Front Door
Q: Is the “front door” the only way that people can enter the behavioral health system?
A: No. The “front door” is designed to serve as a streamlined and accessible way to connect people to the appropriate clinical assessment and treatment when they may not otherwise know where to turn.
Q: What kind of assistance does the “front door” provide?
A: An individual or their loved one can call or “chat” through a centralized, single phone number/website. A staff person will answer the call/chat and will gather information to determine what help is needed; a brief clinical assessment may be conducted when appropriate. The front door staff then will help the caller navigate and connect to the appropriate next steps, which may include referral to a Community Behavioral Health Center (CBHC) or other outpatient provider, referral to mobile crisis intervention, or connection to other behavioral health services.
Q: How does the “front door” interface with existing call lines such as 211, 911, 988, and the Bureau of Substance Addiction Services (BSAS) Substance Use Disorder (SUD) helpline?
A: The “front door” is a statewide resource, available by phone and online/mobile “chat,” for triage and connection to appropriate behavioral health services. EOHHS intends to ensure seamless connection between the “front door” and other resources such as the BSAS SUD helpline, Mass 211 line, and the National Suicide Prevention Lifeline.
Q: Are individuals experiencing early signs of mental illness eligible to access the “front door”?
A: The “front door” is an entry point to treatment for all individuals, regardless of their diagnosis or prior experience or history with behavioral health treatment. The front door exists to help individuals or their loved ones figure out where and how to find help when they need it.
Q: Are individuals required to be approved for DMH services to use the “front door”?
A: No. The “front door” is intended to function as an entry point to treatment for all individuals, regardless of their diagnosis, prior experience or history with behavioral health treatment or insurance coverage.
Community Behavioral Health Centers (CBHCs)
Q: What are the key service components of the Community Behavioral Health Centers?
A: The CBHCs are a new provider designation that serves as an entry point for timely, flexible, person-centered, high-quality mental health and addiction treatment on an urgent and ongoing basis. Key service components of CBHCs focus on quality and outcomes, including offering trauma-informed care and evidence-based practices. These services include:
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Integrated mental health and addiction treatment
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Extended hours, including evenings and weekends
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Same-day access to intake and brief assessment, urgent and crisis treatment including medications, and drop-in treatment and support(e.g., group sessions, peer supports)
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24/7 mobile and community crisis response with Community Crisis Stabilization for youth and adults
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Telehealth and flexible service delivery locations (e.g., home, school, etc.)
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Peer supports
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Care coordination
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Ability to serve all ages, including child and family-specific treatment models and models for older adults
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Ability to meet a variety of language needs and serve individuals from diverse cultural backgrounds
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Evidence-based and evidence-informed treatments to meet individual needs, including interventions and close coordination for individuals with BH needs who are involved with other systems, including the justice system or children in the care and custody of the Commonwealth.
Q: How are CBHCs paid under the MassHealth program?
A: MassHealth provides payment through a flexible, bundled encounter-based payment model for outpatient and urgent evaluation and treatment. A Request for Information (RFI) was released in Summer 2021 to collect feedback and inform the rate development and service components included in the encounter bundle, and to gather input on the rate structure for 24/7 community and mobile crisis services. There is also a pay-for-performance component of CBHC payment.
Q: Is there a value-based payment component to the CBHC payment structure?
A: MassHealth has included a pay-for-performance element of the CBHC payment structure, based on well-established quality and outcomes measures. The first year of this program is pay for reporting in order to establish baselines and implement new data collection and reporting processes. CBHCs are also required to report several additional performance measures, including timeliness of initial evaluations, urgent, crisis, and routine visits, as well as member experience.
Q: Do MassHealth’s managed care entities contract with the CBHCs?
A: Yes. CBHCs are contracted to serve MassHealth members across all managed care and fee-for-service (FFS) programs.
Q: Do commercial insurers contract with CBHCs?
A: Commercial insurers are strongly encouraged to contract with CBHCs and to adopt the CBHC care delivery and reimbursement model to ensure that all Massachusetts residents have access to CBHCs regardless of insurance coverage. EOHHS is engaging directly with commercial health insurance carriers, as well as with the Division of Insurance (DOI), Group Insurance Commission (GIC) and the Massachusetts Health Connector to encourage commercial adoption of key elements of the Roadmap, including contracting with the new network of CBHCs.
Q: How do the CBHCs relate to the restructured crisis system?
A: CBHCs were procured in conjunction with the re-procurement of the Emergency Services Program/ Mobile Crisis Intervention (ESP/MCI) system. New Youth Community Crisis Stabilization (CCS) services have also recently become available, alongside the existing Adult CCS service, as part of the enhanced ESP/MCI system. In addition to outpatient and urgent treatment, all CBHCs provide 24/7 community and mobile crisis services, including ESP/MCI and CCS, for a defined geographic area. The geographic regions assigned to CBHCs may be similar to current ESP/MCI regions or may be modified.
Q: What is the difference between CBHCs and the national Certified Community Behavioral Health Clinic (CCBHC) model?
A: CBHC service delivery expectations are similar with CCBHC service delivery expectations. Both models focus on delivering a continuum of outpatient, urgent, and crisis mental health and SUD services on an open-access basis and in a person-centered, evidence-based manner. Key differences include that CBHCs will be required to deliver specialized services for children and youth, which is not required in the national CCBHC program. In addition, the CBHC requirements and encounter rate will not include supported employment, targeted case management, intensive outpatient, or day treatment. CBHCs may offer some of these services, but they will not be included in the CBHC scope of services or encounter rate. CBHCs will be required to facilitate referrals to needed behavioral health services not provided by the CBHC. EOHHS anticipates that participation in the CBHC model will create synergies for providers that are pursuing SAMHSA CCBHC designation.
Q: Are CBHCs required to have partnerships with other service providers?
A: CBHCs are expected to maintain formal referral partnerships with specialty behavioral health providers to ensure member access to certain services that are not directly delivered by the CBHC, such as methadone treatment and naltrexone injection, Children’s Behavioral Health Initiative (CBHI) services, and certain evidence-based practices. CBHCs have flexibility to determine the structures of these partnerships.
Q: How have CBHI services, performance specifications and payment methodologies been incorporated into CBHCs? Do CBHCs provide ICC? MCI?
A: CBHCs are not required to deliver Intensive Care Coordination (ICC), Family Support and Training (FS&T), In-Home Therapy (IHT), Therapeutic Mentor (TM), or In-Home Behavioral Services (IHBS), but they are expected to maintain strong referral partnerships with CBHI providers and facilitate access to those services as needed. Each CBHC delivers 24/7 community and mobile crisis services, including Mobile Crisis Intervention, for a defined geographic region.
Q: Will there be future opportunities for providers to become CBHCs?
Yes.
Behavioral Health Urgent Care
The following pertains to MassHealth Behavioral Health Urgent Care, updated April 4, 2022
Network
Q: Must MCEs contract with all Mental Health Centers (MHCs) designated as Behavioral Health Urgent Care providers (“Behavioral Health Urgent Care providers”) if such providers are not already within the MCE’s provider networks?
A: No, however, ACPPs, MCOs, and the BH Vendor must contract with all Mental Health Centers in their network that are designated as Behavioral Health Urgent Care providers at a rate that reflects a 15% increase over the plan’s otherwise negotiated rates for all applicable procedure codes described in Table 1 of Bulletin 83.
Staffing and Service Delivery
Q: Must staffing composition during Behavioral Health Urgent Care extended appointment availability be the same as staffing composition during regular hours?
A: MassHealth expects Behavioral Health Urgent Care providers to remain open at typical operating capacity during extended appointment availability hours and to have adequate staff to meet Members’ needs during all hours of operation.
Q: Must Behavioral Health Urgent Care providers provide interpretation and translation services during extended appointment availability hours?
A: Yes, appointments that occur during extended hours must employ the same interpretation and translation services as those that occur during typical operating hours.
Q: Must Behavioral Health Urgent Care providers offer services to Members of all ages during extended appointment availability times?
A: Behavioral Health Urgent Care providers must offer services to the population of Members typically served at that location during all hours of operation, including during extended appointment availability.
Q: Can the designated Behavioral Health Urgent Care providers provide urgent MAT evaluations through a partnership agreement with another provider?
A: MassHealth prefers the Behavioral Health Urgent Care providers to perform urgent MAT evaluations onsite, however, MAT evaluations may be provided through a partnership agreement with another provider. Whether provided directly by the Behavioral Health Urgent Care provider, or in partnership with another provider, all urgent MAT evaluations must occur within the specified timeframe.
Q: What are the required extended appointment availability hours?
A: Please refer to Bulletin 76.
Q: May Behavioral Health Urgent Care providers meet the requirement to offer extended appointment availability by providing appointments during extended appointment availability via telehealth?
A: Behavioral Health Urgent Care providers must be open during extended hours. All decisions regarding the appropriateness of telehealth interventions must be made based on Member need, and in collaboration with the Member/Member’s family.
Q: How is “urgent behavioral health need” defined and is there any diagnostic guidance or required screening tool?
A: Urgent behavioral health needs are characterized by changes in behavior or thinking, role dysfunction, emerging intent of self-injury, or threats to others, but do not include immediate risk of harm to self or others. A determination of an urgent behavioral health need should be made by the triaging or treating provider in consultation with the individual seeking treatment or their caregiver or guardian. This does not include emergencies. MassHealth does not require the use of a specific screening tool to make this determination.
Q: Does the “same or next day” requirement for initial diagnostic evaluations start on the date of first contact?
A: Yes. If the need is determined to be urgent, an appointment for initial diagnostic evaluation must be scheduled for the same or next day after the member’s first contact, including calls or visits in-person to schedule an appointment. Urgent psychopharmacology appointments and MAT evaluations shall be completed within 72 hours of the diagnostic evaluation and based on a psychosocial assessment. All other treatment appointments must occur within 14 calendar days of first contact.
Q: Which code modifiers can be billed with the BH UC modifier?
A: Providers may bill any eligible and applicable modifiers in addition to the BH UC modifier, GJ, when billing the procedures codes described in Table 1 of Bulletin 83.
Q: What is the best practice for billing multiple modifiers?
A: BH UC providers should refer to each health plan’s specific billing guidance when billing with multiple modifiers.
Reporting
Q: When must data collection systems be operational, and when will the quarterly data reports be due?
A: MassHealth’s Behavioral Health Vendor will establish a reporting system and due dates on MassHealth’s behalf. MassHealth anticipates that providers will have adequate notice to set up systems to gather the required data.
Q: If an appointment is offered within the designated time frame and the Member declines that appointment, how should the Behavioral Health Urgent Care provider report this?
A: The reporting requirements are outlined in Bulletin 76. The Behavioral Health Urgent Care provider must make best efforts to respond to Members’ needs when scheduling appointments.
Q: Must the Behavioral Health Urgent Care providers meet certain reporting benchmarks or percentages?
A: Benchmarks will be established based on data collected during the first year of Behavioral Health Urgent Care operation. Behavioral Health Urgent Care providers may be required to meet those benchmarks in subsequent years of operation.
Crisis Services
Q: How does the crisis system intersect with the new CBHCs?
A: The Emergency Services Program/ Mobile Crisis Intervention (ESP/MCI) system has been re-procured in conjunction with the procurement of the CBHC system. New Youth Community Crisis Stabilization (CCS) services have also become available alongside the existing Adult CCS service, as part of the enhanced ESP/MCI system. In addition to outpatient and urgent treatment, all CBHCs provide 24/7 community and mobile crisis services, including ESP/MCI and CCS, for a defined geographic area. The geographic regions assigned to CBHCs may be similar to current ESP/MCI regions or may be modified.
Q: How does the Roadmap strengthen the delivery of community and mobile crisis services?
A: The Roadmap creates a stronger 24/7 community and mobile crisis intervention response to provide a robust alternative to the ED for individuals experiencing a behavioral health crisis, with the goal of shifting an even greater share of crisis intervention encounters into the community rather than the ED.
In order to achieve this:
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Accountability for regional 24/7 community and mobile crisis response will be integrated with CBHCs that have the capacity to provide Community Crisis Stabilization for adults and youth, as well as follow-up and ongoing outpatient treatment as appropriate.
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The MassHealth payment model for ESP/MCI will be designed to support enhanced community-based response, crisis intervention, and follow-up. EOHHS plans to take advantage of enhanced federal funding for mobile crisis intervention in the American Rescue Plan to support increased funding for community-based encounters.
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The 24/7 community and mobile crisis system will be available to all residents, regardless of what type of insurance they have. EOHHS is engaging stakeholders, including commercial insurance carriers, to determine how best to achieve this goal.
Acute and Post-Acute Services
Q: What is EOHHS doing to address Emergency Department (ED) boarding and support the increased demand for inpatient psychiatric services in light of the pandemic?
A: During the COVID pandemic there has been a significant increase in patients waiting in EDs for inpatient psychiatric treatment as a result of increased need for acute psychiatric treatment and constrained bed capacity. EOHHS is providing one-time startup funding incentives and supplemental payments (equivalent to 25-30%+ rate add-ons) to increase inpatient capacity, totaling approximately $40 million in state fiscal year 2021. At this time, more than 250 new treatment beds have been committed by hospitals across the Commonwealth, including more than 80 beds for children and adolescents. These treatment beds start to come online in the spring of 2021, and we expect additional beds to open over the course of the year. The MassHealth supplemental funding for expanded child/adolescent inpatient psychiatric bed days will continue through FY23.
EOHHS also provided 10-20% across-the-board rate increases for inpatient psychiatric stays during the first COVID surge in 2020 and is continuing to provide enhanced funding for inpatient psychiatric treatment for COVID-positive patients and dedicated COVID-positive inpatient psychiatric units.
EOHHS also anticipates that expanded access to community-based urgent treatment supported through the Roadmap (e.g., CBHCs, behavioral health urgent care/rapid access) will help to further alleviate ED boarding.
Q: Is EOHHS expanding peer-run respite programs?
A: As a part of the emergency response to the COVID-19 pandemic, DMH has contracted for additional respite beds across the state, including a new respite program in Central Massachusetts operated by a peer run organization. These new respite beds are not limited to DMH clients, and their priority is to serve individuals being discharged from inpatient psychiatric treatment who have complex needs.
Q: What elements of the roadmap target the needs of children with intellectual/developmental disabilities?
A: EOHHS will require that CBHCs provide services for individuals with Autism Spectrum Disorder and those with Intellectual or Developmental Disabilities (ASD/IDD) who have co-occurring behavioral health conditions.
Starting in July 2020, EOHHS launched a specialty consultation service that allows ESP/MCI crisis clinicians to consult with ASD/IDD specialists to improve their ability to appropriately treat youth and young adults with ASD/IDD who are in behavioral health crisis. Through the Roadmap, EOHHS is expanding access to the ASD/IDD expert consultation service to other ambulatory service providers and settings.
In addition, EOHHS has worked with providers to increase the number of inpatient psychiatric units with specialized capacity to treat children and adolescents with ASD/IDD.
Health Equity
Q: What provisions does the Roadmap include to improve behavioral health equity?
A: The Roadmap addresses behavioral health inequities through several key strategies:
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Diversifying the workforce to be more reflective of the Commonwealth’s residents, including through student loan repayment incentives for clinicians with diverse cultural, racial, ethnic, and linguistic competence.
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Expanding coverage of peers for mental health and addiction.
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A multi-lingual “front door,” including ASL interpreters.
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Providing treatment when and where people need it to reduce disparities in access to behavioral health services related to transportation, time off from work and childcare by expanding the availability of integrated behavioral health services within primary care, extending broad telehealth coverage, and requiring extended hours, including weekends, at CBHCs and behavioral health urgent care.
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Providing culturally competent care. Require CBHCs to provide services in clients’ preferred language (including ASL). Require CBHCs to provide tailored services for populations such as individuals who are justice involved, individuals with ASD/IDD, and youth in the care and custody of the Commonwealth.
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Offer training for behavioral health providers in evidence-based practices (e.g., trauma-informed therapies) that better meet the needs of Massachusetts’ diverse populations.
Services Across the Lifespan
Q: How are older adults supported in the Roadmap?
A: All CBHCs are expected to meet the needs of individuals across the lifespan either directly within the provider organization or through formal relationships with other provider organizations with expertise in serving this population. For older adults, this includes providing services in a client’s home or other community environments when appropriate and having connections with local Aging Service Access Points and other community-based aging services providers to help facilitate and coordinate services.
Q: How does the Roadmap strengthen services for children and youth?
A: EOHHS considered the specific needs of youth and families throughout the design of the Roadmap and takes an interagency approach to addressing challenges faced by youth and families in accessing specialized services that meet their needs. CBHCs are required to provide a robust set of youth-specialized outpatient services. These services are staffed with youth-trained clinicians and are able to deliver particular evidence-based practices for children and adolescents, such as structural family therapy and Adolescent Community Reinforcement Approach (A-CRA).
As part of the CBHC network, EOHHS is introducing new Youth Community Crisis Stabilization Services to provide intensive short-term clinical treatment and stabilization to help divert youth from avoidable trips to the ED or inpatient hospitalization.
Q: How is the Roadmap addressing the needs of youth in the custody of the Department of Youth Services (DYS)?
A: During the development of the Roadmap, EOHHS engaged stakeholders who work with youth involved with DYS and their families. Stakeholders identified as a priority the need for youth in DYS facilities to engage in community-based behavioral health treatment as part of their transition back to the community. In 2020, EOHHS implemented a policy that allows youth in DYS custody and their families to access community-based behavioral health treatment usually covered by MassHealth, including CBHI services, prior to the child’s transition back to the community, to enhance continuity of care and engagement in services.
Workforce
Q: How does EOHHS support behavioral health providers as part of this reform initiative?
A: EOHHS continues to support providers through the following strategies:
- Providing financial support in the form of both temporary and permanent rate increases
- Grants and loan repayment programs to support workforce training and educational advancement
- Expansion of the workforce pipeline
- Providing licensing, regulatory and credentialling flexibilities that support workforce capacity by removing barriers but do not impact quality or safety
- Introducing strategies to augment the workforce through innovative care delivery strategies and technology initiatives
Q: Does the Roadmap include initiatives related to provider training, such as training in the delivery of evidence-based practices?
A: EOHHS has partnered with higher-ed to train clinicians on evidence-based clinical practices to enhance the provision of treatment services. Funding is also available for MassHealth-enrolled behavioral health providers to support training for peers, including Recovery Coaches and Certified Peer Specialists, as well as Community Health Workers.
Substance Use Disorder
Q: How does the Roadmap strengthen 24-hour substance use disorder (SUD) services?
A: DPH and MassHealth introduced new regulatory flexibilities and enhanced clinical standards for 24-hour SUD providers in 2022. These included licensure updates to allow flexibility in ATS/CCS beds to allow providers to more easily flex beds and provide continuity of care, and requirements that 24-hour SUD providers improve capacity for medication for addiction treatment (MAT), medication management, and treatment of co-occurring medical and mental health conditions. These enhanced clinical standards have been supported by rate increases for EOHHS contracted programs.
Q: How have funds from the Substance Use Disorder Federal Reinvestment Trust Fund been used to support providers that expand MAT?
A: The SUD Federal Reinvestment Trust Fund has been used in multiples ways to support and expand access to MAT, including investing in the expansion of OBAT and Bridge Clinic services, and supporting low threshold MAT in outpatient settings. The SUD Trust also supported the expansion and enhancement of the 24-hour addiction treatment system, which further expanded access to MAT. In FY22, approximately $70 million from the SUD Trust supported efforts within the Roadmap that align with the statutorily authorized uses of SUD Trust funds.
Glossary of Acronyms
- A-CRA- Adolescent Community Reinforcement Approach
- ACO- Accountable Care Organization
- ASD- Autism Spectrum Disorder
- ATS- Acute Treatment Services
- BH CP- Behavioral Health Community Partner
- BRYT- Bridge for Resilient Youth in Transition
- BSAS- Bureau of Substance Addiction Services
- CANS- Child and Adolescent Needs and Strength
- CBAT- Community Based Acute Treatment
- CBHC- Community Behavioral Health Center
- CCBHC- Certified Community Behavioral Health Center
- CCS- Community Crisis Stabilization
- CMHC- Community Mental Health Center
- CSP- Community Support Program
- CSS- Clinical Stabilization Services
- DBT- Dialectical Behavior Therapy
- DMH- Department of Mental Health
- DOI- Division of Insurance
- DPH- Department of Public Health
- ED- Emergency Department
- EOHHS- Executive Office of Health and Human Services
- ESP- Emergency Services Program
- FFS- Fee for Service
- FS&T- Family Support and Training
- GIC- Group Insurance Commission
- ICC- Intensive Care Coordination
- IDD- Intellectual and Developmental Disability
- IHBS- In-Home Behavioral Services
- IHT- In-Home Therapy
- IOP- Intensive Outpatient Program
- LADC- Licensed Alcohol and Drug Counselor
- LMFT- Licensed Marriage and Family Therapist
- LMHC- Licensed Mental Health Counselor
- LTSS- Long Term Services and Supports
- MAT- Medication for Addiction Treatment
- MBHP- Massachusetts Behavioral Health Partnership
- MCI- Mobile Crisis Intervention
- MCO- Managed Care Organization
- OBAT- Office-Based Addiction Treatment
- OTP- Opioid Treatment Program
- PACT- Program of Assertive Community Treatment
- PDT- Psychiatric Day Treatment
- RC- Recovery Coach
- RFA- Request for Application
- RFP- Request for Proposal
- SAMHSA- Substance Abuse and Mental Health Services Administration
- SCO- Senior Care Options
- SOAP- Structured Outpatient Addiction Program
- SUD- Substance Use Disorder
- TM- Therapeutic Mentor