it crazy, doesn't know where he is, what's going on, anxious, confused. I'm on the phone trying to get there. The nurse will not hold him because he's 22 and he's an adult. So I said, okay, section him, isn't that what it is?
A nurse, a family member, or a police officer, section him. No, we can't do that. I called the police, no, we can't help you. I called this probation officer. It's Saturday, no one can help me. So I'd like to kind of equate that to what if you went to the hospital for a medical emergency, a car accident, a heart attack, and they said go home, and maybe we can see you Monday morning at nine o'clock. Like, you would think that's absurd. You would not accept that type of treatment, but that's what was done to me. I walked in one door of the hospital, I never saw my son again, he walked out the other door. He died. My 22 year old child died. It's only been two years and he should be with me.
I begged for a section and so did he. And I know it's gonna continue happened, it's gonna happen again tonight at five o'clock.2954 Someone's gonna need to be sectioned,2956 but the court's closed, so2958 no2958 one's gonna help that family. And someone's gonna get in a car accident or have another issue, and they're gonna get the treatment they deserve as they should. But why the disparity here? Why the disparity? That's my question. So when you talk about an act creating a commission to reform Section 12, I want you to look at why is it 9 to 5? Because that right there is wrong. Perfect timing. Thank you.
REP MADARO - Thank you so much for your testimony. I'm so sorry for your loss. And I do just wanna say, you know, in this committee, we hear a lot of courageous testimony, particularly from loved ones who have lost children, siblings,2993 parents, you name it. It is not easy to share this testimony. And on behalf of the committee, we extend our condolences to your, to your family and to all those who were impacted. And thank you for being willing to share your stories and to testify. SHOW NON-ESSENTIAL DIALOGUE
SPEAKER20 - Thanks for listening.
SPEAKER1 - Do we have any questions or comments from committee members? Okay. Thank you for your time.
Next, we'll hear a testimony on health plan requirements starting with h 1964, an act that require equitable payment from the commonwealth. First up, we'll hear from David Matioto from the Massachusetts behavioral health system. Good to see you, David.
DAVID MATTEODO - MABHS - HB 1964 - SB 1249 - Thank you Mr. Chairman, members of the committee. David director of the Mass Association Behavioral Health Systems. And I've submitted, written testimony3040 so I'll be brief. I actually represent 51 inpatient behavioral health facilities throughout Massachusetts, psychiatric facilities, substance use facilities, units in general hospitals. In this bill, House 1964, it's a reimbursement bill. I ought be, you know, clear on that. But it would do is say that if the state clients are not moved out of the hospital in a timely manner by the state, if they can't find a placement, they should not reduce the payment to the hospitals. So what happens is, if someone is waiting for a DMH State hospital bed, my hospitals will get the full rate, which is fine. It took me years to negotiate that with DMH.
However, if a kid is waiting for a group home, we get the rate cut. And we have stuck kids for months and we have many of them. So what we're saying is, we're still providing a service, they're getting the same service everyone else is. It's unfortunate because it's not good for the kids to have to stay on a psychiatric unit when they don't need to be there. Our average length of stay is 13 days. Some of these kids stay for weeks and months. So what we're saying is the hospital should not be penalized, they should get their full rate, and the state should develop more alternatives to take care of these folks. That's one of the reasons why have boarding because people can't get discharged. We have hundreds of patients that are ready to go to the next step, whether it's adults or kids that we can't discharge here in Massachusetts. So that's what this bill would do. It's very simple and straightforward. As I say, I submitted written testimony.
And just quickly on another note, I would weigh in on S 1249, the prior auth that's been talked about here. This Legislature, a year and a half ago, Chapter 177, removed prior approval for acute inpatient psychiatric treatment and a couple other acute areas. It's been a great help. And we cut down our administrative burden, we get people into the hospital, we're not trying to fill our beds. We didn't need prior approval, it used to just slow things down. Thank you, Legislature, for Chapter 177. You've done this before. I urge you to take a close look at these other services. So that's my testimony. I hope you give these bills a favorable and particularly the one I'm speaking on, House 1964. Thank you. SHOW NON-ESSENTIAL DIALOGUE
SPEAKER1 - Thank you, David. Questions or comments committee members.
SPEAKER21 - Thanks very much. Your testimony. Thank you.
SPEAKER1 - Now going to circle back to testimony on h 2006, an act relative to behavioral health clinic rates. I believe we heard from leader O'Day on that earlier. First up, we will hear from Jen Honig from the Massachusetts Association For Mental Health.
3225 SPEAKER223225 -3225 Hi.3225 Thank you.
SPEAKER1 - Right?
JENNIFER HONIG - MAMH - HB 2006 - Hi. I'm Jen Honig, co director of public policy and government relations at Mass Association For Mental Health. Thank you Chair Madaro and members of the committee. I offer today testimony in support of House 2006. Over the last several years, we have improved access For people in the Commonwealth who are at risk of or living with mental health and substance use conditions. We're here today to talk about the individuals and families who are still wrestling with how to get access to care in a timely way, both for emerging conditions, that's new conditions that they're not familiar with and don't know quite how to address, as well as people who have persistent conditions and need continued access to treatment.
As Rep O'Day explained, there are still challenges in getting timely access to outpatient care. And delays in receiving such treatment can result in individuals' treatments conditions deteriorating. Some people will end up in crisis care, and some of those people will end up in hospitals. That's a costly and unnecessary outcome. These situations and the deterioration that may result are in large part preventable. We have 400 mental health clinics across the state, investment in workforce for those clinics can make a huge difference. As you've heard, these, investments can help recruit workers and retain them. This bill will help solve our workforce crisis by amending the division of medical assistance statute that details payment rates for community based clinic providers of behavioral health services.
And as you've heard, these covered behavioral health services Include3322 things like evaluation services treatment, care coordination, management of services, and peer support for people who have mental health3330 or substance use conditions. The increase in rates that's being proposed reflects the fact that there's a different level of service required of a clinic as is required by an individual solo practitioner, both in terms3343 of the range of services provided, and Lydia Conley described that, and in the administrative responsibility. The administrative responsibility of behavioral health clinics include care management, record keeping, and treatment planning. They also include service coordination both within a multidisciplinary team and with medical care providers. And clinics must provide staff training, a responsibility that benefits our entire service system as Miss Conley testified.
This bill requires the Division of Insurance to ensure that Medicaid managed care provider rates paid for behavioral health services and behavioral health clinics are at least 20% above comparable behavioral health services delivered by independent practitioners. And it also requires an increase in Medicaid rates paid for behavioral health outpatient services by 5% overall. These behavioral health clinics are providing essential care in the Commonwealth. Clinicians in these clinics are not only assessing and directly responding to patient's needs, but are linking patients to a broad array of services that the clinics are connected to. This makes a world of difference. Thanks very much. SHOW NON-ESSENTIAL DIALOGUE
SPEAKER1 - Thanks, John. Questions or comments from committee members? Okay. Thank you for your testimony.
Next up to testify on age 2006, we have a panel consisting of Emily Stewart, Peter Evers, and Christopher Tuttle. Welcome.
Good afternoon.
CHRISTOPHER TUTTLE - BRIDGEWELL - SB 760 - HB 2006 - Good afternoon. Thank you Mr. Chairman and members of the committee. My name is Christopher Tuttle. I am the president and CEO of Bridgewell Incorporated, headquartered in Peabody. I'm here I'm here today to express my strong support for Senate 760 and House 2006, an act relative3459 to behavioral health clinic rates. Bridgewell is a multipurpose organization3463 providing behavioral health and human services throughout Essex and Middlesex counties. Bridgewell operates over 100 programs, including adult group homes, supportive housing for individuals with intellectual developmental disabilities, rehabilitation programs, substance3478 use disorder programs, affordable housing, and outpatient clinics.
Bridgewell has four outpatient clinic sites located in Lowell Danvers Lynn and Amesbury. Two of the sites are specialty clinics. The Lynn Clinic serves individuals with substance use disorders, and the Danvers clinic is only one of two clinics in the commonwealth that works with children and adults who have intellectual developmental disabilities or autism and a mental health diagnosis. Currently, Bridgewell clinics are serving 5,048 individuals with 6733511 individuals on a wait list. The average time individuals are on the wait list is3517 nine months. Outpatient services are in great demand and are needed now more than ever. Bridgewell operates these clinics because it fits with our mission to provide care and comfort to all served. Although it fits our mission, it is becoming clear that it no longer fits our business model.
Nonprofit human service agencies, like Bridgewell, are also businesses and often we are not viewed as such. In fiscal year 23, the four clinics collectively lost $1.2 million. For the first four months of fiscal year 24, the clinics have collectively lost $633,000. At this current pace, we project a $1.8 million loss for the fiscal year, and Bridgewell is looking at a $3.1 million loss over two years. This is not a sustainable business model. The driving factor for the overwhelming financial crisis Bridgewell and other providers are facing is the current rate of reimbursement outpatient clinics receive from MassHealth. The current rate does not cover the cost of clinicians or overhead services. The payer mix within our clinics is a3583 combination of MassHealth and private insurance. Most individuals we serve receive MassHealth.
On average, all the treatment covered by private insurance and MassHealth, MassHealth reimbursement rate is 36% lower than private insurance. If additional funding is not available for reimbursement rates, Bridgewell will be faced with a difficult decision later this fiscal year. As a business, we can no longer afford to sustain such losses. If we decide to move away from providing these services, there will be thousands of individuals who will lose their provider and need to find another outpatient clinic. And if they are lucky enough to find another provider near them, they'll be put on a wait list that could be six to 12 minutes. Thank you for your time and consideration. SHOW NON-ESSENTIAL DIALOGUE
Thank
SPEAKER14 - you. Thank you.
EMILY STEWART - CASA ESPERANZA - SB 760 - HB 2006 - Thank you chairs and committee members for giving me the opportunity to testify. My name is Emily Stewart, I'm the CEO of Of Casa Esperanza. I'm here today to testify in strong support of SB 760 and HB 2006, and urgent increases to rates for community mental health centers. Casa specializes in delivering a full continuum of culturally and linguistically focused behavioral health services to the Latin community in Massachusetts. We operate a single CMHC in Roxbury five blocks from the intersection of Mass and Cass. Our CMHC serves 900 patients annually, 99% of whom qualify for MassHealth. Currently, we are reimbursed at the same rate as less regulated single service private practices and significantly lower rates than FQHCs and hospitals that rely on us to serve their Spanish speaking patients and train their multilingual workforce. But the growing gap between clinic costs and3690 rates is unsustainable.
Casa CMHC patients are high risk, high need individuals who are homeless, recently incarcerated, and living with co occurring substance use, serious mental illness, and other chronic conditions. 80% speak little or no English, and 43% report suicidality, while 25% report recent overdose. These increasingly acute patients rely on our team of psychiatrists, nurses, clinicians, case managers, and peer specialists for coordinated outreach, crisis prevention and harm reduction, keeping them out of EDs, psychiatric hospitals, and jails, access and care that private practice cannot deliver. And a 100% of Casa's clinic team are bilingual. As new migrants join our community, Casa receives daily referrals from FQHCs and the hospitals for people in need of Spanish language services, but we do not receive the same safety net funding and reimbursement rates.
While we reduce demand on their waiting rooms and beds, they recruit away the bilingual team we have trained. In FY 23, our CMHC experienced 70% staff turnover. Exit interviews show that 11 out of 16 bilingual clinicians trained at Casa were lured away by higher private practice FQHC and hospital salaries. Turnover led to patient transfers resulting in overwhelming caseloads and months long wait lists. Insufficient rates led to deficit of over $300,000 last year. And as federal priorities shift, grant funds that supplement clinic revenues are at risk, threatening the loss of at least 50% of our clinicians and 75% of case managers and peers. Casa is proud of our CMHC and the impact we have, but the commonwealth cannot keep asking the lowest paid healthcare professionals to bear the burden of Medicaid's promise of equity and access. Passage of this bill would deliver rate increases that help CMHC services remain viable and advance MassHealth's commitment to the most vulnerable members of our community. Thank you.
PETER EVERS - BAMSI - HB 2006 - Members of committee, thank you for the opportunity to give testimony today. My name is Peter Evers and I'm the CEO of BAMSI, a multi service agency that serves Southeastern and Central Massachusetts. BAMSI is a full service behavioral health clinic in Whitman, Massachusetts, and I'm here to speak in support of House bill 2006. As you've heard from, my colleagues, we have a similar story, but I'd like to focus on a couple of different issues that require attention in terms of funding vital safety net services. There are around 260 mental health clinics in the Commonwealth. These clinics provide vital services for some of our most economically challenged citizens and some of our newest Americans. Oftentimes, this work is remarkably complicated and requires our clinicians deal with multiple factors which exacerbate the mental health and substance use disorder issues that our clients present with. These clinics are staffed by some of the most dedicated and qualified clinicians doing this difficult work. This network of clinics is basically the only place where freshly qualified masters level therapists can get the supervision and hours of work needed to gain independent licensure.
We're happy to do this and we have a network of supervisors willing to make sure that the next generation of clinical staff are available to help our vulnerable populations. Unfortunately, at the moment, there are many other opportunities and choices for those clinical staff, excuse me, who have gained the hours of supervision to licensure to make more money in the private sector, especially with the growth of companies that offer telehealth to a different population of people in need. Once qualified, our staff have choices to make. The rates our clinics receive from MassHealth are so much lower than are offered by private insurances and venture capital supported remote startups like BetterHelp that our clinicians often have no choice but to follow higher salaries, especially when they have debt from student loans.
The result is that our clinics lose the staff that we have trained to more substantially financed entities to do less complicated work for more money. Essentially, we have trained and nurtured the workforce who will now provide the expertise in another line of work. Around 90% of our funding comes from the state. And as long as These rates remain well below other ways the clinician can get higher salaries, the more difficult it will be to provide help for those who need it most. It is essential that we level the playing field, which is becoming more and more lopsided. We believe that funding for HB 2006 will be a good start in ensuring that our behavioral health services in the Commonwealth are available to all and health inequities are being addressed. Thank you. SHOW NON-ESSENTIAL DIALOGUE
SPEAKER1 - Thank you to the panel for your testimony. Questions or comments from committee members? Okay. Thank you for your time. I wanna recognize that, committee member representative Allison Sullivan Almeida has joined us. Thank you for being with us from back. We're now gonna shift, to testimony on s 1248, enact to increase investment in behavioral health care in the Commonwealth. Up, we'll hear from Jessica LaRochelle from, MAMH.
Jessica, are you with us?
Okay. We will come back. We'll now hear a testimony on a s 1249 and act relative to reducing administrative burden. First4027 up, Liz Lee Leahy
from the4033 Massachusetts association of health plans.
SPEAKER24 - Thank you.
SPEAKER1 - Can you
SPEAKER25 - hear me? Yep.
LIZ LEAHY - MAHP - SB 1249 - Thank you so much Chair Velis, Chair Madaro, and members of the committee. I'm Liz Leahy, senior vice president of advocacy and engagement at the Massachusetts Association of Health Plans. I'm here to share our concerns with Senate bill 1249 which would so significantly restrict the ability of Health Plans to conduct utilization management as to render the process moot. Provisions of the bill would place blanket prohibitions on prior authorization for a broad range of medications, services, and treatments without any examination of the costs or clinical guidelines. And would prevent Health Plans from rejecting claims for individuals that aren't actually enrolled in their plan or whose insurance benefit doesn't provide coverage for the service or treatment provided.
Prior auth and other UM practices are tools used in limited circumstances informed by clinical guidelines and developed with input from local providers practicing in that specialty by plans to protect patients, reduce medical expenses, and prevent dangerous or fraudulent care. When employers buy health insurance coverage or when the state or the federal government contracts with Health Plans to administer health insurance benefits, they expect Health Plans to use these tools to ensure that their members can access safe, evidence based, and cost effective care. A recent analysis from Milliman found that restricting or eliminating prior authorization in Massachusetts would result in an additional 2.2 to $5.6 billion in premium costs annually. In the Medicaid space, capitation payments to plans would increase by up to $1100 per beneficiary per month, which would challenge the state's budget and our ability to meet the cost growth benchmark.
But I'm not blind to the message that's out there on prior authorization. You'll hear from providers who are frustrated by the administrative processes in place today. You'll hear from advocacy organizations who are asking them common sense question, well, why can't we just eliminate prior authorization for services that are routinely approved 90 to 95% of the time? And the answer is that prior auth isn't for that 90 to 95%. It's for the 5 to 10% of denials that catch a drug to drug interaction, that direct patients to a safer alternative or a less expensive site of care, or that prevent harmful care altogether. And this isn't just rhetoric. We have real world experience from earlier this year when Health Plans waived prior authorizations for admissions from acute care hospitals to post acute care facilities at the request of the Secretary of Health and Human Services.
One member of Plan found that waiving prior auth resulted in an increased use of out of network providers by 50%. Another plan found that 22% of members were inappropriately discharged to a4199 skilled nursing facility because of the PA4201 waiver. And both plans indicated increased spending as a result4205 up to $2 million. For members with complex medical and behavioral health needs, inappropriate placement can prolong inpatient care and exacerbate medical conditions. So if eliminating prior auth isn't the solution, then what is? Advancing automation as recommended by NEHI and Health Policy Commission, continued work to standardize the data required to complete a medical necessity determination through the development of standard prior auth forms, and taking incremental thoughtful approaches to broader reforms.
In November, the House passed a bill that does just that by establishing a two year pilot program for prior auth for admissions to post acute care facilities, and by expediting the turnaround time for these types of PAs. MAHP and our member plans are committed working with our provider partners to advance solutions to these complex administrative processes that will preserve the needed role health plans play while streamlining the ways we all conduct our work on behalf of our patients we serve. At a time when healthcare costs threaten our ability to access care, we must focus on common sense solutions to modernize our healthcare system rather than chipping away at needed cost containment tools. Thank you. SHOW NON-ESSENTIAL DIALOGUE
SPEAKER1 - Thank you, Liz. Questions or comments from committee members? Alright. Thanks for your testimony.
SPEAKER26 - Thank you.
SPEAKER1 - Next, we'll hear from Amy Me, Emmert from Dana Farber. Welcome.
SPEAKER27 - Testing.
AMY EMMERT - DANA-FARBER CANCER INSTITUTE - SB 1249 - Good afternoon Chair Velis, and Madaro, and members of the committee. My name is Amy Emmert, I'm executive director of the Stem Cell Transplantation and Cellular Therapies Program at Dana-Farber Cancer Institute. Thank you for the opportunity to provide testimony in support of S 1249, an act relative to reducing administrative burden. Prior authorization has evolved in recent years into an exceptionally burdensome and overbuilt process. It seems disconnected from our shared goals of efficiency, cost saving, and utilization minimization, as well as patient safety, and absorbs resources from higher how you work. In addition, we have a well known challenge helping communities of color to get into oncology treatment in a timely manner.
It's overwhelming for patients to deal with a cancer diagnosis in the first place, but when you add a labyrinthine process for prior authorization, access to care can seem insurmountable. We all must work together to relieve the disproportionate impact these barriers have on communities of color, and payers need to participate in that effort. The Commonwealth of Massachusetts hosts multiple premier provider organizations offering cell therapies, which includes stem cell transplantation and CAR T. In the case of CAR T, patients are eligible per the FDA because they are4369 not responding to other treatment. This4371 means they are progressing and need to get into treatment quickly.
Our organization, like many others, is highly qualified to ensure that patients are suitable for the therapies that our physicians recommend for them. We are regularly inspected and audited and accredited to ensure that we meet national standards specific to the field. We also meet other requirements, to meet other regulatory requirements such as joint commission, CMS, FDA, and AABB. Payers on the other hand often have insufficient numbers of staff to cope with their own complicated process in a timely manner, causing delays to treatment. Our staff call repeatedly to stress the urgency of a patient's care. In many cases, we are asked to obtain multiple prior authorizations for a well defined single treatment plan, as many as five in the case of CAR T.
Payer staff members are too frequently not familiar with the treatments they're reviewing. I provide an example in my written testimony. In this case, our patient had been properly approved with all necessary prior authorizations for a CAR T treatment. On the day before the patient was to begin her first step of the treatment, a third party MD reviewer for the plan, not familiar4440 with the treatment area, decided to rescind the prior authorization based on out of date information that MD was using. Instead of calling us to discuss the issue, which would have allowed us to provide the correct FDA approval information, they called the patient directly and told her that her treatment was denied.
The patient was actually in her car headed to Boston. She turned around, went home very upset. While we worked to correct the error with the payer, which we did quickly, we had to scramble to get this patient back on the schedule. While prior authorization has a role, it needs to reflect diverse patient needs and respect provider expertise. It needs to be streamlined and paired back to the essential information a payer needs. And payers need to ensure they have the staffing they need to manage their own systems. We respectfully request S 1249 to be provided with a favorable report by the committee, and thank you for listening. SHOW NON-ESSENTIAL DIALOGUE
SPEAKER1 - Thank you. Questions or comments from committee members? Thank you for your time. Next, we'll hear from doctor Samuel Payne from Boston IVF.
SPEAKER19 - Am I can you hear me?
SPEAKER1 - Yes. Welcome.
SAMUEL PANG - MMS - SB 1249 - Good afternoon Mr. Chairman and members of the Joint Committee on Mental Health Substance Use and Recovery. My name is Samuel Pang, I am a physician at Boston IVF, and I am testifying on behalf of the4523 Massachusetts Medical Society in support of S 1249, an act to relieve administrative burden. While my practice of medicine does not directly involve mental health substance use and recovery, I'm testifying regarding the process that is currently in place for obtaining prior authorizations. Although I'm testifying on how this affects my practice specifically, I wanna emphasize that this process affects all medical specialties as you will hear, and is cumbersome cumbersome administrative burden regardless of which medical specialty is involved, including mental health and behavioral health providers.
So all of the Massachusetts based health insurance plans require prior authorization for infertility treatments. Depending on which insurance plan, it could take anywhere from two days to three weeks after submission to obtain prior authorization for treatments. Boston IVF has a team of financial coordinators who spend their time working together with our physicians to gather all of the data that is required by the insurance companies in order to submit requests for prior authorizations, not only for each patient, but for each and every treatment cycle. This means that if a treatment on a particular patient is unsuccessful and they need to have another treatment, the prior authorization process needs to be repeated for each and every subsequent treatment attempt.
Because this task is extremely4613 labor intensive, we have more financial coordinators just working on obtaining prior authorizations than we have physicians. So this is a tremendous administrative and cost burden on our practice. Most prior authorization requests are eventually approved. So in the majority of cases, the prior authorization process was purely a speed bump and all of the time and effort that was spent on submitting the prior authorization requests were unnecessary. When there are denials, our physicians then need to get involved by writing letters of medical necessity or scheduling telephone peer to peer discussions with the medical director at the health plans to appeal the denials.
This takes time away from providing patient care, and it's a distraction that we cannot afford in an era when there are physician shortages across most, if not all, medical specialties in the commonwealth, especially in mental health and behavioral health specialties. So in summary, the current prior authorization process is unnecessarily time consuming and burdensome, resulting not only in administrative costs to medical practices, but also stress and burnout in our staff and physicians. Most importantly, it causes frustration in our patients who perceive the prior authorization process purely as an obstacle course which delays their access to medical care. Thank you for the opportunity to testify today. SHOW NON-ESSENTIAL DIALOGUE
SPEAKER1 - Thank you. Questions or comments from committee members? Thank you for your time, doctor Bang.
SPEAKER19 - Thank you.
SPEAKER1 - Next, we'll hear from a panel, consisting of Denny Brennan, Wendy Warren, David Delano, and Lauren Bedell.
DENNY BRENAN - MHDC - SB 1249 - Thank you to the committee members for opportunity to speak with you today. My name is Denny Brennan, I'm the executive director of the Massachusetts Health Data Consortium. And I'm joined by my colleague, Dave Delano, who is a senior director at MHDC, and Lauren Bedel, who is our colleague at the Network for Excellence in Health Innovation and a senior policy associate there. We're here to talk about S 1249 and to provide testimony not into the specific policy changes that this committee has discussed, but to talk about how to fix the process and how to fix it across the entire Commonwealth. Briefly, our organizations have their roots in Massachusetts. MHDC was founded 45 years ago and we focus exclusively on working with health plans, with4777 healthcare providers, with physicians, with patients, with community members, associations, everyone who is involved in healthcare to implement modernizing technologies and collaborative approaches to big problems.
We also work in the4794 exchange of health information through NEHEN, our health information exchange. And that is community governed transparent not for profit health information exchange that promotes a level of health interoperability that's necessary to fix complex processes like prior authorization.4812 NEHI, the Network for Excellence in Health Innovation, excuse me, was formed 20 years ago by healthcare leaders and is designed to do very similar things when it comes to improving the quality, effectiveness, equity, and affordability of healthcare. With respect to our experience, both NEHEN and MHDC, we've conducted numerous prior authorization prototypes and pilots that have required automation but also a high degree of involvement on the part4845 of payers in understanding what kind4847 of decisions they make can actually improve the prior authorization and how physicians, hospitals, and other providers don't have to deal with prior authorizations that are not required.
We also offer a quality measure specification because in addition to4862 prior authorization, Massachusetts4864 payers and providers are going to have to up their game when it comes to exchanging4868 equality data. And we want to make sure that that process isn't encumbered as is prior auth by the same kinds some challenges. So where do we stand in terms of our approach? We propose NEHEN 3.0. We call it NEHEN 3.0 because it's the third iteration of our information sharing technology that will allow payers and providers to automate much of prior authorization. And while I wholeheartedly agree with Senator Friedman's assessment that automation is not the answer, it is a means to the bigger answers the prior authorization required. Because without automation, people and organizations will be required to do this work. And much of this work is now available and ready to be automated at scale.
So multiple providers, multiple Community health centers, multiple physicians can connect to NEHEN 3.0 and thereby connect to multiple health insurance providers, pharmacy benefits managers, government health plans, utilization review organizations, and streamline the process of performing prior authorization considerably. Why is this so important? Between 60 and 80% of prior authorization submissions are unnecessary. Physicians submit prior auth in a just in case manner, they don't know if it's required, and they wanna be sure it's not denied. But we can provide a service that will tell them at the point care, in real time, whether or not a prior authorization is even required. That reduces the burden by at least 50, and in our experience, pushes it up to 80% when automatic approvals are put in place that enable a number of other prior authorizations to go through smoothly and without complication.
What do we ask of the committee? What changes do we recommend to S 1249? One, we want to expand burden reduction reporting measures and improve the transparency. We need to measure the efficiency and effectiveness of PA, we need to report on provider variation. We need to also understand what out of pocket costs are incurred by consumers for whom prior authorization is either approved or, if it's denied, what might they have paid5008 had it been approved. We also5010 wanna convene a burden reduction task force built on the work that we have successfully completed with NEHEN to convene a multi stakeholder task force that includes payers, providers, consumers, health agencies, technology companies to ensure that the policy changes in the bill are successfully implemented and to further reduce administrative burden in line with the Health Policy Commission's 2023 annual healthcare cost trends report and policy recommendations. SHOW NON-ESSENTIAL DIALOGUE
SPEAKER1 - Jenny, thank you.
SPEAKER28 - With that, I appreciate your time. Thank you.
SPEAKER1 - Thank you so much. Thank you. Wendy?
SPEAKER28 - Wendy is not Wendy is not Wendy has joined us. Good. Thank you, Wendy.
SPEAKER1 - Okay. Is, is Wendy with us?
SPEAKER29 - Yes. I I would I would seed my time to allow Denny to finish his presentation, which we all put together. I'm the CEO of NEHI. And I just want Denny to be able to describe the automation process that we're proposing.
Denny, go ahead.
SPEAKER27 - You're on mute, Denny.
SPEAKER1 - So we limit testimony to 3 minutes left individually, Wendy. So if you wanna share some thoughts, I just wanna make sure we're being fair with
SPEAKER28 - Please, Wendy. Go ahead.
SPEAKER27 - I believe Wendy ceded her time to Danny.
SPEAKER29 - Yeah. But, Dave, why don't we Describe I I think because we're really focused on the automation piece. So if it's per individual, I think, Dave, you would be the right Person to talk about Meagan 3 0.
SPEAKER1 - Sure. However you'd like to do it. And I wanna reiterate, you know, we welcome, longer testimony submitting, via Email. So please don't hesitate to do so.
SPEAKER29 - Thank you.
SPEAKER27 - Okay. Alrighty. I guess We'll start.
DAVE DELANO - NEHAN - SB 1249 - So this is Dave Delano, executive director of NEHAN. As Denny pointed out, we've been doing deep level exchange with healthcare payers and providers for 20 some years to basically remove administrative burden and to improve healthcare outcomes. We've been doing this prior authorization work for roughly two years, going back even further with a prototype we did back in 2014. We believe that, as Denny points out, having this automation mechanism set up among payers and providers will not only reduce a great deal of the administrative burden that we've heard everyone describe by automating the exchange of electronic clinical and administrative data between healthcare providers and payers, but then will also provide transparency and ability to measure and produce new and better ways of adopting prior authorization in more appropriate and more useful and more standardized ways.
So there is this, you know, notion that by, and there's Denny's slide, by automating that process, we will provide transparency. And it is also in line with the federal rule, and the federal rule which is expected to come out for burden reduction this month or very close to the end of this month will essentially echo the same sentiments around Medicare programs and how those should be automated for electronic exchange of prior auth data. So that, there is a greatly reduced burden as well as an increased transparency and reporting mechanism for people to further adopt these technologies. It's well underway at the federal level, other states have adopted these mechanisms. We believe it's the right5238 way to go for Massachusetts, and5240 it will make it so that, as Denny5242 points out, much of the burden of prior authorization exchange and communication is automated through electronic health records on the provider side, integrated with the payer side services that are doing medical management and UM and UR review today so that those mechanisms can be essentially seamless for both payers and providers to exchange those those services amongst each other.
It also provides a mechanism for transparency of other types of data, including cost data, in network, out of network services, other alternative treatments. It integrates essentially clinical decision support mechanisms between payers and providers so that appropriate and costly decisions can be made at the time of care and treatment between payers and providers. So this work that we've done with NEHI and Wendy's group, as Denny points out, with MHDC and NEHEN over the past two years, two and a half years really. There are several white papers we've written about this really focused in on automation. In fact, the second work we did with NEHI identified through that multi stakeholder task force that automation was the first step to resolving this entire prior authorization. So thank you for allowing us to testify today. Any questions, please reach out. SHOW NON-ESSENTIAL DIALOGUE
SPEAKER1 - Thank you, David. Is anyone else from your panel testifying?
Okay. Any questions or comments from committee members? We're all set. Alright. Thank you all for your time. Have a nice day.
SPEAKER27 - Thank you.
SPEAKER1 - Next, we'll hear, from a panel consisting of Lita Anderson, Ashley Blackburn and Karen Granoff.
Welcome.
SPEAKER14 - I guess I'll go first.
LEDA ANDERSON - MMS - SB 1249 - Good afternoon Chair Madaro, members of the committee. My name is Leda Anderson, I'm director of advocacy and government relations for the Massachusetts Medical Society. And I'm here today with my colleagues in strong support of Senate 1249. We came together on this issue this session with this new bill because of our shared concern about the impact of prior authorization and the ways in which it delays and denies access to medically necessary care for patients, as well as the costly administrative waste that it creates in our system. I know Senator Friedman talked a lot about this earlier, and I'm sure you've all had your personal experience with with prior authorization. But I wanna emphasize that it really started off as a cost control tool to get at expensive and novel treatments.
And it has expanded over time and become so pervasive, applying so broadly and variably across the different plans, that at this point, it creates more waste than it saves. It is the number one issue that we hear about from our members at the Medical Society, both in terms of the impact that it has on patient care, and the fact that the criteria is increasingly not reflective of evidence based medicine, but also the administrative burden that it imposes on practices. I know Senator Friedman referenced earlier, medical practices spending on average of 14 hours a week. You heard from Doctor Pang that practices have multiple full time staff dedicated solely to processing prior authorization. And that burden takes a toll.
Earlier this year, the Medical Society released a report where more than 55% of our members reported experiencing symptoms of burnout. And prior authorization was listed as a top stressor contributing to that burnout. And it has significant consequences with physicians leaving clinical practice, reducing their hours, ultimately limiting, patient care. And you may have seen recently some plans announcing that they're rolling back on prior authorization, and we certainly applaud that, but statutory changes are necessary to achieve meaningful, standardized progress across the board. And we saw that with the great work in the Mental Health ABC Act that David Matteodo referenced earlier, which eliminated prior authorization for acute mental health services.
And we know that that has had an important impact improving access to care for patients and improving workflow for providers. We do have some measures on the book today, regulating prior auth, but by and large, they are not being complied with. And time and experience has shown that we don't have the data and the tools that we need to meaningfully reign in this practice, which is why we think this legislation is necessary. And I will just underscore what Senator Friedman said earlier. This bill does not eliminate prior authorization. It collects data in order to institute smart data driven reforms and patient protections in order to improve efficiency, and most importantly, to eliminate delays and disruptions and access to for patients.
And if I could just take a quick moment, I do wanna respond to the report that was referenced by my colleague, Liz, from MAHP earlier, we don't think this report, or its findings are all that instructive or relevant for your consideration for a number of reasons, but first and foremost, because it's modeled off a complete elimination of prior authorization, which neither this bill nor any bill before the Legislature proposes to do, and the report acknowledges5568 that. And it also doesn't take into consideration the savings that come from reforming prior authorization processes. So plenty more to say about that. We'll be in touch. We'll be submitting written testimony as well. So thank you for your time. SHOW NON-ESSENTIAL DIALOGUE
SPEAKER1 - Oh,
KAREN GRANOFF - MHA - SB 1249 - Thank you. My name is Karen Granoff. I'm the senior director of managed care for the Massachusetts Health and Hospital Association. And Senator Friedman and others have already articulated many of the challenges with prior auth. I'm not gonna reiterate those right now, but I do wanna talk a little bit about the effect on hospitals. And as was previously referenced by Senator Friedman, MHA recently released a report on billing and insurance related expenses that showed as much as $1.75 billion could potentially be saved in the state's healthcare5621 system and improve affordability, care access, and delivery of services.
The burdensome and varying requirements around prior authorization, the different medical necessity criteria, different interpretations of those necessity criteria, different interpretations of those medical necessity criteria, and the appeals Prior authorization denials are among the major components of administrative costs that are outlined in this report and that need to be streamlined. Just one example of a challenge5650 that hospitals regularly encounter. Hospitals, as you certainly know, are know we're open 24/7, 365 days a year, insurance companies are not. Meaning that it's not unusual for a case manager to wait until the next business day for a response from an5666 insurer on an urgent request to transfer a patient.
This was particularly problematic over the Thanksgiving holiday and will be a problem again because Christmas and New Year's both fall5677 on Mondays, making it three long days when insurance offices will be closed. MHA's throughput report has clearly showed that insurance issues were the number one problem in timely discharges from acute care to post acute settings, which is why we appreciate the attention that's being paid now to those issues. As my colleague recently just referenced, Blue Cross Blue Shield of Massachusetts recently eliminated prior authorization requirements for home care services when a patient is being discharged from post acute or acute hospital setting. We greatly appreciate that change. It's gonna benefit both as well as providers, and we applaud Blue Cross for doing that.
Cigna and UnitedHealthcare have also recently announced they'd be reducing prior authorization requirements by 20 to 25%. And these examples illustrate that reductions in prior auth burdens are both necessary and feasible without eliminating the practice. We agree with Professor David Cutler, who is also an HPC board member, who has recommended that prior authorization must be simplified and standardized by applying it more selectively and implementing it more automatically. We support what you just previously heard on automating prior authorization. And as Leda already said, we are not recommending that prior authorization be eliminated, but just said it'd be streamlined and thought about in a much more sensible way than it currently is.
ASHLEY BLACKBURN - HEALTH CARE FOR ALL - SB 1249 - Thank you. Thank you to the chairs and members of the committee for the opportunity to testify today in support of Senate bill 1249. My name is Ashley Blackburn, and I'm a director of policy and government relations at Health Care For All. In addition to our legislative advocacy, Health Care For All also provides direct consumer assistance through our toll free helpline that takes over 20,000 calls a year staffed by enrollment counselors in five different languages. I am here today supporting this bill because of the issues we hear directly on our helpline from callers every day. We hear reports of delays in care, breaks in treatment, and administrative redundancies due to the way our authorization system works.
For example, recently, one of our helpline callers lost his coverage after a divorce. Our staff was able to get him enrolled in new coverage, but he had to change providers according to his new plan's network. He had5821 an active prior authorization for blood pressure medication from his previous insurer,5825 but he couldn't get the medication approved through the new insurer until he5829 saw his new doctor. During this break in receiving his medication, he was hospitalized for a cardiac event. Had he been able to carry his prior authorization to his new plan to continue his course of treatment, this hospitalization could have been avoided. So there are three key aspects of this bill that are designed to improve patient access to care and to avoid scenarios like the story I just described.
First, the bill requires a prior authorization to be valid for the duration of a treatment or for at least one year minimizing re-approvals when the course of treatment hasn't changed. Second, it ensures that when a patient switches health plans, like the story I just described, that there's a grace period to get approval from the new health plan to avoid breaks in treatment. And, finally, it would also ensure that after a plan has approved care, it cannot be retrospectively denied. In all of our work at Health Care For5880 All, we try to make policy recommendations that are both rooted in issues that we hear from community members, but that also take into consideration the constraints and realities of our healthcare system. And we think this bill really strikes that balance. It addresses pain points for both providers and for5896 patients while still preserving prior5898 authorization as a tool for utilization and cost management in appropriate circumstances. Thank you for the opportunity to testify. SHOW NON-ESSENTIAL DIALOGUE
SPEAKER1 - Thank you. Questions or comments from committee members?
SPEAKER17 - Thank you for your time.
SPEAKER1 - Next, we will hear from a panel, consisting of Kerwin Amo, Jonathan Crow, and Danielle Adams.
Welcome. And apologies for any mispronunciations of names.
SPEAKER32 - Yep. Please.
DANIELLE ADAMS - ALS ASSOCIATION - SB 1249 - Good afternoon Mr. Chair and members of the committee. Thank you for the opportunity to speak this morning afternoon. My name is Danielle Adams, I'm the managing director of advocacy with the ALS Association here in support of Senate Bill 1249. If you're not familiar with ALS or Lou Gehrig's disease, it is a progressive disease that solely robs a person's ability to walk, talk, and eventually breathe. And the average prognosis for someone with ALS is about two to five years. So given the severity of their rapid progression, timely access to treatments is vital. Currently, as you've heard today, the prior authorization process poses significant obstacles and delays for many patients, but I'll share just a few points about how this impacts people living with ALS specifically.
Like an advocate named Bruce Rosenblum, who last year was prescribed oral RODACAVA, which is a newer medication for the treatment of ALS which helps to slow the progression. Despite the fact that the FDA approved the drug for all ALS patients, his prior authorization request as well as two appeals were denied over the course of seven months stating that he was ineligible for the drug through a process6014 that was inexcusably long. He had slightly better luck with Relivrio, another ALS medication. He received prior authorization in six weeks, which I would argue for someone with a fatal diagnosis is still inexcusably long. But the same week that he received approval for this drug, a fellow ALS patient covered by the same private insurance company received a denial that said that the formulary alternative for the drug was Relivrio, which is a a cheaper medication.
A trained eye can read the FDA labels for these 2 drugs and understand that they are not pharmacological alternatives to one another, but rather an insurance company's attempt at covering a lower cost medication. For Bruce and many others, these denials are arbitrary and inconsistent in addition to being incredibly lengthy, burdensome, and frustrating. We heard earlier in opposition to this bill that the intent behind prior authorization is to help control those 5 to 10% of cases where these checks and balances are necessary. But in practice, it's also impacting people living with ALS who only live between two and five years and do not have the time to wait around through these countless appeals and denials for prescriptions that they are being prescribed.
Here in Massachusetts, we are in the epicenter of research search and new treatment discoveries. And when new treatments are approved for a disease that currently has no cure, the system should work so that patients are able to access them when they pay for insurance. If not, these discoveries are wasted, clinical guidance is ignored, and in the case of ALS, being denied life extending medications and waiting through appeals processes is quite literally costing them their lives. So for these reasons and for the many other reasons you've heard today, we ask for your support for this bill. Thank you.
JONATHAN CROWE - MGH - SB 1249 - Good afternoon Chair Madaro and members of the committee. My name is Doctor Jonathan Crowe, and I'm a vascular neurology physician practicing at Massachusetts General Hospital and Brigham and Women's Hospital here in Boston. I'm here today to speak in support of S 1249, an act to relieve administrative burden. I'm testifying here today because I believe all patients in our commonwealth deserve timely access to medical care. I know the committee shares this belief with me. Sadly, I've seen how our current prior authorization policies harm patients in my own practice. Let me explain. I recently was working in the intensive care unit. One of my patients there was an elderly woman who lives alone. Her doctors had discovered an abnormal heart6156 rhythm and recommended a medication to prevent future strokes.
That medicine needed a prior authorization and this led to a delay. While she was waiting for approval, she suffered a large life threatening stroke and ended up in the intensive care unit. That's where I met her. I remember standing by her bed while she struggled to move and speak. I remember thinking to myself, this is not a failure of medicine, this is a failure of our current system. This absolutely should not have happened, and we must act now to prevent this from happening to more patients. One additional problem with our current prior authorization process is the appeal process. In my years doing prior authorization appeals, I've never once spoken to another neurologist during the appeal process. That means that the person hearing the appeal is not a member of my specialty and does not necessarily understand the clinical situation or needs my patients have. This leads to more delays in care and more patient harm. S 1249 will improve timely access to care and reduce administrative burden. It will not fix all our prior authorization problems but it will greatly help. I urge the committee to support S 1249. I thank the committee for its time, and I'm happy to answer any questions.
KERWIN AMO - HEALTH CARE FOR ALL - SB 1249 - Good afternoon Chair Madaro and members of the joint committee. My name is Kerwin Amo. I'm a health justice organizer6254 at Health Care For All, but today I'm here as constituent of Watertown. I'm here to speak in support of S 1249, an act relative to reducing administrative burden. You see, at the age of 2, I was diagnosed with sickle cell anemia. For those of you who may not be familiar, sickle cell anemia is a genetic disease which mainly affects people of color. The disease changes the shape of red blood cells turning them into the shape of a sickle. Blood cells often get stuck in the blood vessels causing immense pain and other side effects. There is no cure for this disease only treatments to manage the symptoms.
I'm currently prescribed Morphine immediate release and long acting for pain. I've been on pain medication for as long as I can remember. My providers and I have always had a plan for what to do when I enter into a pain crisis to manage my symptoms at home. In 2017, my health plan began to require me to obtain a prior authorization. I would only be informed that I needed a PA when I went to pick up my medication at the pharmacy. I would request my prescription, drive to the pharmacy, and would be informed by the pharm tech that my medication needed a PA. I'd call my doctor's office to inform them of the issue, and they would tell me that they had already submitted the PA electronically. I6332 drive back to the pharmacy only to be informed6334 that the PA hadn't been approved.
While this was a painful inconvenience, it never caused any major problems. That is until March of 2022. One day, I felt extreme pain in my lower back, I reached for my medication and noticed I had a couple of days worth. I immediately called the prescription to my provider and was notified that the prescription was sent to the pharmacy. Now I anticipated there would be a three day delay. However, this time, my prescriptions took longer to fill. I ran out of medications and what started off as a manageable pain crisis quickly escalated into an unbearable episode. Without my medications, I ended up in the emergency room and then was admitted for the next couple of days resulting in a $20,000 hospital bill with a $750 co pay.
Now this all could have been avoided if the prescriptions that I've been for my entire life for a condition that will never go away, didn't suddenly require prior authorization. In fact, a few days before Thanksgiving this year, I requested a refill on my prescription, before the break, and was shocked to find that my medication needed a PA, which was random because I haven't been required to get a prior authorization this year or in the last three years for any of my prescriptions. I'm sharing my story with you all today, not only in behalf of myself, but also on behalf of all of those with6418 a chronic and invisible illness. Help us fix an unnecessary, inconvenient, and costly barrier to patient care. Thank you for the opportunity to testify today. I humbly ask that you vote favorably to move S 1249, an act relative to reduce administrative burden out of committee. Thank you for your time. SHOW NON-ESSENTIAL DIALOGUE
SPEAKER1 - Thank you for your testimony, and Kerwin, thank you for the courage of sharing our personal story. Questions or comments from committee members? Thank you for your time.
K. Next, we're gonna hear, testimony on s 1253, an actor moved administrative burns to behavioral health Services. We will hear from Lee Simons.
LEIGH SIMMONS - MHA - SB 1253 - SB 1267 - Hello. Thank you Chairman Madaro and members of the committee for your time this afternoon. My name is Leigh Simons, and I'm senior director of healthcare policy at the Massachusetts Health and Hospital Association which serves as a unified voice for providers across the commonwealth. On behalf of our members, thank you for the opportunity to speak in support of S 1253 and also S 1267. If you don't mind, I'll start with S 1267, an act expanding access to mental health services filed by Senator Oliveira. A companion House bill filed by Representative Decker is in front of the Joint Committee on Financial Services. This legislature, the Healey administration, and the previous Baker administration have done extraordinary work to increase access to behavioral healthcare.
In particular, last year's ABC Act made historic strides to break down barriers to critical behavioral health services for thousands of patients in need. And, of course, the Legislature also6524 made an unprecedented financial investment in the system through the establishment of the Behavioral Health Trust Fund that will significantly expand the pipeline of caregivers, yet we we still have work to do. As you may know, MHA reports Behavioral health boarding data from hospitals around the commonwealth each week. While those numbers are down from a high of 700 borders, last Monday, there were nearly 500 patients in acute care hospitals in Massachusetts hospitals awaiting inpatient behavioral healthcare.
This legislation builds off the progress we have made by ensuring the services required within the ABC Act are viable. It aligns coverage requirements of behavioral health crisis services with6563 how these services are delivered under the reforms made by the road map for behavioral health reform, and importantly, ensures commercial coverage of these services. The bill also aligns the approval process for psychiatric units and acute care hospitals with the approval process for freestanding psychiatric facilities. And it waives application fees for Innovative, mobile integrated health services that have a behavioral health focus. To address workforce challenges, this bill allows qualified physician assistants to admit psychiatric patients and codifies DPH regulations that expand the definition of licensed mental health professionals to include master's level clinicians working towards licensure.
And finally, this legislation established a one time task force to evaluate and report on the financial status and sustainability of the inpatient behavioral health system. Taken together, these changes would make it easier for much needed beds to online and ensure patients have the care team and insurance coverage they need. S 1253 filed by Senator Keenan would Improve access to behavioral health services by expanding the number of behavioral health settings that must be covered without prior authorization. It requires medical necessity be determined by the patient's treating clinician, similar to what has previously been legislated for substance use disorder services.
The legislation make some technical fixes to address regulatory barriers related to Chapter 177's elimination of prior authorization for inpatient psychiatric services, where some of the notification provisions outside of its intent, shifted the burden of prior auth from the EDs to inpatient units. A companion House bill filed by Representative Scanlon, who you heard from earlier today, is also in front of the Joint Committee on Financial Services. Thanks so much for your time this afternoon. MHA and our members urge the committee to grant S 1267 and S 1253 favorable reports, and we'll follow-up with greater detail in our written testimony. Thank you. SHOW NON-ESSENTIAL DIALOGUE
6675 SPEAKER16675 -6675 Thank6675 you, Lee. Questions or comments from committee members?6677 Alright. Nice to see you.
SPEAKER7 - You too.
SPEAKER1 - We're gonna circle back, to s 1248. I think I saw Jessica LaRochelle online. Are you with us, Jessica?
SPEAKER24 - I am.6690 Can you hear me, chair?
SPEAKER1 - Yep. Take it away.
SPEAKER24 - Great. Thank you. And and thank you for the opportunity to be heard.6696 I'm sorry that I missed my original time.
6698 SPEAKER16698 -6698 No6698 worries.
JESSICA LAROCHELLE - MAMH - SB 1248 - Chair Madaro, honorable members of the Joint Committee on Mental Health Substance Use and Recovery, my name is Jessica LaRochelle, and I'm the co director for public policy and government relations at the Massachusetts Association For Mental Health. I'm also here today representing the Children's Mental Health Campaign. And I'm here to testify in strong support of S 1248, an act to increase investment in behavioral healthcare in the commonwealth. As you well know, our behavioral health system has long been underfunded and this has left individuals and families without6731 access to timely and appropriate care. The stats that Leigh6735 just shared about ED boarding, make that evident.
Also, the underfunding of the behavioral health system has led us to a current workforce crisis. As the Association For Behavioral Healthcare reports, for every 13 clinicians that lead their outpatient mental health clinics, they can only fill 10 spots. And this is driving preventable illness and disability, it's driving increased mortality, and it's creating undue health system costs and societal costs. So, if we look at our total medical expenditures in the Commonwealth, I think we can all agree that behavioral health makes up too small of a proportion. What this bill does is that it creates a process and a timeline for increasing6786 this proportion of behavioral health expenditures while keeping within total medical expenditures as set by the cost growth benchmark.
And these targets for behavioral health expenditures would apply both to individual healthcare entities of a certain size, as well as the system in aggregate. And we have the infrastructure to do this through the Health Policy Commission as well as the Center For Health Information and Analysis. Furthermore, the bill would create a six month task force that6821 would be chaired by the Health Policy Commission. And the task force would6825 create guiding principles to help entities reach targets for increased behavioral health spending. And they could recommend upstream interventions such as early intervention, integrated behavioral health and primary care, urgent care to avoid ED visits, and even coverage for peer supports and recovery coaches. The Legislature and the administration have made significant investments in the behavioral health system in recent years, and we're very, very grateful. But that's just the beginning. This bill helps us to make longer term sustainable investments in behavioral health to meet the needs of individuals, families, and communities in the commonwealth. Thank you for your consideration. SHOW NON-ESSENTIAL DIALOGUE
SPEAKER1 - Thank you, Jessica. Any feedback from committee members?
SPEAKER8 - Thank you.
SPEAKER1 - Nice to see you. Thank you for your time.
Alright. And last but not least, we'll hear testimony on s 1267, an act expanding access to mental health This is, first up,6891 we have Ariana Ploren.
SPEAKER33 - Hi. Can you hear me?
SPEAKER1 - Yes.
SPEAKER33 - Okay.
ARIANA PLORAN - WEST SPRINGFIELD POLICE DEPARTMENT - SB 1267 - SB 1249 - SB 2012 - Hi. My name is Ariana Florin. I am a licensed mental health professional with an LMHC licensure in the state of Massachusetts. My current role is for West Springfield Police Department. I am the mental health coordinator and co response clinician. As well as I am part of the Bay State Medical Center emergency psychiatry team. I'm here to support the Senate bill for 1267, in adding LMHCs to Section 12s. I have a very particular role, and it's quite interesting and dynamic where I am alongside police officers to facilitate mental health evaluations, risk assessments on scene through 911 or dispatch or referrals made by police officers and other individuals in town.
Police officers have about a three day training for mental health during the academy. As with I, I have a four years bachelor's level degree, I have three years full time master's level degree. I also have 3,360 hours postgraduate work to then take a board certified test for licensure. There has been conflicts when I'm out on scenes with police officers regarding mental health professionals because they are seen when you're looking at an individual in a mental crisis as black and white, where I am trained to see mental health and the human complexity as more gray. Excuse me. My radio is on.
I have found that it's been troubling sometimes when I'm trying to explain that I feel that this person's in acute crisis need, and I have to have a police officer sign my Section 12s. I fill them out appropriately, I do explain to them why I feel the acute need is there, but ultimately, it's up to them to sign the Section 12. And it creates a hindrance and an inefficiency of my job when ultimately, I am the mental health trained professional on scene. And it also Creates issues with time were ultimately for 911 calls, time is very pertinent to what we do. I also am in support of several of the other bills including, Senate 1249 and as well as the bill to have the commission for Section 12 reform. I do agree with the testimony that was prior heard that ultimately having individuals on the ground with boots in the workforce, in the panel as well to have a greater understanding of what's happening within our communities. Thank you for your time. SHOW NON-ESSENTIAL DIALOGUE
SPEAKER1 - Thank you for your testimony, Arianna. Any, comments or questions from committee members? Okay. Thank you.
Last but not least, we'll hear from Matthew Leone.
MATTHEW LEONE - CONCERNED CITIZEN - SB 1267 - Alright. Thank you very much for having me here today, Mr. Chairman. I'm speaking now in support of this bill in particular to, and very much in the same way as Ariana had, just provided testimony on, and regarding the addition of the licensed mental health counselor to the Section 12. I am a licensed mental health counselor and have been for many years. I currently work for a community Center for Human Development, and I'm assistant program director of a community behavioral health center and many years as a manager within crisis services in addition to managing law enforcement collaborative personnel such as core response clinicians. And have found that it has often created many issues in which a clinician with a licensed mental health counselor license is not able to sign the Section 12.
And this has, as Ariana has mentioned, creates issues in the field working with police officers, when the co response clinician with an LMHC is riding with them or parallel to them and unable to sign Section 12s, And time is often of the essence to get folks to the emergency department during those times, often for safety reasons and in order to, many systems have put in place protocols in which a licensed independent clinical social workers is then contacted to provide their okay and their name for the Section 12. But this creates undue burden, in the field when there are many folks with, the licensed mental health counselor, licensed that are working in these roles that are there on scene and able to sign.
This also has created issues within the crisis services as many agencies have had to put together different workflows as far as Section 12 protocols. And due to not having, an LICSW or other on scene or in the office to sign at any given time, whereas many of my colleagues within LMHC are available as well. So, not looking to add this as a reason to do more involuntary commitments, but to do them in a safe, efficient manner in order to get folks that are on the Section 12A to an emergency department for safety. Thank you for my time. SHOW NON-ESSENTIAL DIALOGUE
SPEAKER1 - Thank you. Anything from the committee? Alright. Thank you so much for your testimony. Did anyone sign up that, we may have missed? Okay. Going online. Alright. Do we have a a motion to adjourn?
SPEAKER8 - Motion to adjourn. Alright. Thank
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