Bill > S2403

This bill aims to limit retroactive denials of health insurance claims for mental health and substance abuse services. The key provisions are: 1. It prohibits the Group Insurance Commission, MassHealth, and private insurers from imposing retroactive claim denials for behavioral health services unless the claim was submitted fraudulently, is subject to adjustment due to expected payment from another payer, is under legal action, was already paid for, or the services were not delivered. Even in these cases, the provider must be given at least 15 days' notice and 12 months to address the issue. 2. It defines "behavioral health" to include mental health and substance use disorder prevention, recovery, and treatment services, and "retroactive claim denial" as an action to deny a previously paid claim and require repayment. 3. It directs the Division of Medical Assistance to develop an internal process to reconcile claims due to retroactive eligibility changes or duplicate enrollments for MassHealth enrollees, without requiring provider involvement, and to report back to the legislature within 5 months.

Health and Social Services

https://malegislature.gov/Bills/190/S2403