Resources

This section includes resources for CliniciansUNITED members. Check back often for updates.

Medical Necessity Testimony for Health Policy Commission

In August, CliniciansUNITED submitted testimony to the Health Policy Commission on proposed changes to medical necessity criteria. You can read the full request for testimony with description of  the proposed changes here. A snippet of our testimony:

“Clinicians spend an inordinate amount of unpaid time on the phone and completing online authorizations with insurance companies making the case for why their clients meet medical necessity requirements to continue treatment. The insurance representatives have never met the client, yet they make the decision on whether or not treatment is approved. How is this the standard of care that we are working toward keeping?”

To read CU’s full submitted testimony, click here.

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SB649 & HB1812 Testimonies and Fact Sheets

On June 24th, Senate Bill 649, An Act to promote the accessibility, quality and continuity of care for consumers of behavioral health, substance use disorder and mental health services, had a hearing in front of the Joint Committee on Health Care Financing. CU members, staff, and allies testified in support of this important piece of legislation that would drastically increase access to mental health care in Massachusetts. This bill addresses access challenges by creating state action immunity for providers who choose to engage in joint negotiations with insurance providers on issues such as reimbursement rates and medical necessity criteria.

Click here to view the fact sheet on reform initiative SB649. 

Click here for CU’s submitted testimony for SB649

On July 16th, CU testified in front of the Joint Committee on Mental Health and Substance Abuse in support of House Bill 1812, An Act to promote accessibility and affordability of behavioral health and substance abuse services for recipients of MassHealth. This bill, filed by Rep. Jim O’Day,  will require mental health carve-outs to make their contracts and executive compensation publicly available. The purpose of this bill is to shine a light on how effectively tax dollars are being spent to provide essential behavioral health and substance abuse services to those that need them most.

Click here to view the fact sheet on reform initiative HB1812

Click here for CU’s submitted testimony for HB1812

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Donahue Institute Research Highlights Barriers to Mental Health Access in MA

Developed and conducted by the University of Massachusetts Donahue Institute, the Challenges of Private Practice study documents the experiences of a broad range of private practice clinicians – and the challenges they face in providing mental health care in Massachusetts.

The Donahue Institute survey was commissioned by CliniciansUNITED, a multi-disciplinary group of mental health clinicians affiliated with the Massachusetts Human Service Workers Union – SEIU Local 509. Through professional research, public education and advocacy, CliniciansUNITED aims to forward policies that improve the affordability and accessibility of mental health care for all Bay State residents.

RELATED RESOURCES


‘CHALLENGES OF PRIVATE PRACTICE’ EXECUTIVE SUMMARY —  APRIL, 2015

UMDI Executive Summary Cover_ds


FULL ‘CHALLENGES OF PRIVATE PRACTICE’ REPORT —  APRIL, 2015

Click here to download a printable copy of the report (PDF). 


PRESENTATION OF THE ‘CHALLENGES OF PRIVATE PRACTICE’ STUDY FINDINGS —  MAY 6, 2015

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ICD-10 Code Implementation Delayed Until October 2015

ICD -10 ImageAs you have undoubtedly read, the U.S. House and Senate recently passed the so-called “Doc Fix” — legislation that delayed previously-scheduled cuts to Medicare payments. But tucked into the bill was a less-scrutinized provision to delay the planned transition to ICD-10 codes for billing purposes. The measures were signed into law by President Obama on April 1.

As a result, Medicare reimbursements will remain the same for 2014 — and clinicians will NOT be required to switch to ICD-10 codes for billing purposes on October 1, 2014. The transition to ICD-10 has been delayed until at least October of 2015.

 

Additional resources on DSM IV and ICD-9 (courtesy of CU member Erica Kirsners):

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A Guide to Chapter 224 (Payment Reform) for Clinicians

Guide to Chapter 224 for Clinicians_cover_Page_1 Approved by the legislature and Governor Patrick in 2012, Chapter 224 (An Act Improving the Quality of Health Care and Reducing Costs through Increased Transparency, Efficiency and Innovation) sets goals for future growth of public and private health costs, creates new state entities to oversee health providers, and contains many provisions designed to promote changes in the delivery of health care and systems of payment for that care. Implementation of Chapter 224 will affect all health care providers in Massachusetts, including mental health clinicians.

This primer covers several key elements of the law – including Cost Control and System Reforms, New State Entities, and other Behavioral Health Entities. Download the full ‘Guide to Payment Reform’ here.

 

Additional links on payment reform:

Chapter 224 of the Acts of 2012, An Act Improving the Quality of Health Care and Reducing Costs through Increased Transparency, Efficiency and Innovation
A copy of the Massachusetts legislation that sets benchmarks for future health cost growth and contains provisions designed to transform public and private health care delivery and payments systems.

Summary of Chapter 224
A comprehensive summary of Chapter 224, produced by the Blue Cross Blue Shield of Massachusetts Foundation

The 2013 Behavioral Health Integration Task Force Report
This report details the 29 separate recommendations put forward by the Behavorial Health Integration Task Force — including payment reform and mental health parity in rates; privacy policies in integration of services; and general coordination of care.

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State & Federal Mental Health Parity Resources

Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008
The 2008 federal mental health parity law

Mental Health Parity and Addiction Equity Act Fact Sheet (Center for Consumer Information & Insurance Oversight)
This website provides information about the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008

Mental Health Parity and Addiction Equity Act Fact Sheet (Department of Labor)
This website provides information about the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008

Chapter 80 of the Acts of 2000, An Act Relative to Mental Health Benefits
A copy of the 2000 Massachusetts mental health parity law

Chapter 256 of the Acts of 2008, An Act Relative to Mental Health Parity
A copy of the 2008 Massachusetts mental health parity law that expanded the 2000 law.

Disclosure and Compliance Requirements for Carriers, and Process for Handling Complaints for Non-Compliance with Federal and State Mental Health and Substance Use Disorder Parity Laws (Division of Insurance Bulletin, May 31, 2013)
This bulletin provides guidance concerning enforcement of federal and state mental health parity laws. It reviews the requirement that carriers provide subscribers with written notice of their rights under mental health parity laws and describes the processes for carriers to certify their compliance with parity laws, and for consumers to complain about non-compliance with these laws.

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The Affordable Care Act (ACA) and Mental Health

ACA_approvalThere’s been no shortage of conversation around the Affordable Care Act since its initial implementation in October, 2013. But little attention has been paid to the practical implications of the ACA on mental health clinicians, their practices, and the patients they serve. Below are two well-documented sets of resources on the Affordable Care Act, vis-a-vis mental health.

Substance Abuse and Mental Health Services Administration: Health Reform Basics website
This SAMHSA website provides resources on federal health reform and its effect on people facing mental health challenges.

Mental Health in Health Care Reform
This fact sheet from the Bazelon Center for Mental Health Law provides an overview of provisions in the federal Affordable Care Act that affect mental health services.  (Note that Congress has yet to appropriate funds for some of the grant and demonstration programs authorized in the federal law and described in this fact sheet).

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Behavioral Health Integration Task Force Report

BHITF Report CoverEarlier this summer, the Behavioral Health Integration Task Force issued its formal report, making a host of recommendations for the delivery and integration of mental health services in Massachusetts. The report makes 29 separate recommendations — with general consensus around three major priorities:

  • Payment reform and mental health parity in rates
  • Privacy policies in integration of services
  • Coordination of care

While it is unlikely that Commonwealth officials will tackle all 29 issues at once, CliniciansUNITED will continue to monitor efforts to implement these recommendations at the administrative and legislative levels.

Click here to read the full report.

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Other Payment Reform & Mental Health Background Resources

Compass_mapRESOURCES

Glossary of Cost Containment Terms
Description of key terms used in Chapter 224; includes some terms specific to Chapter 224 and other more widely used terms.

SAMHSA Health Care Integration website
This federal Substance Abuse and Mental Health Services Administration website provides some background and links to additional information on primary and behavioral health integration initiatives.

ORGANIZATIONS

Bazelon Center for Mental Health Law: http://www.bazelon.org/
Parity Implementation Coalition: http://parityispersonal.org/
National Association of Social Workers, Massachusetts Chapter: http://naswma.org/
Massachusetts Psychiatric Society: http://www.psychiatry-mps.org/
Massachusetts Association for Marriage & Family Therapy: http://mamft.org/
Massachusetts Psychological Association: currently under construction

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