April 1st, 2015

Bill seeks to eliminate MassHealth plan barriers

Call it the backup plan.

A bill filed at the Massachusetts State House would require MassHealth to cover all services psychologists provide – regardless of which MassHealth plan an individual has – and ensure that MassHealth recipients have the same access to psychological services as Medicare covered individuals.

Lead sponsors Rep. Ruth B. Balser (D-Newton) and Sen. Joan B. Lovely (D-Salem) jointly filed the proposal in their respective chambers in January with full support from the Massachusetts Psychological Association (MPA).

“Since the legislative cycle is a two-year process and the deadline for filing bills was in January we thought filing the bill was important,” explained Michael A. Goldberg, Ph.D., MPA director of professional affairs and past-president.

But in the meantime, Goldberg said the association will push Gov. Charlie Baker’s administration for a regulatory change to remove a barrier unique to unmanaged MassHealth plans, one that undermines ongoing efforts to integrate behavioral health services into primary care.

A MassHealth regulation prohibits coverage of treatment by independently licensed psychologists who are part of the MassHealth network. Commercial plans, Medicare and managed MassHealth plans do not have this barrier.

Those with a commercial plan or Medicare plan as their primary health plan and have a standard MassHealth plan as their secondary carrier do not have secondary coverage for treatment provided by individually licensed psychologists. The result is an interruption of psychological treatment for people who change from a commercial plan or Medicare to a MassHealth Standard Plan.

Goldberg said MassHealth Director of Behavioral Health Unit Chris Counihan indicated he supported changing the regulation at a meeting with MPA last summer.

“However, we were only a few months away from a new governor and new administration taking over. It was clear that getting the change done before the change in government took place was not likely,” Goldberg said. “Now that the new administration is in place, we intend to meet with them and seek regulatory change but have the bill filed as a backup.”

Officials from the Executive Office of Health and Human Services did not respond to requests for comment as of deadline.

MPA wants to void a regulation dating back to the 1970s that prevents psychologists from directly billing and receiving payment from MassHealth for mental health treatment services, said James Leffert, Ed.D., chair of the association’s Advocacy Committee.

It’s hard to believe that there is such a rule, but it reflects someone’s notion at the time that mental health treatment, including to poor, working class and disabled people, would be provided by medical doctors (psychiatrists) and psychologists would only do assessment,” Leffert wrote in an email.

Leffert added that psychologists in private practice are unable to recover co-payments and deductibles for adults on MassHealth who have other primary insurance because they cannot bill MassHealth as secondary insurance. “This is a big disincentive for mental health professionals to serve MassHealth enrollees who are in this situation,” he added.

Moreover, while Massachusetts law mandates MassHealth coverage for Autism Spectrum Disorder it fails to mandate coverage for treatments by psychologists even though the field of psychology created those treatments and those treatments have always been in the scope of practice for psychologists.

Balser said she believes it is important to ensure consumers can receive services provided by psychologists no matter who is the payer.

“While it may be possible to have this adjustment made through regulation, it is always sensible to file legislation, in case that turns out to be necessary,” Balser said.

By Janine Weisman

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