Effective for dates of service beginning Jan. 3, 2023 and per MassHealth, hospitals will be required to bill directly for behavioral health crisis intervention for Tufts Health Together members who present in the emergency department. Hospitals may choose to subcontract out for these services; however, they must submit the claims using per diem code S9485.

In addition, and as part of the Baker-Polito Administration’s Roadmap for Behavioral Health Reform, a statewide network of Community Behavioral Health Centers (CBHC) will provide access to around-the-clock community and mobile crisis intervention services for a defined geographic area that hospitals can utilize. Previously, crisis assessments could be rendered by and billed to Emergency Service Program, (ESP) providers and Mobile Crisis Intervention (MCI) teams in community-based settings as well as the emergency department.

In response to ensuring that providers are going above and beyond, we're happy to provide these bundled payments for the work they're doing. Beginning in Rate Year 2023, MassHealth will pay hospitals for inpatient mental health services using the current per diem rate with an additional per admission rate for admissions with specific identifiers available through claims data. This work is part of a multi-year payment reform effort to move toward a risk-adjusted payment methodology.

For more information, refer to the Outpatient Behavioral Health (Mental Health & Substance Use Disorder) Professional Payment Policy.