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 implement fully interoperable electronic health records (EHR) systems that connect through the Mass HIway, it remains unknown how this will apply to solo and small-group behavioral health clinicians. Connection requirements are being phased in and by the end of 2020, acute care hospitals, community health centers, and medium/large medical ambulatory care practices must meet connection requirements. Individual clinicians are not required to connect -- only the organizations. The Mass HIway team will keep the healthcare community updated. Announcements of connection deadlines will provide at least one year’s notice prior to connection deadlines.
Any updates regarding EHR regulations and behavioral health will be posted here and on the MNS list serv. Medical practitioners governed by the Board of Medicine are further along in adopting EHR's than are behavioral health clinicians, although more and more behavioral health clinicians are making the move from paper to electronic records. Various task forces are discussing how to reconcile the unique privacy concerns in behavioral health and the prevalence of solo behavioral health practitioners with use of EHR's. Patients must give consent for their healthcare information to be transmitted via the MassHIway. The Mass eHealth Institute is the state agency coordinating information technology innovation and use, working closely with the MA Executive Office of Health and Human Services (EOHHS).