Bill > S2529

Introduced Session

This bill seeks to expand access to behavioral health care services by requiring the Department of Human Services (DHS) to establish a two-year Urgent Care Facility Behavioral Health Pilot Program. The goal of the program will be to provide behavioral health care at hospital urgent care facilities to stabilize individuals experiencing behavioral health crises in a way that reduces unnecessary emergency department and inpatient admissions. In doing so, it is the sponsor's goal to provide quality, timely behavioral health care in a setting that offers positive patient outcomes, addresses the stigma associated with behavioral health issues, reduces the burden on hospital emergency room departments, and minimizes costs. Under the bill, "behavioral health" or "behavioral health care" means procedures or services rendered by a health care or mental health care provider for the treatment of a mental illness, a mental health or emotional disorder, or a substance use disorder. Within 180 days after the effective date of the bill or, if the DHS submits State plan amendments or waivers to receive federal reimbursement under Medicaid for services provided under the bill, within 30 days of the receipt of any necessary federal approvals, the DHS is required to issue a request for proposals and select one or more Medicaid managed care organizations to participate in the pilot program. Under the bill, the two-year pilot program is to commence upon the selection of the managed care organizations. The managed care organizations selected are to demonstrate the ability to meet the requirements of the pilot program and are required to operate in each of the northern, central, and southern regions of the State. The selected managed care organizations are required to contract with six hospitals, with two in each of the northern, central, and southern regions of the State, to provide integrated behavioral health care within one of the hospital's urgent care facilities. In determining which hospitals to contract with, the selected managed care organizations are to prioritize hospitals that specialize in pediatric care if feasible. Under the bill, a participating urgent care facility is required to provide services 24 hours per day, seven days per week. Furthermore, to be eligible, a hospital is to demonstrate the ability to coordinate a patient's care with primary care providers, outpatient behavioral health and substance abuse providers, community health centers, and social service providers, and may not receive funding from the DHS to provide Early Intervention Support Services. Each participating urgent care facility is required to integrate behavioral health care with the facility's existing physical health services, which will, at a minimum, include: employing a behavioral health team of at least one licensed behavioral clinician and one licensed clinical social worker; partnering with one or more licensed psychiatrists to provided services, as needed, via telemedicine and telehealth; providing behavioral health awareness and intervention training to staff; and using warm hand-offs, rapid referrals, supportive contacts, and other efficient and supportive care transition methods. The pilot program is to be funded in part through the Medicaid program using a value-based payment system. The value-based payment system is to be modeled on, and be consistent with, the population-based payment methodology that is described under Category 4 of the alternative payment methodologies (APM) framework developed by the Health Care Payment Learning and Action Network. Specifically, the value-based payment system is required to provide for a quarterly advanced bundled payment to be provided to the managed care organization for the purposes of financing the total cost of behavioral health care that is provided by participating urgent care facilities. The quarterly bundled payment rate is to be established by the Commissioner of Human Services and is required to be based on the commissioner's evaluation of the following factors: (1) an assessment of claims data indicating the cost to provide behavioral health care in hospital emergency departments and inpatient settings, absent the pilot program; (2) the number of patients who are expected to be served by the pilot program; (3) the average anticipated per-patient cost of care under the pilot program; (4) the anticipated costs to participating urgent care facilities of complying with the provisions of the bill; and (5) any other factors that may affect the cost of care. Once established, the quarterly bundled payment may not be increased, regardless of whether the actual costs of care received by patients under the pilot program exceed the bundled payment rate provided. If the managed care organization, in cooperation with participating urgent care facilities, is able to reduce the per-patient costs of care for patients receiving care and services under the pilot program, the managed care organization may retain, and will not be required to repay, any remaining unexpended bundled payment funds. The managed care organization will be required to share any savings achieved with participating urgent care facilities at a rate that is proportional to the rate of per-patient cost reduction savings achieved by each such facility. If the actual per-patient costs of care for patients receiving care and services under the pilot program exceed the advanced bundled payment rate established by the commissioner, the managed care organization is to ensure that all patients continue to receive appropriate services and care from participating urgent care facilities without being subject to an increase in out-of-pocket costs. Any financial loss incurred by the managed care organization as a result of an increase in the per-patient cost of care for patients in the pilot program is to be shared by the managed care organization with participating urgent care facilities at a rate that is proportional to the rate of per-patient cost increase attributed to each facility. The bill requires the DHS, within 90 days after the two-year pilot program is terminated, to prepare and submit a written report of its findings and recommendations to the Governor and Legislature. The Commissioner of Human Services will be required to apply for any State plan amendments or waivers as may be necessary to implement the bill's provisions and secure federal financial participation for State Medicaid expenditures under the federal Medicaid program.

Committee Categories

Jim Beach (D)*,  Patrick Diegnan (D)*, 

Introduced in the Senate, Referred to Senate Health, Human Services and Senior Citizens Committee (on 05/12/2022)

Official Document