October 26, 2016
Ms. Catrice Williams, Office of the General Counsel
Department of Public Health
250 Washington Street
Boston, MA 02108
RE: Proposed amendments to 105 CMR 140.000 Licensure of Clinics
Dear Ms. Williams:
The Association for Behavioral Healthcare (ABH) is a statewide association representing more than eighty community-based mental health and addiction treatment provider organizations. Our members are the primary providers of publicly-funded behavioral healthcare services in the Commonwealth, serving approximately 81,000 Massachusetts residents daily, 1.5 million residents annually, and employing over 46,500 people.
ABH member organizations appreciate the Baker Administration’s commitment to addressing the often burdensome, duplicative regulations which make it more difficult for mental health and addiction treatment organizations to provide high-quality services to some of the Commonwealth’s most vulnerable citizens. We strongly support many of the changes proposed to 105 CMR 140.000 Licensure of Clinics which address these concerns.
140.103 (E)(2) Submission and Approval of Plans
ABH strongly supports the new language included in this section which says, “Those provisions of the Facility Guidelines Institute’s Guidelines for Design and Construction of Health Care Facilities which pertain to services a particular clinic does not provide shall not apply to the clinic”. ABH recommended changes to this section during the Baker administration’s regulatory review process.
DPH currently requireslicensed mental health clinics and day treatment providers to fulfill the FGI Guidelines for more complex facilities like Outpatient Psychiatric Centers (OP13) and Outpatient Rehabilitation Therapy Facilities (OP14). Sections of the OP13 checklist include nurse and staff stations, requirements for nourishment areas and soiled holding rooms which are not necessary for an outpatient mental health clinic. Allowing DPH flexibility when they approve plans for new clinic sites is essential as the FGI Guidelines were developed for more medically-focused clinics.
140.121: Period of License
ABH is concerned with proposed changes in 140.121 which remove the ability of the Department to issue a provisional license to a clinic that is not in full compliance with applicable requirements. We believe that if the provider is making a good faith effort through a corrective action plan to meet the full criteria, the Department should have the ability to issue a provisional license for a predetermined period of time so the provider is able to achieve full compliance.
140.206: Utility Closet and 140.207 Reserved
ABH supports the change to the language in this section which would require a “utility” closet instead of a “janitor’s” closet and would also remove the storage space requirement.
140.302: Patient Records
ABH supports the changes to this section which allow clinics to maintain centralized records documenting all the services rendered to the clinic patients. This change takes into account the move to electronic health records where documents no longer have to be located “on the premises” to be available in a central location.
140.510 Mental Health Services
ABH greatly appreciates and strongly supports the changes outlined in this section allowing more flexibility for providers to do short term interventions without requiring a complete diagnostic evaluation. We request the department consider increasing the proposed limit of “beyond four sessions” to instead “beyond eight sessions.”
As you know, many urgent, one time, short term interventions, do not require the current, quite lengthy diagnostic evaluation defined in 105 CMR 140.520(B)(1) through (3). Evaluations should be appropriate to the complaint and the issues for whichclients are seeking help. This situation is quite common in medical practices where the “treatment plan” might be very brief and focused on a specific problem. In addition, in an age of integration where behavioral health providers are working in medical practices, a full evaluation may not be appropriate and actually be a barrier to integrating behavioral health into primary care sites.
ABH also requests the Department consider adding a second category of individuals for the brief diagnostic evaluation. Providers report that it is very difficult to engage parents and other family members in group therapy due to the lengthy diagnostic evaluation. Allowing these group sessions to fall into a separate diagnostic category for eight to twelve sessions would encourage more individuals to participate in these clinically appropriate and important groups.
140.530 (C)(a) Personnel Qualifications
ABH does not support the changes outlined in 140.530 (C)(a) which currently allows a board eligible psychiatrist to be included on the required multidisciplinary staff of the clinic. The proposed change to allow only board certified psychiatrist would disqualify psychiatrists working towards certification, may hinder providers from hiring psychiatrists from other jurisdictions and will make it more difficult to find psychiatrists to fill existing vacancies. In 2015, ABH surveyed our membership and 60% of clinics reported an opening for a psychiatrist. Lack of access to the appropriate workforce continues to be an issue for mental health clinics across the Commonwealth. This proposed change will exacerbate those workforce issues.
A close examination of MassHealth’s proposed accountable care organization (ACO) contract shows that the Model A ACO requires “board certified or board eligible psychiatrists” to perform utilization review and render denials. Clinics that provide these services should only be required to meet the same standard.
140.560: Mental Health Outreach Programs
ABH strongly supports the removal of section (C) which currently references MassHealth regulations. The MassHealth regulations outline stringent requirements for the operational hours of outreach clinics.
ABH requests the department take a closer look at the language outlined in section (E) as some providers interpret this clause as preventing a behavioral health provider from renting space from an existing primary care clinic. Co-location is an important step for many providers as they work to better integrate primary care and behavioral health services.
Thank you for your consideration.
Sincerely,
Vicker V. DiGravio III
President/CEO