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HD 6053

A communication from the Massachusetts Health Policy Commission (see Section 145 of Chapter 126 of the Acts of 2022) submitting a report entitled: “Emergency Boarding in the Commonwealth of Massachusetts”

194th Legislature (2025-2026)

Massachusetts HPC will study and report on behavioral health ED boarding, identifying causes, outcomes, costs, and payer reimbursement to reduce hospital burden and improve care.

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Bill Summary · HD 6053

Executive summary

HD 6053 (194th Massachusetts Legislature) focuses on an analysis and reporting requirement related to behavioral health ED boarding in the Commonwealth, with an emphasis on the ongoing effects of the COVID-19 pandemic. It directs the Massachusetts Health Policy Commission (HPC) to study boarding in emergency departments and other acute care settings, assess costs, outcomes, workforce impacts, and payer policies, and to benchmark practices against other states. The bill requires a formal report and recommendations to address burdens on hospitals, patient outcomes, and payer reimbursement.

Purpose and intent

  • To analyze the ongoing effects of the COVID-19 pandemic on behavioral health (BH) emergency department (ED) boarding in Massachusetts acute care settings.
  • To identify factors driving BH ED boarding, assess outcomes and quality of care for boarded patients, and evaluate payer reimbursement practices.
  • To review best practices and actions taken in other states and develop recommendations to reduce the burden on acute care hospitals and improve care for BH patients who board.

Key provisions and changes

  • Mandate: The HPC, established in Chapter 6D, must analyze BH ED boarding and issue a report titled “Emergency Boarding in the Commonwealth of Massachusetts” under Section 145 of Chapter 126 of the Acts of 2022.
  • Scope of review:
    • ED visits with BH, behavioral health, substance use disorder, or alcohol-related diagnoses.
    • Metrics: length of stay for boarding, primary reason for waiting, level of care required, insurance coverage, and payer reimbursement for boarders.
    • Demographics and social determinants: data on age, race, ethnicity, language, gender, homelessness, etc.
    • Care coordination and workforce considerations; effects of COVID-19 on length of stay and workforce shortages.
    • Health plan resources and their impact on care for boarders.
    • Cross-state comparisons and best practices.
  • Timeline and reporting: Not later than July 1, 2023, HPC must submit its report to the clerks of the House and Senate, Ways and Means committees, and the Joint Committee on Mental Health, Substance Use and Recovery; and the Joint Committee on Healthcare Financing, including recommendations on:
    • Burden on acute care hospitals.
    • Patient outcomes and quality of care for boarded BH patients.
    • Payer reimbursement arrangements for BH boarders.
  • Definitions and methodology: The bill relies on the HPC’s definitions and CHIA data, including 12-hour boarding as a benchmark (unless otherwise specified in sections), and distinguishes BH boarding from non-BH boarding where relevant.
  • Related program context (information included in the bill text, not a standalone requirement):
    • Describes existing Massachusetts efforts to address BH ED boarding, including EPIA (Expedited Psychiatric Inpatient Admission) policies, the Behavioral Health Roadmap, Community Behavioral Health Centers (CBHCs), BH Helpline, and the Behavioral Health Referral and Treatment Platform (BHTRP).
    • Outlines existing data collection challenges and policy changes affecting BH care and ED boarding (e.g., payments, observation status, crisis services, and ambulance diversion considerations).
    • Provides stakeholder perspectives on barriers to placement, bed availability, transport, and safety concerns.
  • No direct funding appropriations are specified in the bill text; the focus is on reporting and policy recommendations.

Who would be affected

  • Behavioral health patients who seek care in Massachusetts EDs and may experience boarding.
  • Acute care hospitals (EDs, medical/surgical units, observation units) handling BH cases.
  • Payers (commercial insurers, MassHealth, and other public payers) responsible for reimbursements related to BH boarding and ED care.
  • State agencies and policymakers (HPC, DMH, DPH, MassHealth, DOI, and relevant committees) involved in data collection, policy design, and implementation of recommendations.
  • Providers and health systems engaging with BH care pathways, community-based resources (CBHCs), and crisis services.

Procedural and timeline aspects

  • The primary procedural requirement is for the HPC to complete and submit the report by July 1, 2023.
  • The report would include legislative and policy recommendations aimed at reducing ED boarding, improving outcomes, and clarifying payer reimbursements.
  • The document outlines ongoing monitoring and potential alignment with broader BH policy initiatives (BH Roadmap, BHTRP, CBHCs, and EPIA-related policies) to support implementation of the recommendations.

Potential impact

  • Enhanced understanding of BH ED boarding dynamics in Massachusetts, including timing, causes, and outcomes.
  • Data-driven policy recommendations to reduce boarding times, improve safe discharge planning, and optimize care transitions from ED to inpatient or community-based settings.
  • Clarification of payer roles and reimbursement structures to incentivize timely placement and appropriate levels of care for BH patients.
  • Potential improvements in care coordination, workforce planning, and community-based BH resources to alleviate ED crowding and improve patient outcomes.

If you’d like, I can adapt this summary to emphasize specific sections (e.g., data metrics, governance, or implementation steps) or tailor it for a briefing to a particular audience (legislators, health system leaders, or the public).

Compiled from official sources — confirm details with the bill’s official record.

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