Bill > S769

This bill provides continuity of care for mental health patients by introducing several key provisions. First, it defines a "continuing course of treatment" as having at least one visit in the past 4 months for the same or similar mental health diagnosis or symptoms. The bill requires health insurance carriers to allow insured individuals to continue treatment with a mental health provider who has been involuntarily or voluntarily disenrolled from the network (except for quality or fraud reasons) or whose carrier has changed. Under this provision, the carrier must reimburse the out-of-network mental health professional at the usual network rate, using the median reimbursement rate if multiple rates exist. Patients may be required to pay a higher co-payment only if it directly results from increased costs of using a non-network provider, and the carrier must provide an actuarial demonstration of these increased costs if requested. The bill ensures that no additional charges, costs, or deductibles can be levied due to using this out-of-network option, protecting patients' ability to maintain continuity of care with their existing mental health provider.

Budget and Finance, Business and Industry, Health and Social Services

https://malegislature.gov/Bills/194/S769