At the State Level
Massachusetts had a head start in implementing healthcare reforms. The federal Affordable Care Act (ACA) is modeled on the 2006 MA healthcare reform law, which required all citizens in the Commonwealth to have health insurance and established insurance exchanges. Furthermore, in 2012, MA Chapter 224 became law: An Act Improving the Quality of Health Care and Reducing Costs through Increased Transparency, Efficiency and Innovation. The schedule for implementing specific elements of this act, focused on healthcare delivery systems and payment reform, is at the end of the law.
Chapter 224 established the Health Policy Commission, which is charged with advancing “ a more transparent, accountable, and innovative health care system through independent policy leadership and programs. Our goal is better health and better care at a lower cost across the Commonwealth.” The HPC monitors healthcare cost trends and sets annual goals for keeping cost increases low. The Commission also solicits input from healthcare stakeholders in developing new models of care, such as Patient Centered Medical Homes (PCMH) and Accountable Care Organizations (ACO). The HPC then sets the standards and certifies health care organizations as PCMHs or ACOs. ACO certification standards are being updated for 2022-2023 certification. In 2017, Massachusetts became the first state to have statewide, all-payer standards of care for care delivery. PCMH certification stresses the importance of integrating behavioral health care in primary care settings.
Electronic health records (EHR) are central to providing integrated care, according to state and federal laws. The Mass HIway is the Massachusetts Health Information Exchange (HIE) allows all healthcare clinicians to “push” (send) and “pull” (access and receive) patient information via this secure electronic communication network (with patient consent). An EHR system is not required to connect. For information on how to enroll and/or sign up to receive newsletter, go to: http://www.masshiway.net/HPP/index.htm
Although MA Chapter 224 states that all healthcare providers will connect through the Mass HIway, as of April 2022, no plans to require this for solo and small-group behavioral health clinicians have been announced. Connection requirements have been phased in over a 4-year period that extends into 2022 and affect only these health care facilities: acute care hospitals, community health centers, and medium/large medical ambulatory care practice. Individual clinicians are not required to connect -- only the organizations. The Mass HIway team will keep the healthcare community updated of any additional phase-in requirements. The regulations (101 CMR 20.08(1b)) specify that future guidance will provide at least one year notice for affected provider organizations to connect to the Mass HIway. Any additional requirements related to neuropsychologists will be posted here and on the MNS list serv, but no such plans are on the horizon as of April 2022.
Medical practitioners governed by the Board of Medicine have generally been further along in adopting EHR's relative to behavioral health clinicians, although behavioral health clinicians and practices are increasingly moving from paper to electronic records. Various task forces analyzed the unique privacy concerns in behavioral health. As of April 2022, requirements to adopt EHR’s in Massachusetts behavioral health practices is off the table. Should this change, any announcement regarding EHR requirements will be posted here and on the MNS list serv.