Bill
Bill > S2403
MA S2403
To limit retroactive denials of health insurance claims for mental health and substance abuse services
summary
Introduced
04/09/2018
04/09/2018
In Committee
04/09/2018
04/09/2018
Crossed Over
Passed
Dead
12/31/2018
12/31/2018
Introduced Session
190th General Court
Bill Summary
For legislation to limit retroactive denials of health insurance claims for mental health and substance abuse services,- reports the accompanying bill (Senate, No. 2403).
AI Summary
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.
Committee Categories
Health and Social Services
Sponsors (0)
No sponsors listed
Last Action
Accompanied H4315 (on 06/07/2018)
Official Document
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bill summary
Document Type | Source Location |
---|---|
State Bill Page | https://malegislature.gov/Bills/190/S2403 |
Bill | https://malegislature.gov/Bills/190/S2403.pdf |
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