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September, 2022
The best news for MACEP in the 2022/23 legislative session is what didn’t happen - the legislature DID NOT pass legislation to impose a default rate for reimbursement of Out of Network (OON) services.
MACEP, along with the Mass Hospital Association and our physician colleagues at the Mass Medical Society and other specialty societies successfully beat back efforts by Governor Baker and the state Senate to limit reimbursement of OON services to the median in-network rate. Several of the bills proposed would also close off access to an independent dispute resolution process.  Expectations are that we’ll be back fighting this issue again in the next session, but it is hoped that as the federal law takes effect, the impetus for action on the state level will be lessened. 

More Good news – Mental Health Bill Signed into Law
Comprehensive legislation to boost access to mental health services in Massachusetts has been signed into law. After months of negotiation around competing bills by the House, Senate and Governor Baker, the final legislation puts in place provisions long supported by MACEP to improve access to inpatient and outpatient care, reduce emergency department boarding, expand insurance coverage, increase enforcement of state and federal parity laws, enhance community and school based services, and support workforce development initiatives.
Here’s a link to Chapter 177 of the Acts of 2022, An Act Addressing Barriers to Care for Mental Health
Here are the highlights of the bill for emergency physicians and your patients:
·       Creates online portals to provide access to real-time data on youth and adults seeking mental health and substance use services.  Includes a search function that allows health care providers to easily search and find open beds using a number of criteria. (Section 2).
·       Updates the expedited psychiatric inpatient admissions (EPIA) protocol and creates an expedited evaluation and stabilization process for patients under 18.
·       Requires the Department of Mental Health to develop an expedited psychiatric inpatient admission advisory council to investigate and recommend policies and solutions regarding the emergency department boarding of patients seeking mental health and substance use disorder services. Includes a representative of MACEP on the council. 
·       Requires the development of a 988 crisis hotline center that operates 24/7 to provide suicide prevention and behavioral health crisis services. Also expands 911 to bridge the gap until 988 is implemented by increasing training, funding and capacity for regional emergency responses to behavioral health crises.
·       Implements full system accountability for monitoring compliance of state and federal parity laws and regulations by the Health Policy Commission, the Division of Insurance and the Attorney General’s Office.  Allows for imposition of fines for violations. Requires all qualified student health insurance plans to comply with state and federal parity laws.
·       Requires public and private insurance coverage of critical behavioral health services including mental health acute treatment, community based acute treatment and intensive community based acute treatment – without prior authorization!
·       Requires public and private insurance coverage of annual mental health wellness exams.
·       Enhances school based behavioral health services and programming and increases access points for youth for effective behavioral health treatment
·       Enhances community based behavioral health services by requiring the development of a standard form for exchanging confidential behavioral health information, and improving the accessibility of culturally competent behavioral health services.
·       Includes several provisions to support behavioral health workforce development.

MACEP Takes a Seat on the Stroke Advisory Taskforce
The FY’23 state budget included an outside section to create a Stroke Advisory Taskforce, including a representative of MACEP, to advise the Department of Public Health (DPH) on the development of the stroke system of care for the Commonwealth. 
Specifically, Section 42 requires DPH to “convene a group of experts which shall include, but not limited to, a representative from the American Stroke Association, a representative from The Massachusetts Neurologic Association, Inc., a representative from the Society of Neurointerventional Surgery, a representative from Massachusetts College of Emergency Physicians, Inc. and a representative of a regional EMS council created pursuant to section 4 of chapter 111C, with input from key stroke stakeholders and professional societies, to form a stroke advisory taskforce that shall assist with data oversight, program management and advice regarding the stroke system of care. The task force shall meet not less than biannually to review data and provide advice.
However, another outside section that would have required DPH to establish a statewide standard prehospital care protocol related to the assessment, treatment, and transport of stroke patients was vetoed by Governor Baker. In his veto message, the Governor noted his support for updating stroke protocols in the Commonwealth, but opposed Section 143’s “prescriptive requirement that DPH develop and assign hospitals to a tiered system” because “this requirement may result in unnecessary routing of stroke patients, which would produce an unmanageable burden for certain hospitals and unreasonable delays in accessing care for certain patients.”  With the end of the formal legislative session behind us, it is unlikely that the legislature will override the Governor’s veto, thus, expect this issue to be back before the legislature next year.

Lastly, the following MACEP priorities did not get passed this year and will be revisited in the 2023/24 legislative session: 
  • T-CPR
In written and oral testimony, MACEP registered its strong support for H.2386 and S.1489, identical bills that would ensure that all 911 call dispatchers are trained and able to coach bystanders to perform CPR. Also known as dispatcher-assisted CPR or telephone CPR (T-CPR), this legislation is important as 911 dispatchers are often the first point of contact in an emergency and in such emergencies, every minute matters.  T-CPR is an effective and low-cost strategy to improve cardiac arrest survival, yet it is underutilized. H.2386 is on hold in the Public Health Committee until 12/31/22, the last day of the legislative session.  S.1489 was put into a study.  It is expected that the T-CPR bills will be refiled for consideration in the 23/24 legislative session.
  • Workplace Violence
MACEP is committed to ensuring the safety and wellbeing of not only our patients receiving treatment, but for every member of our emergency department team. To that end, the College actively supports legislation to prevent workplace violence in health care facilities and to strengthen enforcement and penalties for violations.  Unfortunately, the bill was watered down before being reported out of the Public Safety Committee, including the deletion of language to impose penalties for violations, narrowing the definition of workplace and relaxation of reporting requirements.  The bill remains in the House Ways and Means Committee, but further action on the bill is unlikely in this session.  MACEP will continue its advocacy on this issue next year.


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