Bill > S1253

This bill aims to remove administrative barriers to accessing behavioral health services. The key provisions include: 1. Requiring the Group Insurance Commission, Medicaid, and private insurers to cover medically necessary mental health and substance use disorder services within various treatment settings, including inpatient psychiatric facilities, community health centers, and outpatient substance use disorder providers, without requiring prior authorization. Providers are required to notify the insurer of the admission and initial treatment plan within three business days. 2. Prohibiting insurers from recouping payments for claims more than 12 months after the original payment, or more than 90 days after the original payment for services provided to retroactively terminated or disenrolled members, as long as the provider can document that they verified the member's eligibility at the time of service. 3. Preventing insurers from recouping payments for services that were previously deemed medically necessary or approved by the insurer. Overall, this bill aims to streamline the administrative processes involved in accessing behavioral health services and ensure that patients can receive timely and appropriate care without facing unnecessary barriers.

Health and Social Services

https://malegislature.gov/Bills/193/S1253