The bill requires a Medi-Cal managed care plan to accept that a pediatric patient meets medical-necessity requirements when a provider substantiates any specified pediatric subacute-care criterion, without imposing or requiring additional criteria. If the Department of Health Care Services develops a standard form for authorization or reauthorization of pediatric or adult subacute-care services, plans must accept it as sufficient and may not create or require a separate form from the plan or another entity.

A plan may not require a subsequent treatment authorization request when a patient returns to subacute care from a bed hold for acute hospitalization. The department may impose sanctions under Welfare and Institutions Code Section 14197.7 on plans that violate the standard-form or bed-hold requirements.

FULL SUMMARY

Establishes a statewide hospital discharge-data system under a new subpart of Hawaii Revised Statutes chapter 323D. Beginning July 1, 2027, hospitals other than the state hospital must submit inpatient discharge reports at least quarterly, covering live discharges and deaths—including newborns—from acute care, intensive care, long-term acute care, psychiatric, substance-abuse, and comprehensive-rehabilitation settings. Licensed short-term acute-care hospitals, organized ambulatory health-care facilities, emergency departments, lithotripsy centers, and cardiac catheterization laboratories must also submit quarterly reports for specified outpatient, surgical, cardiology, gastrointestinal, lithotripsy, and endoscopy services. Reports must follow procedures developed by the hospital discharge data working group, identify each facility location, and comply with rules governing transfers, observation patients, and ambulatory visits.

Reporting facilities must provide underlying medical-record, billing, and related documentation for audits, and an executive officer, administrator, or designee must certify that reports are accurate, complete, and verifiable. A facility may request permission to resubmit a certified report within 12 months after its original due date, but must document the reasons, causes, corrective-action plan, affected records, data types, and proposed submission date; the state agency may approve resubmission when it would significantly improve data quality. Facilities must also report changes in designated data-submission personnel and provide required data elements and codes, including patient, diagnosis, procedure, date, charge, and provider information drawn from standard institutional billing data.

The state agency must make reports available for public inspection, while patient-specific records may be released only after de-identification of specified identifiers and dates. The State Health Planning and Development Agency must convene a working group by September 1, 2026, with designated state officials and invited health-care, provider, exchange, and data-analytics representatives; the group must hold public stakeholder meetings, develop reporting procedures, submit findings and recommendations to the Legislature at least 20 days before the 2027 regular session, and cease to exist June 30, 2027. The bill appropriates an unspecified amount from state general revenues for fiscal year 2026–2027 for Department of Health implementation, redesignates existing chapter 323D provisions as subpart A, and takes effect July 1, 3000.

FULL SUMMARY

Establishes a statewide hospital discharge data system under chapter 323D of the Hawaii Revised Statutes. Beginning July 1, 2027, hospitals must submit inpatient discharge data reports at least quarterly, including live discharges and deaths from acute care, intensive care, long-term acute care, psychiatric, substance-abuse, and comprehensive-rehabilitation settings. Licensed short-term acute care hospitals, organized ambulatory health care facilities, emergency departments, lithotripsy centers, and cardiac catheterization laboratories must also submit at least quarterly reports covering specified outpatient, surgical, cardiology, gastrointestinal, lithotripsy, and endoscopy services. Reports must follow procedures developed by the working group, identify each reporting location, include required data elements and codes, and distinguish specified acute-care and rehabilitative discharge records. Observation patients are excluded unless admitted as inpatients, and reporting ceases upon transfer or discharge to Medicare-certified skilled nursing or hospice care.

Requires each reporting facility’s executive officer, administrator, or designee to certify that submissions are accurate, complete, and verifiable; permits correction requests within twelve months of the original due date, subject to state-agency approval and specified explanations and corrective-action information; and requires notice of changes in designated reporting personnel. The state agency must audit supporting medical and billing records, make reports available for public inspection, and withhold patient-specific records unless specified identifiers are de-identified. The State Health Planning and Development Agency must convene a stakeholder working group by September 1, 2026, to develop submission procedures, hold public meetings, and submit findings and recommendations to the Legislature at least 20 days before the 2027 regular session; the group expires June 30, 2027. The bill appropriates $200,000 from state general revenues for fiscal year 2026–2027, to be expended by the Department of Health, and takes effect July 1, 2026.

FULL SUMMARY

The bill changes Hawaii’s involuntary-hospitalization standards by revising “dangerous to self” to cover a person who recently threatened or attempted suicide or serious bodily harm, or who is “gravely disabled.” It defines “gravely disabled” as being unable, without supervision and assistance, to prevent physical or psychiatric deterioration or meet needs for nourishment, essential medical care (including mental-health treatment), shelter, or self-protection, when failure to receive adequate treatment would probably result in death, substantial bodily injury, or serious physical debilitation or disease. It also defines “psychiatric deterioration” as substantial impairment or an obvious decline in judgment, reasoning, or behavioral control.

The bill extends the period covered by “imminently dangerous to self or others” from the next 45 days to the next 90 days. It changes emergency-admission notification provisions to expressly permit the patient to telephone a reciprocal beneficiary and an adult friend, in addition to the guardian, family member, and attorney. It separately identifies reciprocal beneficiaries in the facility’s notification responsibilities and permits an adult patient to request that family members or reciprocal beneficiaries not be notified, while retaining the patient’s ability to waive notification and the facility’s reasonable-efforts duty regarding required notifications.

The maximum emergency-hospitalization period increases from 48 to 72 hours after admission, unless the patient voluntarily agrees to continued hospitalization or proceedings for court-ordered evaluation or hospitalization are initiated. If the period expires on a weekend or holiday, initiation may occur by the close of the next court day; once proceedings begin, the facility may detain the patient until further court order. The changes take effect July 1, 2025, and do not affect matured rights or duties, incurred penalties, or proceedings begun before that date.

FULL SUMMARY

The Maryland Department of Health must report to the Governor and General Assembly by December 1, 2026, and annually through 2030, on licensed adolescent psychiatric inpatient beds by county; pediatric psychiatric emergency-department boarding and overstay metrics; staffing and licensure barriers; and recommended rate or regulatory changes needed to maintain sufficient bed capacity. The Department must use available data systems, including the State inpatient psychiatric bed registry and referral system, to prepare these reports.

By December 1, 2026, the Department, consulting with the National Association of State Mental Health Program Directors and Prince George’s County’s local behavioral health authority, must study and report on resources, staffing parameters, treatment plans, and therapeutic environments that would promote the best possible outcomes for adolescents receiving inpatient psychiatric care and ensure that appropriate services are provided. The Department may partner with relevant organizations for the study.

The provisions requiring at least 24 adolescent psychiatric inpatient beds in Prince George’s County, including potential procurement and grant mechanisms, are removed. The Act takes effect June 1, 2026.

FULL SUMMARY

The bill requires the Maryland Department of Health, in consultation with the Prince George’s County local behavioral health authority, to ensure at least 24 licensed adolescent psychiatric inpatient beds are established and continuously operated in Prince George’s County by December 31, 2028. The beds may be provided by expanding an existing inpatient facility, contracting with a private or nonprofit operator, or establishing a public-private partnership. The Department must prioritize approaches that reduce pediatric psychiatric emergency-department boarding and inpatient overstays, are measurable through the State’s psychiatric bed registry and referral system, and provide access regardless of payer, including Medicaid.

If expanding an existing facility would not meet the 2028 deadline, the Department must issue a request for proposals by June 30, 2027, distributing it at least to private or nonprofit operators with demonstrated experience establishing adolescent psychiatric inpatient capacity in Maryland. The Department must also administer a competitive grant program for the required beds. Grant recipients may be hospitals, psychiatric facilities, nonprofit health care providers, or public-private partnerships, and funds may be used only for renovation, construction, safety or ligature upgrades, or workforce start-up expenses.

Beginning October 1, 2027, and annually through 2030, the Department must report to the Governor and General Assembly on the number and location of licensed adolescent psychiatric inpatient beds by county; pediatric psychiatric emergency-department boarding and overstay metrics; staffing and licensure barriers; and recommended rate or regulatory changes needed to maintain sufficient capacity. The reports must use available data systems, including the State inpatient psychiatric registry and referral system. The Act takes effect July 1, 2026.

FULL SUMMARY

The report analyzes FY2025 emergency-department boarding of patients awaiting inpatient psychiatric admission under Massachusetts’ Expedited Psychiatric Inpatient Admission (EPIA) protocol. It reports 1,509 EPIA referrals, with an average time to placement of 2.5 days; 23.9% involved patients under 18 and 76.2% involved adults. Youth referrals were escalated after 48 hours of boarding and adult referrals after 60 hours. The report describes demographic, insurance, diagnostic, and placement-barrier data, noting that public insurance covered 83.1% of youth and 78.7% of adults boarding beyond the applicable threshold. Phase 1 of the Behavioral Health Treatment Referral Platform (BH TRP), launched in February 2025, automated referrals and insurer notifications; Phase 2 is intended to automate referrals to community behavioral health centers and community-based acute treatment programs.

The report finds that boarding volumes and average placement times have declined from prior peaks but remain a significant system problem. Approximately one-third of patients referred to the Department of Mental Health no longer required inpatient care after stabilization or a change in level of care, and the principal barriers included unavailable beds, medical complexity, disposition problems, aggression, unit acuity, autism or developmental needs, and lack of insurance. The Council also reports that direct admissions from community settings increased substantially, reaching 410 in 2025, and supports further use of diversion, crisis-stabilization, peer, family-support, and community-based services.

The Council recommends that the Division of Insurance oversee full implementation of behavioral-health coverage and payment-parity requirements; expand Council membership to include an older-adult representative; maintain and expand emergency-department diversion and specialized services; and require psychiatric inpatient units to admit and discharge patients 24 hours a day, seven days a week, potentially using weekend payment incentives. It also recommends continuing direct admissions, improving BH TRP data collection and stakeholder reporting, providing annual EPIA-protocol training, convening expert planning groups for complex patient populations, establishing statewide behavioral-health capacity planning, fully implementing BH TRP Phase 2 referrals to community programs, reviewing psychiatric facilities’ medical-care competencies and discharge capacity, and continuing implementation of the Behavioral Health Roadmap.

FULL SUMMARY

The report presents the Expedited Psychiatric Inpatient Admission (EPIA) Advisory Council’s FY2024 review of behavioral-health emergency-department boarding in Massachusetts. It reports 3,998 EPIA referrals, an average placement time of three days, and declining boarding volume compared with FY2022 and FY2023. Youth accounted for 30% of referrals and were escalated after 48 hours of boarding; adults accounted for 70% and were escalated after 60 hours. Approximately one-third of referrals ultimately involved a change in level of care such that inpatient admission was no longer required, with the report attributing this in part to emergency-department interventions and diversionary services.

The report identifies system capacity and placement barriers—including unavailable beds, unit acuity, medical complexity, specialty-unit needs, developmental disabilities, autism, and delayed discharges—as major contributors to prolonged stays. Public insurance covered roughly 83% of both youth and adult EPIA populations waiting for extended periods. It also describes the Behavioral Health Treatment Referral Platform, developed under contract with PointClickCare, as a tool intended to improve referral communication, bed searches, data collection, and coordination among emergency departments, psychiatric facilities, insurers, and state agencies.

The Council recommends that the Division of Insurance oversee implementation of behavioral-health coverage and payment-parity requirements; expand emergency-department diversion, crisis stabilization, respite, peer, family, and community-based services; require psychiatric inpatient units to admit and discharge patients 24 hours a day, seven days a week, potentially with weekend incentives; and expand direct community admissions with accepted pre-admission screening and transportation. It further recommends annual EPIA-protocol training, broader use of referral-platform data for system planning, expert guidance for complex populations, review of admission denials and facility clinical competencies, expanded services for patients whose care level changes, and continued implementation of the Behavioral Health Roadmap.

FULL SUMMARY

The report presents the Massachusetts Expedited Psychiatric Inpatient Admission (EPIA) Advisory Council’s FY2024 review of behavioral-health patients boarding in emergency departments and recommendations to reduce delays. The EPIA protocol coordinates emergency departments, insurers, psychiatric facilities, and state agencies, with escalation to the Department of Mental Health for prolonged cases; the Behavioral Health Treatment Referral Platform is being implemented to improve referrals, bed searches, and communication. The Council recorded 3,998 referrals, with an average placement time of three days; youth cases are escalated after 48 hours of boarding and adult cases after 60 hours.

Boarding volumes continued to decline from FY2022 through FY2024, although wait times remained relatively stable at approximately three to six days for youth and two to three days for adults. Youth represented 30% of referrals and adults 70%. The most frequent barriers included no identified barrier, unavailable beds, aggression, medical complexity, unit acuity, and unsuccessful prior admissions. Thirty-three percent of referred patients experienced a change in level of care and no longer required inpatient admission, while patients with autism, intellectual or developmental disabilities, medical comorbidities, dementia, or other specialized needs generally faced longer placement times. Public insurance covered roughly 83% of both youth and adult patients with prolonged boarding.

The Council recommends that the Division of Insurance oversee implementation of behavioral-health coverage and payment-parity requirements; expand emergency-department diversion, crisis stabilization, respite, peer, family-support, and community-based services; and require psychiatric inpatient units to admit and discharge patients 24 hours a day, seven days a week, potentially using weekend payment incentives. Additional recommendations call for direct community admissions, recurring EPIA training, expanded referral-platform data sharing, expert best-practice development for complex patient populations, statewide behavioral-health capacity planning, improved medical competencies in psychiatric facilities, and broader commercial coverage and promotion of Community Behavioral Health Center services.

FULL SUMMARY

The report presents FY2025 data and findings from Massachusetts’ Expedited Psychiatric Inpatient Admission (EPIA) Advisory Council on behavioral-health patients boarding in emergency departments while awaiting inpatient psychiatric placement. The council recorded 1,509 referrals, with an average placement time of 2.5 days; youth under 18 accounted for 23.9% and were escalated after 48 hours of boarding, while adults were escalated after 60 hours. Phase 1 of the Behavioral Health Treatment Referral Platform (BH TRP), launched in February 2025, automated referrals and notifications among emergency departments, inpatient facilities, payers, and state agencies; Phase 2 is intended to automate referrals to community behavioral health centers and community-based acute treatment programs. The report notes continuing declines in boarding volume and placement time, although delays remain significant for patients with autism, developmental disabilities, medical complexity, aggression, eating disorders, and limited bed availability.

The report recommends that the Division of Insurance oversee full implementation of behavioral-health coverage and payment-parity requirements; expand council membership to include an older-adult representative; maintain and expand emergency-department diversion, crisis stabilization, peer, family-support, and specialized services; strengthen resources for patients with autism, developmental disabilities, medical comorbidities, and state-agency involvement; and reinforce timely notification of treating clinicians when patients under 18 are discharged from emergency departments. It also recommends requiring psychiatric inpatient units to admit and discharge patients 24 hours a day, 7 days a week, with possible weekend incentives and resources for safe discharges, while continuing direct community admissions to reduce unnecessary emergency-department use.

For the Department of Mental Health, the Executive Office of Health and Human Services, and the council, the report recommends refining data collection as BH TRP expands, providing annual EPIA-protocol training to relevant hospital, insurer, and psychiatric-facility staff, using admission-denial data to assess capacity and selective-admission practices, establishing statewide behavioral-health planning based on multiple data sources, completing BH TRP Phase 2 referrals to community programs, expanding diversionary services, reviewing clinical competency and staffing requirements for medically complex patients, and ensuring commercial coverage of community-based behavioral-health services. The council also calls for an expert panel on best practices for aggression, co-occurring medical and behavioral conditions, autism and developmental disorders, and patients involved with state agencies.

FULL SUMMARY

The bill inserts a new section in chapter 6A requiring the secretary of health and human services to develop and maintain a confidential, secure online portal for real-time searches of licensed psychiatric and substance use disorder inpatient beds for adults seeking admission from an emergency department or hospital medical floor. The portal must identify each bed’s location, care specialty, and insurance requirements; portal information is not a public record. The bill defines an adult as an individual older than 22 and establishes thresholds for “boarding” and awaiting post-acute care disposition.

It replaces provisions governing the state health resource plan and focused assessments. The plan must promote equitable statewide and regional distribution of resources and address quality and access, workforce adequacy, cost-growth targets, innovative delivery and payment models, duplication, health equity and disparities, integration of oral, mental, behavioral health and substance use services, housing and home-care coordination, utilization trends, and the determination-of-need and cost-and-market-review processes. Focused assessments must evaluate resource capacity against projected need, disparities, critical providers, additional service requirements, workforce needs, access barriers, and related legislative, regulatory, or policy recommendations.

The bill revises determination-of-need standards to require consideration of the state health resource plan, cost-containment goals, health-equity and workforce effects, and relevant analyses and data from specified state entities. The Department of Public Health may not approve an application when the Office of Health Resource Planning finds that existing supply, distribution, and capacity exceed projected statewide or regional need, subject to specified exceptions for research, training, projects without increased capacity, and projects unlikely to increase public patient-care charges. Determinations must rely on the written record and applicable criteria in effect when the application was filed, including the office’s report, and decisions and reasons must be written and public.

Each hospital must file annually, within 30 days after the start of its fiscal year, a department-approved plan to eliminate unnecessary duplicate diagnostic services. Plans must address interoperable exchange of test results, improved transmission and receipt of results, and procedures for determining whether prior results can be used in treatment. The department must act within 30 days, with approval deemed to occur after 45 days without action; hospitals may be required to revise deficient plans and face civil penalties of up to $500,000 for specified failures. Health insurance payers may deny payment for medically unnecessary duplicate services, and hospitals may not balance bill insured patients for denied duplicates. The department must issue implementing regulations. The bill also requires the department to require all licensed facilities to operate 24 hours a day, seven days a week for admissions and discharges.

FULL SUMMARY

The report documents the work of the Massachusetts Special Commission on Access to Behavioral Health Services for Children and Families, established through the FY2026 budget. The Commission examined behavioral health services for Massachusetts children and adolescents under 22—including mental health, substance use, and autism-related services—barriers involving eligibility, affordability, insurance denials, authorization, staffing, wait times, geography, funding, and the feasibility of a single integrated children’s behavioral health agency. It submitted findings and recommendations for improving access, coordination, equity, capacity, and accountability.

Short-term recommendations call for family- and youth-driven system design; a cross-agency equity-accountability framework; a coordinated workforce strategy addressing compensation, training, recruitment, retention, cultural and linguistic competency, and licensing; coordination among MassHealth and commercial payers to reduce coverage gaps, prior-authorization and billing burdens, cost-sharing, and cost-shifting; improved coordination among state agencies; and stronger “front-door” navigation through existing resources such as the Behavioral Health Help Line and state-agency review teams. The proposed implementation sequence is to confirm recommendations and assign lead agencies in year one, then refine them with continued family input and begin the most feasible initiatives in years two and three.

Longer-term recommendations requiring additional investment include studies of school-based capacity, bridge programs, early-childhood prevention, family navigation, and residential capacity for youth with complex needs; centralized real-time tracking of beds and service availability; shared cross-agency data systems for access, waitlists, outcomes, disparities, and critical incidents; expanded community-based diversion and step-down services; increased inpatient and residential capacity; and enhanced supports for children with ASD/developmental disabilities, medical complexity, aggressive behavior, homelessness, or cross-system involvement. The report also recommends enforceable language-access standards, equity reporting and corrective-action thresholds, standardized referral and level-of-care criteria, warm handoffs and transition planning, maximum wait-time standards, and an interagency children’s behavioral health council with shared outcomes and annual public reporting. Its single-agency analysis concludes that creating a comprehensive integrated children’s behavioral health agency is not feasible in the near term, while targeted coordination and integration of agency processes and funding should be pursued.

FULL SUMMARY

The report presents the findings and recommendations of the Massachusetts Special Commission on Access to Behavioral Health Services for Children and Families, established through the FY2026 budget. It examines behavioral health services for children and adolescents under 22—including mental health, substance use disorder, and autism-related services—along with access barriers, funding across state agencies and MassHealth, the feasibility of a single integrated children’s behavioral health agency, and a three-year strategic approach. The report identifies fragmented entry and referral pathways, workforce shortages, payment and coverage barriers, inadequate service capacity, geographic and demographic disparities, and limited cross-agency data and accountability as central problems (pp. 3–7).

For near-term action, the Commission recommends designing the system with families, establishing cross-agency equity accountability, coordinating a youth behavioral health workforce strategy, aligning payers to reduce coverage and administrative barriers, improving coordination among DMH, DDS, DCF, DYS, DPH, the Division of Insurance, MassHealth, EEC, and DESE, and optimizing front-door access and navigation resources such as the Behavioral Health Help Line and agency review teams (pp. 9–11). The proposed implementation sequence is to confirm recommendations and assign lead agencies in year one, then update and begin implementing the most feasible initiatives in years two and three.

Longer-term recommendations include further studies of school-based capacity, bridge programs, early-childhood prevention, family navigation, and residential capacity for youth with complex needs; a centralized real-time bed and service availability system; and a shared cross-agency data system for access, waitlists, outcomes, disparities, and critical incidents (p. 12). Additional proposals include a single entry point, standardized referral and eligibility processes, language-access standards, equity reporting and corrective-action requirements, specialized pathways and enhanced reimbursement for high-acuity youth, warm handoffs and maximum wait-time standards, expanded step-down and community-based services, public reporting of emergency-department boarding, and formalized interagency governance with shared outcomes and data systems (pp. 33–44). The evaluation of a single integrated children’s behavioral health agency concludes that comprehensive consolidation is not feasible at present, while targeted coordination and integration remain appropriate objectives (pp. 45–46).

FULL SUMMARY

The Massachusetts Health Policy Commission reports on behavioral-health emergency-department (ED) boarding, defined generally as a behavioral-health ED visit lasting at least 12 hours. The report analyzes 2020–2024 data, existing state initiatives, payment policies, stakeholder-identified barriers, and approaches used in other states. It finds that behavioral-health boarding rose from 31.7% of behavioral-health ED visits in 2020 to 39.6% in 2022, then declined to 37.5% in 2024, while overall ED boarding increased from 7.5% to 11.4% over the period (chart, page 5). In 2024, approximately 26% of behavioral-health boarding cases ended in routine discharge, and children and older adults generally faced longer placement times than working-age adults (pages 6 and 8). MassHealth members and people experiencing housing instability were disproportionately represented among behavioral-health ED visits and boarding cases (table, page 7).

The report recommends expanding data collection and public reporting, including tracking changes in patients’ required level of care and revising the Expedited Psychiatric Inpatient Admission (EPIA) reporting process to include patients held over 24 hours in observation or medical/surgical beds while awaiting inpatient placement. It also recommends broader studies of psychiatric, residential, partial-hospitalization, and freestanding psychiatric capacity; analysis of admission, discharge, medical-clearance, workforce, and payment practices; and continued development of best practices for patients with aggression, autism or developmental disabilities, co-occurring medical conditions, housing instability, or other placement challenges.

To reduce boarding, the report recommends promoting the Behavioral Health Help Line, Community Behavioral Health Centers, and behavioral-health urgent-care services; supporting direct community admissions and limiting unnecessary medical-clearance requirements; reviewing ambulance-diversion rules to permit transport to hospitals with appropriate psychiatric beds or certain non-acute settings; developing alternative transportation; and expanding safe-discharge supports, including home-based, partial-hospitalization, and other community services. It further recommends clarifying reimbursement for care delivered while patients board in EDs, continuing to assess behavioral-health payment rates, ensuring adequate payment for step-down and community care, and investing in behavioral-health workforce training, retention, diversity, and capacity.

FULL SUMMARY

The Massachusetts Health Policy Commission analyzes behavioral-health emergency-department (ED) boarding from 2020–2024 pursuant to Section 145 of Chapter 126 of the Acts of 2022. It defines boarding generally as a behavioral-health ED visit lasting at least 12 hours, reports that the boarding rate for behavioral-health visits rose from 31.7% in 2020 to 37.5% in 2024, and identifies inpatient-bed shortages, discharge bottlenecks, medical-clearance practices, workforce constraints, transportation delays, and gaps in community services as principal barriers. MassHealth-insured, unstably housed, lower-income, Black non-Hispanic, and male patients were disproportionately represented among boarded residents; children and older adults generally faced longer placement times.

The report recommends expanding data collection and public reporting, including recording changes in patients’ required level of care and extending EPIA reporting to patients held over 24 hours in observation or medical/surgical beds while awaiting inpatient placement. It also calls for broader statewide behavioral-health capacity and freestanding psychiatric-facility studies covering bed types, specialized capacity, residential and partial-hospitalization services, workforce needs, payment, admissions, discharge practices, and outcomes.

Additional recommendations include developing best practices for hard-to-place patients; convening stakeholders on safe discharge and home- and community-based services; continuing promotion of the Behavioral Health Help Line, Community Behavioral Health Centers, and behavioral-health urgent care; supporting direct community admissions and transparent, evidence-based medical screening; reviewing ambulance diversion rules to permit transport to appropriate psychiatric or non-acute settings; developing alternative patient transportation; expanding discharge supports; clarifying ED boarding reimbursement with the Division of Insurance and MassHealth; maintaining adequate payment for stepdown and community care; and strengthening the behavioral-health workforce through improved working conditions, training pipelines, diversity, licensing, and retention.

FULL SUMMARY

The bill inserts requirements for an annual statewide behavioral-health capacity study coordinated by the Executive Office of Health and Human Services. The study must use inpatient-facility census and expedited psychiatric-admission data to identify operating units and special-population capacity by region, estimate needed beds and operating costs, consult stakeholders, and issue recommendations and proposed legislation by December 31 each year, including measures to reduce emergency-department boarding. It also creates a commission to expand specialty behavioral-health inpatient beds for adults and youth and recommend funding and a multi-payer rate structure. The commission must assess bed availability, populations facing longer waits, licensed versus operational capacity, current payment models, alternative payment approaches, and equitable rates, and submit findings, recommendations, and draft legislation or regulations within one year after the act’s effective date.

The bill replaces the minimum standards for certified accountable care organizations (ACOs) with requirements for separate legal status, specified governance and consumer representation, alternative-payment participation, payment coordination, interoperable health-information technology, an approved internal appeals plan, access to medically necessary behavioral and physical health services across the care continuum, evidence-based behavioral-health guidelines—including 24/7 admissions and discharges—price-reporting systems, behavioral-health expenditure reporting, a risk certificate, and patient shared decision-making. It also requires a study of behavioral-health practice variation and evidence-based outcomes across the continuum of care, with recommendations on data, quality measurement, access, transitions, and patient outcomes.

The bill requires the Department of Mental Health to establish and periodically update clinical competencies and operational standards for licensed psychiatric facilities, require free-standing facilities to maintain medical-facility affiliations, collect quality and outcome data, and operate admissions and discharges 24/7. Facilities may face remediation plans or penalties of $100 per day per affected patient, capped at $500,000 annually. New admission rules generally prohibit denial when a patient meets facility criteria and operational capacity is available, while allowing documented denials approved by the medical director when patient needs exceed facility capability; facilities must report admission requests, admissions, denials, reasons, and referral data monthly. Determinations of need must consider the statewide planning report. Acute-care hospitals and satellite emergency facilities must apply policies nondiscriminatorily to patients with mental-health or substance-use conditions, annually review and certify compliance across specified administrative, operational, clinical, medication, staffing, and financial policies, and operate a state complaint process and reporting regulations.

The bill adds two requirements to Section 12(a) of Chapter 123 of the Massachusetts General Laws. A person may not be involuntarily held for more than 72 hours at a facility not authorized by the Department to conduct evaluations under Section 12(b); anyone held beyond 72 hours must be released. A psychiatric hold exceeding 48 hours at such an unauthorized facility must be referred to the Committee for Public Counsel Services for appointment of counsel.

FULL SUMMARY

Section 12 of Chapter 123 of the Massachusetts General Laws is amended to restrict restraint at facilities not authorized by the Department to perform evaluations. Before restraint, the person—or the person’s parent or legal guardian—must have an opportunity to apply for voluntary admission and be informed of the right to voluntary admission and the 72-hour maximum restraint period. A person restrained for more than 72 hours must be released or transferred to an authorized evaluation facility, although the superintendent may discharge the person earlier if the person is not in need of care and treatment.

If restraint at an unauthorized facility exceeds 48 hours, the facility must, upon the person’s request, notify the Committee for Public Counsel Services of the person’s name and location. The committee must immediately appoint an attorney to meet with the person, subject to withdrawal of the appointment if the attorney determines that the person knowingly waives representation or is or will be represented by another attorney. A person who believes the restraint resulted from abuse or misuse may request, personally or through counsel, an emergency hearing in the district court with jurisdiction; unless a delay is requested, the court must hold the hearing on the filing date or by the next business day.

FULL SUMMARY

The act appropriates funding for fiscal year 2026, ending June 30, 2026, for state departments, agencies, institutions, debt service, federal grants, trust funds and permanent improvements. It establishes a $61.6905 billion projected revenue framework, provides $1.323 billion in unrestricted general government aid, and authorizes approximately $7.362 billion in total municipal and regional aid. Major appropriations support MassHealth and behavioral health, early education and child care, public schools and universal school meals, housing and homelessness programs, transportation, public safety, environmental programs, workforce development, higher education and veterans’ services. Numerous line items impose reporting requirements, earmark funds for specified programs and organizations, and authorize transfers among appropriations and trust funds.

The act creates or restructures several programs and funds. It establishes the Massachusetts Secure Choice Savings Fund and Secure Choice Savings Program for private-sector employees of employers generally having at least 25 employees, operating for at least two years and lacking a qualified retirement plan. Covered employers must automatically enroll employees who do not opt out, facilitate payroll deductions and remit contributions; the default contribution is 6 percent of wages, escalating by 1 percentage point annually to a maximum of 10 percent. Employers may sponsor an alternative retirement plan, and penalties for failing to enroll employees are $250 per employee initially and $500 for subsequent years, subject to reasonable-cause exceptions; penalties cannot be imposed until one year after required state notice. The act also establishes the Old Harbor Reservation Trust Fund, Middlesex Fells Reservation Fund and Affirming Health Care Trust Fund; creates a small business ombudsperson; requires a public housing-production funding dashboard; authorizes qualifying regional transit authorities to provide fare-free fixed-route and complementary paratransit service subject to appropriation; and permits certain municipalities to convert wine-and-malt beverage licenses into all-alcohol licenses without increasing the authorized license total.

Statutory changes include restructuring the Massachusetts Commission Against Discrimination as an independent five-member agency with regional offices, a full-time executive director and a diverse advisory board; transferring administration of crime-victim compensation to the Massachusetts Office for Victim Assistance and making related records confidential; expanding permissible campaign expenditures to include qualified adult-care services; authorizing electronic vehicle titles, ownership transfers and signatures; changing broker-fee responsibility so the party that engages the broker pays; revising estate-tax calculations; requiring new benefit screening, accounting, conservation and financial-literacy services for children in Department of Children and Families custody; and requiring a task force and report on interstate telehealth barriers. The act also increases transportation bonding capacity to $550 million while barring use for a single project costing over $1 billion absent specific legislative approval, requires project-spending transparency, and directs studies on pyrite or pyrrhotite foundation damage, housing-related tax exemptions, third-party housing inspections and telehealth reciprocity. Except where otherwise specified, the act takes effect July 1, 2025; specified provisions take effect August 1, 2025, January 1, 2026 or January 1, 2027.

FULL SUMMARY

The report documents the Massachusetts Office of the Child Advocate’s Fiscal Year 2024 activities, oversight work, strategic framework, and policy priorities. The OCA responded to 532 Complaint Line inquiries, reviewed 278 critical incident reports involving 380 children, 465 supported abuse or neglect reports involving 676 children in out-of-home settings, and 15 Foster Care Review safety alerts involving 17 children. It followed up with state agencies on 426 matters, identified DCF case-practice concerns in 329 reviewed matters, filed four abuse or neglect allegations, and conducted one non-public investigation. The oversight functions and FY24 metrics are summarized in the table on page 29, while critical-incident trends and outcomes appear in the charts on pages 41–53.

The report describes implementation of the OCA’s FY24–FY26 strategic framework covering safety and quality improvement, prevention, transition to adulthood, underserved populations, complex behavioral-health needs, service awareness, data quality, and organizational capacity. During FY24, the Center on Child Wellbeing & Trauma was incorporated into the OCA; the office expanded from 20 to 30 staff and revised its data-collection system to better track case concerns, agency responses, and demographic characteristics. OCA initiatives included trauma-responsive training for congregate-care, education, shelter, and child-serving providers; mandated-reporter training completed by 7,897 individuals; expansion of the Massachusetts Youth Diversion Program to seven counties; support for young mothers and newcomer families; language-access research; LGBTQ+ provider toolkits; and development of a youth-focused Complaint Line outreach campaign.

The report also presents research findings and recommendations on Family Resource Centers, problematic sexual behavior, juvenile justice data and racial disparities, child fatality prevention, and services for transition-age youth. The Family Resource Center recommendations call for a focus on preventing child-protection and Child Requiring Assistance involvement, increased funding for staffing and sites, and stronger integration with other systems. Appendix A identifies legislative priorities concerning child-welfare protections, foster children’s rights, substance-exposed newborns, the Child Requiring Assistance system, Child Fatality Review governance, access to juvenile court data, and bail procedures; it notes that legislation on substance-exposed newborns was signed into law in December 2024.

FULL SUMMARY

The report fulfills the Expedited Psychiatric Inpatient Admission (EPIA) Advisory Council’s annual reporting function by reviewing emergency-department boarding of patients requiring inpatient behavioral-health care and recommending measures to reduce delays. It describes the EPIA protocol, under which emergency-department evaluation teams, insurers, inpatient psychiatric providers, and state agencies share responsibility for securing placement; insurers are notified within 24 hours, formal assistance and escalation procedures begin when placement is not secured by 24 hours, and cases are referred to the Department of Mental Health at 60 hours—or 48 hours for patients under 18. The protocol also calls for standardized admission packets, secure electronic information exchange, active insurer assistance, payment for clinically necessary special supports, and use of in- and out-of-network options when necessary.

For February through September 2023, the Council recorded 3,745 EPIA referrals, with youth under 18 comprising 33.3 percent and adults 66.7 percent. Average time to placement was 3.1 days; youth referrals had longer placement times than the overall average, and the report identifies autism, developmental or intellectual disabilities, medical complexity, specialized behavioral needs, aggression, and lack of available beds among significant barriers. For adults, notable delays were associated with autism, dementia, medical comorbidity, sexualized behavior, and single-room requirements. Approximately one-third of referrals sent to the Department of Mental Health no longer required inpatient care by the time of review, indicating that some patients could instead receive crisis stabilization, respite, outpatient, or community-based services.

The Council recommends annual EPIA training for inpatient-provider, emergency-department, insurer, and state-agency staff; expanded emergency-department diversion and Behavioral Health Roadmap services; specialty services for autism and developmental disabilities; family education and mobile crisis resources; and a short-term expert panel on best practices for aggressive behavior and complex clinical presentations. It also recommends greater use of crisis stabilization units, respite programs, peer specialists, and parent supports; continued implementation of behavioral-health coverage and payment requirements, including commercial-carrier coverage of community-based behavioral-health-center services; legislative oversight of relevant behavioral-health and insurance provisions; expanded direct admissions from community settings; 24-hour, seven-day inpatient admission and discharge operations; and regulatory steps to allow clinically appropriate EMS transport directly to community behavioral-health centers or mobile-crisis-intervention locations.

FULL SUMMARY

The bill establishes a statewide mobile crisis response system for adults with intellectual or developmental disabilities or mental illness who experience behavioral health crises. The Department of Human Services, in consultation with the Department of Health and specified departmental divisions, must ensure at least one approved mobile crisis response agency and one licensed temporary stabilization unit in each of New Jersey’s northern, central, and southern regions. Eligible adults must generally be Medicaid or NJ FamilyCare beneficiaries, or receive disability services through the Division of Developmental Disabilities or Division of Mental Health and Addiction Services; services must also be deemed necessary under the bill’s specified approval requirements.

Approved agencies must employ qualified mobile crisis teams supervised by a licensed psychiatrist and provide up to 72 hours of mobile, face-to-face crisis services over no more than four days. Teams must respond within 24 hours, or within one hour for situations requiring an immediate response unless the family requests a delay; assess safety and contributing factors, deliver clinical interventions, develop an individualized crisis stabilization plan, and provide information and referrals to families and caregivers. If stabilization cannot be achieved in the home, the team may transport the adult to a licensed, nonclinical temporary stabilization unit for up to seven days, subject to daily review and immediate discharge when continued placement is unnecessary. With prior departmental approval, teams may provide in-home stabilization management services for up to eight weeks, including behavioral health interventions, medication management, rehabilitation, referrals, and support; the crisis plan must be reviewed at least weekly.

The bill requires service registration and detailed individual records, background checks for mobile crisis and stabilization-unit personnel, and crisis training for group-home direct-care staff. It directs the Department of Health to license and inspect stabilization units, authorizes fee-for-service reimbursement—including a maximum of 64 fifteen-minute units for approved stabilization management monitoring—and requires certain repeat episodes to be served without additional reimbursement. It also requires designation and operation of statewide 9-8-8 hotline centers, integration with mobile crisis and emergency-response systems, limited law-enforcement co-response for high-risk situations, and follow-up and specialized-population services. A continuously dedicated 9-8-8 trust fund would be supported by a monthly fee on New Jersey residents subscribing to commercial mobile or IP-enabled voice services, excluding mobile users receiving federal Lifeline benefits; the fee amount is to be set at a fixed rate. The act would take effect on the first day of the sixth month after enactment.

FULL SUMMARY

The bill establishes the New York-Dominican Health Partnership Commission to assess and design a potential state-funded pilot providing primary, preventive, and chronic-disease-management services in the Dominican Republic to New York Medicaid enrollees aged 65 or older who reside there part-time, retain Medicaid eligibility, and lack qualifying private, senior, or retiree coverage in the Dominican Republic. The pilot would be explored through a partnership with the Dominican Republic’s Seguro Nacional de Salud (SeNaSa) and its Contributory Subsidized Regime; acute care, emergency care, and surgical interventions would be excluded. The bill does not expand federal Medicaid coverage or New York Medicaid residency eligibility, and any pilot would initially rely exclusively on state appropriations unless federal approval and matching funds are obtained.

The commission would have 12 members drawn from specified state agencies, legislative appointees, the governor, Dominican diplomatic representation, and a New York-based academic or medical expert. It must study legal and regulatory feasibility, beneficiary population and utilization, provider quality and accreditation, comparative costs, implementation barriers, and fiscal effects. It must also develop a detailed pilot framework covering eligibility verification, enrollment, service scope, geographic targeting, quality controls, care coordination, payment and contracting systems, health-information exchange, telehealth, provider credentialing, evaluation metrics, and potential federal section 1115 waiver or designated state health program pathways. State agencies must provide requested information and assistance, with the Department of Health coordinating cooperation and supplying Medicaid data.

The commission must submit an interim report within 12 months and a final report within two years after the act’s effective date. The final report must include a proposed pilot design, draft legislation and memoranda of understanding, cost and savings estimates, an implementation plan, evaluation criteria, a federal waiver strategy, and any dissenting views. The act takes effect immediately and expires three years after that date.

FULL SUMMARY

The Pennsylvania Department of Health proposes a comprehensive rewrite of Chapter 27 governing communicable and noncommunicable diseases. It would add 73 reportable diseases, infections, conditions, and exposures for health care practitioners and facilities, and 53 additional laboratory-reporting categories, including COVID-19, mpox, novel and emerging infections, antimicrobial-resistant organisms, additional tick- and mosquito-borne diseases, foodborne toxins, environmental exposures, and specified arsenic, cadmium, mercury, carbon-monoxide, and lead results. Reporting would generally use the electronic disease surveillance system, with immediate telephone reporting followed by electronic reporting within 24 hours for specified high-risk conditions; other deadlines would be 24 hours, the next work day, or 5 work days. The proposal also requires hospitals to submit emergency-department syndromic-surveillance data as close to real time as possible and no later than 24 hours after presentation, respond to Department inquiries within 24 hours, and provide additional reports when requested. Laboratories would have to submit certain isolates or specimens within 5 work days, report reflex culture results, immediately contact the Bureau of Laboratories regarding suspected listed select agents or toxins, and report any select-agent release, exposure, loss, or theft within 1 hour, followed by a written report within 7 days.

The proposal creates a birth-defects registry and requires reporting of specified congenital malformations, chromosomal abnormalities, and abnormal neonatal-screening findings within 180 work days of diagnosis for live-born infants diagnosed before age one and for non-live-born fetuses at least 19 weeks’ gestation or, absent a gestational estimate, at least 500 grams. It separately requires continued reporting of neonatal abstinence syndrome, adds reporting of treatment for tuberculosis and six specified sexually transmitted diseases within 5 work days, and requires records concerning tuberculosis evaluation and treatment within 48 hours upon request. Immunization administrators would have to report each vaccination to the Department’s immunization information system within 30 days, except in Philadelphia County and unless the patient declines in writing. Prenatal syphilis testing would apply statewide during the third trimester and to every newborn and stillbirth unless the pregnant or postpartum individual objects; new sections would require prenatal hepatitis C testing at the first examination or within 15 days, and HIV testing during the first examination or first trimester and again during the third trimester, subject to objection. Cancer reporting would cover brain-related tumors and use the electronic cancer registry, with practitioner reports due within 180 days rather than 5 work days.

The regulation consolidates exclusion and readmission rules for schools, colleges, universities, child-care settings, food handlers, and direct-care health practitioners, adding criteria for 18 conditions and revising symptom-based exclusions, fever thresholds, treatment periods, laboratory-clearance requirements, and outbreak exclusions for susceptible persons. It authorizes the Department and local health authorities to investigate cases, outbreaks, public-health emergencies, and unusual occurrences; conduct contact tracing and partner services; access and securely receive patient records; and require schools to provide timely access to individuals and permit private interviews without obstruction. Disease-control authority is broadened to include prevention, containment, and mitigation of diseases, infections, conditions, and toxin exposures, including isolation, quarantine, segregation, modified quarantine, and other appropriate measures. The proposal replaces obsolete local morbidity-reporting terminology, limits veterinarian reporting to specified zoonotic risks and unusual events, expands rabies-exposure reporting to mammal scratches and contamination of wounds or mucous membranes, requires third-trimester HIV and hepatitis C screening as specified above, and permits restrictions on contaminated animals, animal products, and related materials. Public comments are due within 45 days after publication; final-form provisions would take effect upon publication in the Pennsylvania Bulletin, while the birth-defects reporting section would take effect 30 days after a separate notice announcing launch of the registry.

The Medicaid Care Transition Program has been established by the Department of Human Services in Pennsylvania to enhance the transition of Medicaid patients from hospital emergency departments to suitable postacute care settings. This initiative aims to address the challenges associated with patient placement delays, which can adversely affect hospital operations and resource management.

The program is expected to significantly impact the healthcare industry, particularly hospitals, behavioral health crisis centers, and Medicaid managed care plans. By streamlining the transition process, the program seeks to alleviate issues such as prolonged hospital stays and emergency department overcrowding, which can lead to increased operational costs for healthcare facilities.

To ensure accountability and transparency, the Department of Human Services will prepare and submit an annual report on the program's implementation and outcomes, beginning one year after the program's effective date. This reporting requirement will help track the program's effectiveness in improving patient outcomes and reducing the strain on emergency services.

Overall, the Medicaid Care Transition Program is designed to facilitate a more efficient placement process for Medicaid patients, ultimately benefiting both patients and healthcare providers by improving care continuity and resource allocation.

The Medicaid Care Transition Program is designed to improve the efficiency of patient placements from hospital emergency departments to appropriate postacute care settings for individuals enrolled in Medicaid. This initiative particularly focuses on those requiring behavioral health or long-term care services, aiming to streamline care transitions and enhance the quality of care.

The program will significantly impact the healthcare industry, especially hospitals, behavioral health crisis centers, and Medicaid managed care plans. It requires collaboration between hospitals and responsible entities to ensure timely patient placements, thereby addressing delays that can affect patient outcomes.

While specific monetary impacts are not detailed, the program is anticipated to reduce costs associated with prolonged emergency department stays. By improving resource allocation and decreasing the financial burden on hospitals due to overcrowding and delayed treatments, the program aims to create a more efficient healthcare system.

Overall, the Medicaid Care Transition Program seeks to enhance the care experience for Medicaid enrollees by minimizing delays in patient placement and ensuring that individuals receive the appropriate care in a timely manner.

FULL SUMMARY

The bill adds Section 44-7-255 to the South Carolina Code to define a “justified emergency” for hospital use of patient beds in hallways, corridors, and other means of egress. Qualifying circumstances include declared emergencies, natural or manmade disasters, mass-transit, industrial, or construction accidents, chemical/biological/radiological/nuclear events, specified violent incidents, acute contagious-disease outbreaks, and exhaustion of all available emergency-department treatment space. During such an emergency, beds may be used in these areas only when a designated emergency-department leadership official determines that all other appropriate hospital treatment space is exhausted and patient health and safety would otherwise be jeopardized.

Hospitals must document each determination within seven calendar days on a Department of Public Health electronic form, recording the emergency’s timing and nature, the exhaustion of other treatment space, increased patient risk, and the responsible official’s signature. Hospitals must retain the records and submit copies to the department at least quarterly. Beds must be removed when not being used for patient care during the emergency; hospitals must maintain clear pathways, keep exits unblocked, and avoid partitions or structures that obstruct sprinkler, fire-alarm, or detection systems. Hospitals also must develop written justified-emergency protocols and require relevant patient-care employees to familiarize themselves with them. The act takes effect upon gubernatorial approval.

Effective July 1, 2026, the provision governing temporary detention of a person who is also subject to an emergency custody order will require the community services board designee to conduct the post-treatment evaluation; it removes the separate reference to a certified evaluator. The bill also extends liability protection to security personnel assisting a licensed health professional with a detention under § 37.2-1104(C), shielding them from claims based on the person's lack of consent.