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Hospitals and provider groups seek equitable payment and clearer MassHealth MCO rate documentation
Summary
The Mass. Association for Behavioral Health asked legislators to advance H.2232 to ensure hospitals receive full negotiated rates for state clients awaiting discharge and to back H.2233/S.1404 to require comparable access to behavioral‑health services across MassHealth managed‑care plans.
David Matioto, executive director of the Massachusetts Association for Behavioral Health, summarized two bills asking for favorable reports: H.2232 (an act to require equitable payment) and H.2233 / S.1404 (an act to require comparable access across MassHealth MCOs).
Matioto said H.2232 would require that hospitals receive their full negotiated rate when treating a state client (for example, a child placed through DCF or an adult awaiting DMH placement) until discharge, a rule similar to an existing approach for some DMH‑awaiting patients and one that could put pressure on MCOs to facilitate timely placements and reduce long inpatient waits. He told the committee the average length of stay on a psychiatric unit is about 13 days and noted some patients currently remain hospitalized for months while discharge is delayed.
On H.2233 / S.1404, Matioto asked for comparable access to services and medications for MassHealth enrollees regardless of the managed‑care vendor, and for annual documentation from MCOs describing how they determine rates and conduct utilization management. He described provider concerns about denials and payment delays — including reports that some MCOs may be using algorithms or other tools to manage care — and recommended transparency so providers and the committee can better understand rate setting and utilization review practices.
The sponsor asked for favorable reports; no formal committee action occurred during the hearing. Written testimony and additional materials were submitted for the record.
Provenance: - topicintro: David Matioto testimony beginning at 00:31:36. - topfinish: end of Matioto’s summary at 00:36:40.
