A communication from the Executive Office of Health and Human Services (see item 4000-0500 of Section 2 of Chapter 140 of the Acts of 2024) submitting its comparative analysis of the rate differential for inpatient psychiatric and substance use hospital per diem payments achieved by Accountable Care Organizations (ACOs) and Community Partners

194th Legislature (2025-2026)

Bill Summary: HD 4963 OverviewThis bill, introduced on August 4, 2025, is a communication from the Executive Office of Health and Human Services (EOHHS) regarding a comparative ana

Placed on file

Overview

This bill, introduced on August 4, 2025, is a communication from the Executive Office of Health and Human Services (EOHHS) regarding a comparative analysis of the rate differential for inpatient psychiatric and substance use hospital per diem payments achieved by Accountable Care Organizations (ACOs) and Community Partners.

Purpose and Intent

The primary purpose of this bill is for EOHHS to submit its analysis comparing the rate differentials for inpatient psychiatric and substance use hospital payments between ACOs and Community Partners. This analysis is required under item 4000-0500 of Section 2 of Chapter 140 of the Acts of 2024.

The goal of this analysis is to provide policymakers and stakeholders with data and insights into how the payment rates for these critical behavioral health services differ between the two care delivery models - ACOs and Community Partners. This information can help inform future policy decisions and payment reforms in this area.

Key Provisions

The key provisions of this bill are:

EOHHS must submit a comparative analysis of the rate differentials for inpatient psychiatric and substance use hospital per diem payments achieved by ACOs vs. Community Partners.

The analysis must include specific data on the payment rate differences between the two models, including any variation by geographic region or patient population.

EOHHS must also provide context and explanations for the observed rate differentials, such as differences in service delivery, patient acuity, provider contracting, or other factors.

The completed analysis must be filed with the Legislature for their review and consideration.

Affected Stakeholders

The primary stakeholders affected by this bill include:

Accountable Care Organizations (ACOs) providing inpatient psychiatric and substance use treatment services

Community-based behavioral health providers and Community Partners

Patients and families accessing inpatient psychiatric and substance use treatment

Policymakers and state health agencies responsible for overseeing and reforming behavioral health payment models

Timeline and Procedure

This bill has been placed on file, meaning it has been submitted to the Legislature but has not yet been taken up for consideration or a vote. EOHHS has a deadline under the 2024 legislation to submit the required comparative analysis, which this bill represents.

Once the analysis is filed, the Legislature will have the opportunity to review the findings and determine if any further action or policy changes are warranted based on the data and insights provided.