Bill > H1135

This bill requires various health insurance providers in Massachusetts to provide coverage for two specific mental health treatment approaches: Coordinated Specialty Care (CSC) for first-episode psychosis and Assertive Community Treatment (ACT) for individuals with serious mental illness or serious emotional disturbance. The bill defines these treatment models as evidence-based, team-based approaches that offer comprehensive rehabilitation and support services, with specific provisions for both adult and pediatric patients. Key provisions include mandating that insurance plans cover these services without limiting the number of visits, requiring payment through a bundled treatment model rather than fee-for-service, and establishing that medical necessity can be determined without requiring prior disability or functional impairment. The bill applies to student health insurance plans, state employee insurance, individual and group health insurance policies, and various types of health maintenance organizations. Additionally, the legislation requires insurance carriers to develop adequate provider networks for these services, with potential financial penalties for non-compliance, and mandates an independent analysis after five years to assess the impact of these coverage requirements on healthcare costs and outcomes. The bill is designed to improve access to comprehensive, evidence-based mental health treatment, particularly for individuals experiencing first-episode psychosis or serious mental health conditions.

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https://malegislature.gov/Bills/194/H1135