Bill > H4898

This bill mandates that various insurance providers, including those covering state employees, Medicaid managed care organizations, and private health insurers, must cover medically necessary "acute treatment services" (24-hour medically supervised addiction treatment), "clinical stabilization services" (post-detoxification treatment for addiction recovery), and "co-occurring treatment services" (detoxification for individuals with co-occurring mental health and substance use disorders) for up to 14 days. Crucially, these services will not require preauthorization, meaning patients can access them without prior approval from their insurer, although facilities must notify the insurer of admission and the treatment plan within 48 hours, and utilization reviews can begin on day 7. The bill also ensures coverage, without preauthorization, for substance use disorder evaluations ordered by a doctor. The determination of medical necessity for these treatments will be made by the treating clinician in consultation with the patient.

Health and Social Services

Joint Committee on Financial Services (Joint)

https://malegislature.gov/Bills/194/H4898