Bill > H4896

This bill mandates that health insurance plans and contracts, including those for student health, state employees, individual accident and sickness policies, nonprofit hospital service corporations, medical service corporations, and health maintenance organizations, must provide coverage for "Coordinated Specialty Care" (CSC) and "Assertive Community Treatment" (ACT) services. CSC is defined as a recovery-oriented treatment program for individuals experiencing their first episode of psychosis, while ACT is a team-based, evidence-based practice offering comprehensive treatment, rehabilitation, and support services for serious mental illness. The bill specifies that these services are for individuals with a "serious mental illness" (defined as a mental disorder causing significant functional impairment in adults) or "serious emotional disturbance" (defined similarly for children and adolescents under 19), and that medical necessity for these treatments should be presumed upon a recommendation from a qualified healthcare professional, without requiring prior disability or functional impairment. It also requires that the credentialing of the lead psychiatrist or clinical leader of a CSC or ACT team will credential all members of that team with an insurer, and mandates that payment for these services should be bundled rather than fee-for-service. Furthermore, the bill requires the Division of Insurance to convene a working group to develop a coding solution for these bundled treatment models and directs various state entities to promulgate necessary regulations and assess the impact of these coverage mandates on healthcare costs and savings after five years, with carriers needing to demonstrate adequate provider networks by the effective date or face penalties and out-of-network coverage requirements.

Health and Social Services

Joint Committee on Financial Services (Joint)

https://malegislature.gov/Bills/194/H4896