Bill > H1319

This bill establishes comprehensive insurance coverage for substance use disorder treatment services, specifically defining and mandating coverage for three key levels of care: acute treatment services, clinical stabilization services, and a newly defined category called "transitional support services". These services, which are defined by the department of public health, provide residential and support services for adults and adolescents recovering from addiction. The bill requires insurance carriers, including group insurance, health maintenance organizations, and Medicaid-related plans, to cover these medically necessary services for up to 30 days without requiring preauthorization. Key provisions include mandating that treatment facilities notify carriers within 48 hours of admission, provide an initial treatment plan, and submit a discharge plan, while preventing carriers from making restrictive utilization review decisions unless a patient has received at least 30 consecutive days of services. The bill also requires the center for health information and analysis to conduct comprehensive reviews of these coverage changes, with initial and final reports to be submitted in 2026 and 2028 respectively, examining the impact on the continuum of care, patient access, and associated costs. The new insurance coverage requirements will take effect on October 1, 2026, aiming to improve access to comprehensive addiction treatment and support services.

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https://malegislature.gov/Bills/194/H1319