Bill > H1167

This bill aims to improve patient-centered access to behavioral health services in accountable care organizations (ACOs) in Massachusetts. The key provisions include: 1. Requiring all ACOs in the state to offer patient navigation and care coordination services through "Patient Engagement Advocates" - licensed social workers, certified nursing aides, community health workers, or peer support specialists. These advocates will help patients access appropriate behavioral health providers, navigate insurance, schedule appointments, provide transportation assistance, and coordinate care between providers. 2. Mandating that primary care providers within ACOs directly connect patients with diagnosed mental health or substance use disorders, or those showing symptoms, to the Patient Engagement Advocates within 7 days of discharge or identification. 3. Allowing ACOs to initiate discharge proceedings for patients who refuse further treatment after an initial evaluation, but requiring them to connect those patients with a Patient Engagement Advocate before or within 7 days of discharge. 4. Prohibiting ACOs from restricting referrals to only in-network behavioral health specialists. 5. Providing funding for a pilot program with a community-based organization to offer additional patient and provider support services, including an evidence-based patient empowerment program. The goal is to improve access, coordination, and continuity of care for individuals with behavioral health needs within the ACO model.

Health and Social Services

https://malegislature.gov/Bills/193/H1167