Bill > H4894

This bill aims to expand coverage and clarify medical necessity for various mental health treatments for individuals insured under different state plans and insurance policies. It defines "mental health acute treatment" as 24-hour medically supervised inpatient services, "mental health crisis stabilization services" as 24-hour clinically managed diversionary or step-down services, "community-based acute treatment (CBAT)" as 24-hour clinically managed diversionary or step-down services for children and adolescents, and "intensive community-based acute treatment (ICBAT)" as more intensive versions of CBAT. For state employees and retirees insured by the Group Insurance Commission, the bill mandates coverage for medically necessary mental health acute treatment without requiring prior authorization, with medical necessity determined by the treating clinician. It also mandates coverage for mental health crisis stabilization services for up to 14 days, CBAT for up to 21 days, and ICBAT for up to 14 days, with specific notification requirements for facilities and allowing utilization review to begin after a certain number of days. Similar provisions are extended to individuals covered by MassHealth, private insurance policies, health and welfare funds, hospital service plans, medical service agreements, and health maintenance organizations, ensuring coverage for these mental health services without prior authorization and establishing the treating clinician as the determinant of medical necessity.

Health and Social Services

Joint Committee on Financial Services (Joint)

https://malegislature.gov/Bills/194/H4894