Massachusetts 2023-2024 Regular Session

Massachusetts House Bill H1004 Compare Versions

Only one version of the bill is available at this time.

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1	1	1 of 2
2	2	HOUSE DOCKET, NO. 602 FILED ON: 1/13/2023
3	3	HOUSE . . . . . . . . . . . . . . . No. 1004
4	4	The Commonwealth of Massachusetts
5	5	_________________
6	6	PRESENTED BY:
7	7	Kimberly N. Ferguson
8	8	_________________
9	9	To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
10	10	Court assembled:
11	11	The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:
12	12	An Act relative to cognitive rehabilitation for individuals with an acquired brain injury.
13	13	_______________
14	14	PETITION OF:
15	15	NAME:DISTRICT/ADDRESS :DATE ADDED:Kimberly N. Ferguson1st Worcester1/13/2023Steven S. Howitt4th Bristol1/25/2023Susan Williams Gifford2nd Plymouth1/26/2023John Barrett, III1st Berkshire1/26/2023Michael D. BradySecond Plymouth and Norfolk1/26/2023Lindsay N. Sabadosa1st Hampshire1/26/2023Hannah Kane11th Worcester1/26/2023Donald H. Wong9th Essex1/26/2023F. Jay Barrows1st Bristol1/26/2023Brian W. Murray10th Worcester1/27/2023Marcus S. Vaughn9th Norfolk1/27/2023Angelo L. D'Emilia8th Plymouth1/27/2023Susannah M. Whipps2nd Franklin1/27/2023Joseph D. McKenna18th Worcester1/27/2023Tackey Chan2nd Norfolk2/1/2023David K. Muradian, Jr.9th Worcester2/6/2023Thomas M. Stanley9th Middlesex2/6/2023Paul McMurtry11th Norfolk2/8/2023 2 of 2
16	16	Jack Patrick Lewis7th Middlesex2/8/2023Patrick M. O'ConnorFirst Plymouth and Norfolk2/8/2023Tricia Farley-Bouvier2nd Berkshire2/8/2023Joanne M. ComerfordHampshire, Franklin and Worcester2/9/2023Colleen M. Garry36th Middlesex2/9/2023James B. EldridgeMiddlesex and Worcester2/11/2023Dylan A. FernandesBarnstable, Dukes and Nantucket3/7/2023 1 of 17
17	17	HOUSE DOCKET, NO. 602 FILED ON: 1/13/2023
18	18	HOUSE . . . . . . . . . . . . . . . No. 1004
19	19	By Representative Ferguson of Holden, a petition (accompanied by bill, House, No. 1004) of
20	20	Kimberly N. Ferguson and others relative to healthcare insurance coverage for cognitive
21	21	rehabilitation for individuals with an acquired brain injury. Financial Services.
22	22	The Commonwealth of Massachusetts
23	23	_______________
24	24	In the One Hundred and Ninety-Third General Court
25	25	(2023-2024)
26	26	_______________
27	27	An Act relative to cognitive rehabilitation for individuals with an acquired brain injury.
28	28	Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
29	29	of the same, as follows:
30	30	1 SECTION 1. Chapter 32A of the General Laws, as appearing in the 2020 Official
31	31	2Edition, is hereby amended by inserting after section 17R the following section:-
32	32	3 Section 17S. (a) For purposes of this section, the following terms shall have the following
33	33	4meanings:-
34	34	5 “Acquired brain injury (ABI)” is any injury to the brain which occurs after birth and can
35	35	6be caused by infectious diseases, metabolic disorders, endocrine disorders or diminished oxygen,
36	36	7brain tumors, toxins, disease that affects the blood supply to the brain, stroke or a traumatic brain
37	37	8injury.
38	38	9 “Cognitive communication therapy” treats problems with communication which have an
39	39	10underlying cause in a cognitive deficit rather than a primary language or speech deficit. 2 of 17
40	40	11 “Cognitive rehabilitation therapy (CRT)” is a process of re-learning cognitive skills
41	41	12essential for daily living through the coordinated specialized, integrated therapeutic treatments
42	42	13which are provided in dynamic settings designed for efficient and effective re-learning following
43	43	14damage to brain cells or brain chemistry due to brain injury.
44	44	15 “Community reintegration services” provide incremental guided real-world therapeutic
45	45	16training to develop skills essential for an individual to participate in life: to re-enter employment;
46	46	17to go to school and engage in other productive activity; to safely live independently; and to
47	47	18participate in their community while avoiding re-hospitalization and long-term support needs.
48	48	19 “Functional rehabilitation therapy and remediation” is a structured approach to
49	49	20rehabilitation for brain disorders which emphasizes learning by doing, and focuses re-learning a
50	50	21specific task in a prescribed format, with maximum opportunity for repeated correct practice.
51	51	22Compensatory strategies are developed for those skills which are persistently impaired and
52	52	23individuals are trained on daily implementation. To ensure acquisition and use, focus is set on re-
53	53	24learning those skills essential for safe daily living in the environment in which they will be used:
54	54	25home and community settings.
55	55	26 “Medical necessity” or “medically necessary,” health care services that are consistent
56	56	27with generally accepted principles of professional medical practice.
57	57	28 “Neurobehavioral therapy” is a set of medical and therapeutic assessment and treatments
58	58	29focused on behavioral impairments associated with brain disease or injury and the amelioration
59	59	30of these impairments through the development of pro-social behavior. 3 of 17
60	60	31 “Neurocognitive therapy” is treatment of disorders in which the primary clinical deficit is
61	61	32in cognitive function which has not been present since birth and is a decline from a previously
62	62	33attained level of function.
63	63	34 “Neurofeedback therapy” is a direct training of brain function to enhance self-regulatory
64	64	35capacity or an individual’s ability to exert control over behavior, thoughts and feelings. It is a
65	65	36form of biofeedback whereby a patient can learn to control brain activity that is measured and
66	66	37recorded by an electroencephalogram.
67	67	38 “Neuropsychological testing” is a set of medical and therapeutic assessment and
68	68	39treatments focused on amelioration of cognitive, emotional, psychosocial and behavioral deficits
69	69	40caused by brain injury.
70	70	41 “Psychophysiological testing and treatment” is a set of medical and therapeutic
71	71	42assessment and treatments focused on psychophysiological disorders or physical disorders with
72	72	43psychological overlay.
73	73	44 “Post-acute residential treatment” includes integrated medical and therapeutic services,
74	74	45treatment, education, and skills training within a 24/7 real-world environment of care- a home
75	75	46and community setting. Maximum opportunity to for correct practice of skill in the context of
76	76	47use develops new neural pathways which ensure ongoing skill use and avoidance of re-
77	77	48hospitalization and long-term care.
78	78	49 (b) Any coverage offered by the commission to an active or retired employee of the
79	79	50commonwealth insured under the group insurance commission shall provide coverage for
80	80	51medically necessary treatment related to or as a result of an acquired brain injury. Medically
81	81	52necessary treatment shall include, but is not limited to, cognitive rehabilitation therapy; cognitive 4 of 17
82	82	53communication therapy; neurocognitive therapy and rehabilitation; neurobehavioral,
83	83	54neurophysiological, neuropsychological and psychophysiological testing and treatment;
84	84	55neurofeedback therapy; functional rehabilitation therapy and remediation; community
85	85	56reintegration services; post-acute residential treatment services; inpatient services; outpatient and
86	86	57day treatment services; home and community based treatment. The benefits in this section shall
87	87	58not include any lifetime limitation or unreasonable annual limitation of the number of days or
88	88	59sessions of treatment services. Any limitations shall be separately stated by the commission. The
89	89	60benefits in this section shall not be subject to any greater deductible, coinsurance, copayments, or
90	90	61out-of-pocket limits than any other benefit provided by the commission.
91	91	62 (c) The commissioner of insurance shall require a health benefit plan issuer to provide
92	92	63adequate training to personnel responsible for preauthorization of coverage or utilization review
93	93	64for services under this section, in consultation with the Brain Injury Association of
94	94	65Massachusetts.
95	95	66 (d) Individual practitioners and treatment facilities shall be qualified to provide acute care
96	96	67and post-acute care rehabilitation services through possession of the appropriate licenses,
97	97	68accreditation, training and experience deemed customary and routine in the trade practice.
98	98	69 SECTION 2. Chapter 175 of the General Laws, as appearing in the 2020 Official Edition,
99	99	70is hereby amended by inserting after section 47QQ, the following section:-
100	100	71 Section 47RR. (a) For purposes of this section, the following terms shall have the
101	101	72following meanings:-
102	102	73 “Acquired brain injury (ABI)” is any injury to the brain which occurs after birth and can
103	103	74be caused by infectious diseases, metabolic disorders, endocrine disorders or diminished oxygen, 5 of 17
104	104	75brain tumors, toxins, disease that affects the blood supply to the brain, stroke or a traumatic brain
105	105	76injury.
106	106	77 “Cognitive communication therapy” treats problems with communication which have an
107	107	78underlying cause in a cognitive deficit rather than a primary language or speech deficit.
108	108	79 “Cognitive rehabilitation therapy (CRT)” is a process of relearning cognitive skills
109	109	80essential for daily living through the coordinated specialized, integrated therapeutic treatments
110	110	81which are provided in dynamic settings designed for efficient and effective re-learning following
111	111	82damage to brain cells or brain chemistry due to brain injury.
112	112	83 “Community reintegration services” provide incremental guided real-world therapeutic
113	113	84training to develop skills essential for an individual to participate in life: to re-enter employment;
114	114	85to go to school and engage in other productive activity; to safely live independently; and to
115	115	86participate in their community while avoiding re-hospitalization and long-term support needs.
116	116	87 “Functional rehabilitation therapy and remediation” is a structured approach to
117	117	88rehabilitation for brain disorders which emphasizes learning by doing, and focuses relearning a
118	118	89specific task in a prescribed format, with maximum opportunity for repeated correct practice.
119	119	90Compensatory strategies are developed for those skills which are persistently impaired and
120	120	91individuals are trained on daily implementation. To ensure acquisition and use, focus is set on re-
121	121	92learning those skills essential for safe daily living in the environment in which they will be used:
122	122	93home and community settings.
123	123	94 “Medical necessity” or “medically necessary,” health care services that are consistent
124	124	95with generally accepted principles of professional medical practice. 6 of 17
125	125	96 “Neurobehavioral therapy” is a set of medical and therapeutic assessment and treatments
126	126	97focused on behavioral impairments associated with brain disease or injury and the amelioration
127	127	98of these impairments through the development of pro-social behavior.
128	128	99 “Neurocognitive therapy” is treatment of disorders in which the primary clinical deficit is
129	129	100in cognitive function which has not been present since birth and is a decline from a previously
130	130	101attained level of function.
131	131	102 “Neurofeedback therapy” is a direct training of brain function to enhance self-regulatory
132	132	103capacity or an individual’s ability to exert control over behavior, thoughts and feelings. It is a
133	133	104form of biofeedback whereby a patient can learn to control brain activity that is measured and
134	134	105recorded by an electroencephalogram.
135	135	106 “Neuropsychological testing” is a set of medical and therapeutic assessment and
136	136	107treatments focused on amelioration of cognitive, emotional, psychosocial and behavioral deficits
137	137	108caused by brain injury.
138	138	109 “Psychophysiological testing and treatment” is a set of medical and therapeutic
139	139	110assessment and treatments focused on psychophysiological disorders or physical disorders with
140	140	111psychological overlay.
141	141	112 “Post-acute residential treatment” includes integrated medical and therapeutic services,
142	142	113treatment, education, and skills training within a 24/7 real-world environment of care - a home
143	143	114and community setting. Maximum opportunity for correct practice of skill in the context of use
144	144	115develops new neural pathways which ensure ongoing skill use and avoidance of re-
145	145	116hospitalization and long-term care. 7 of 17
146	146	117 (b) The following shall provide coverage for medically necessary treatment related to or
147	147	118as a result of an acquired brain injury: (ii)any policy of accident and sickness insurance, as
148	148	119described in section 108, which provides hospital expense and surgical expense insurance and
149	149	120which is delivered, issued or subsequently renewed by agreement between the insurer and
150	150	121policyholder in the commonwealth; (ii) any blanket or general policy of insurance described in
151	151	122subdivision (A), (C) or (D) of section 110 which provides hospital expense and surgical expense
152	152	123insurance and which is delivered, issued or subsequently renewed by agreement between the
153	153	124insurer and the policyholder in or outside of the commonwealth; or (iii) any employees’ health
154	154	125and welfare fund which provides hospital expense and surgical expense benefits and which is
155	155	126delivered, issued or renewed to any person or group of persons in the commonwealth. Medically
156	156	127necessary treatment shall include, but is not limited to, cognitive rehabilitation therapy; cognitive
157	157	128communication therapy; neurocognitive therapy and rehabilitation; neurobehavioral,
158	158	129neurophysiological, neuropsychological and psychophysiological testing and treatment;
159	159	130neurofeedback therapy; functional rehabilitation therapy and remediation; community
160	160	131reintegration services; post-acute residential treatment services; inpatient services; outpatient and
161	161	132day treatment services; home and community based treatment. The benefits in this section shall
162	162	133not include any lifetime limitation or unreasonable annual limitation of the number of days or
163	163	134sessions of treatment services. Any limitations shall be separately stated by the insurer. The
164	164	135benefits in this section shall not be subject to any greater deductible, coinsurance, copayments, or
165	165	136out-of-pocket limits than any other benefit provided by the insurer.
166	166	137 (c) The commissioner of insurance shall require a health benefit plan issuer to provide
167	167	138adequate training to personnel responsible for preauthorization of coverage or utilization review 8 of 17
168	168	139for services under this section, in consultation with the Brain Injury Association of
169	169	140Massachusetts.
170	170	141 (d) Individual practitioners and treatment facilities shall be qualified to provide acute care
171	171	142and post-acute care rehabilitation services through possession of the appropriate licenses,
172	172	143accreditation, training and experience deemed customary and routine in the trade practice.
173	173	144 SECTION 3. Chapter 176A of the General Law, as appearing in the 2020 Official
174	174	145Edition, is hereby amended by inserting after section 8QQ the following section:-
175	175	146 Section 8RR. (a) For purposes of this section, the following terms shall have the
176	176	147following meanings:-
177	177	148 “Acquired brain injury (ABI)” is any injury to the brain which occurs after birth and can
178	178	149be caused by infectious diseases, metabolic disorders, endocrine disorders or diminished oxygen,
179	179	150brain tumors, toxins, disease that affects the blood supply to the brain, stroke or a traumatic brain
180	180	151injury.
181	181	152 “Cognitive communication therapy” treats problems with communication which have an
182	182	153underlying cause in a cognitive deficit rather than a primary language or speech deficit.
183	183	154 “Cognitive rehabilitation therapy (CRT)” is a process of re-learning cognitive skills
184	184	155essential for daily living through the coordinated specialized, integrated therapeutic treatments
185	185	156which are provided in dynamic settings designed for efficient and effective re-learning following
186	186	157damage to brain cells or brain chemistry due to brain injury.
187	187	158 “Community reintegration services” provide incremental guided real-world therapeutic
188	188	159training to develop skills essential for an individual to participate in life: to re-enter employment; 9 of 17
189	189	160to go to school and engage in other productive activity; to safely live independently; and to
190	190	161participate in their community while avoiding re-hospitalization and long-term support needs.
191	191	162 “Functional rehabilitation therapy and remediation” is a structured approach to
192	192	163rehabilitation for brain disorders which emphasizes learning by doing, and focuses re-learning a
193	193	164specific task in a prescribed format with maximum opportunity for repeated correct practice.
194	194	165Compensatory strategies are developed for those skills which are persistently impaired and
195	195	166individuals are trained on daily implementation. To ensure acquisition and use, focus is set on re-
196	196	167learning those skills essential for safe daily living in the environment in which they will be used:
197	197	168home and community settings.
198	198	169 “Medical necessity” or “medically necessary,” health care services that are consistent
199	199	170with generally accepted principles of professional medical practice.
200	200	171 “Neurobehavioral therapy” is a set of medical and therapeutic assessment and treatments
201	201	172focused on behavioral impairments associated with brain disease or injury and the amelioration
202	202	173of these impairments through the development of pro-social behavior.
203	203	174 “Neurocognitive therapy” is treatment of disorders in which the primary clinical deficit is
204	204	175in cognitive function which has not been present since birth and is a decline from a previously
205	205	176attained level of function.
206	206	177 “Neurofeedback therapy” is a direct training of brain function to enhance self-regulatory
207	207	178capacity or an individual’s ability to exert control over behavior, thoughts and feelings. It is a
208	208	179form of biofeedback whereby a patient can learn to control brain activity that is measured and
209	209	180recorded by an electroencephalogram. 10 of 17
210	210	181 “Neuropsychological testing” is a set of medical and therapeutic assessment and
211	211	182treatments focused on amelioration of cognitive, emotional, psychosocial and behavioral deficits
212	212	183caused by brain injury.
213	213	184 “Psychophysiological testing and treatment” is a set of medical and therapeutic
214	214	185assessment and treatments focused on psychophysiological disorders or physical disorders with
215	215	186psychological overlay.
216	216	187 “Post-acute residential treatment” includes integrated medical and therapeutic services,
217	217	188treatment, education, and skills training within a 24/7 real-world environment of care- a home
218	218	189and community setting. Maximum opportunity for correct practice of skill in the context of use
219	219	190develops new neural pathways which ensure ongoing skill use and avoidance of re-
220	220	191hospitalization and long-term care.
221	221	192 (b) Any contract between a subscriber and the corporation under an individual or group
222	222	193hospital service plan which is delivered, issued or renewed within the commonwealth shall
223	223	194provide coverage for medically necessary treatment related to or as a result of an acquired brain
224	224	195injury. Medically necessary treatment shall include, but is not limited to, cognitive rehabilitation
225	225	196therapy; cognitive communication therapy; neurocognitive therapy and rehabilitation;
226	226	197neurobehavioral, neurophysiological, neuropsychological and psychophysiological testing and
227	227	198treatment; neurofeedback therapy; functional rehabilitation therapy and remediation; community
228	228	199reintegration services; post-acute residential treatment services; inpatient services; outpatient and
229	229	200day treatment services; home and community based treatment. The benefits in this section shall
230	230	201not include any lifetime limitation or unreasonable annual limitation of the number of days or
231	231	202sessions of treatment services. Any limitations shall be separately stated by the insurer. The 11 of 17
232	232	203benefits in this section shall not be subject to any greater deductible, coinsurance, copayments, or
233	233	204out-of-pocket limits than any other benefit provided by the insurer.
234	234	205 (c) The commissioner of insurance shall require a health benefit plan issuer to provide
235	235	206adequate training to personnel responsible for preauthorization of coverage or utilization review
236	236	207for services under this section, in consultation with the Brain Injury Association of
237	237	208Massachusetts.
238	238	209 (d) Individual practitioners and treatment facilities shall be qualified to provide acute care
239	239	210and post-acute care rehabilitation services through possession of the appropriate licenses,
240	240	211accreditation, training and experience deemed customary and routine in the trade practice.
241	241	212 SECTION 4. Chapter 176B of the General Laws, as appearing in the 2020 Official
242	242	213Edition, is hereby amended by inserting after section 4QQ the following section:-
243	243	214 Section 4RR. (a) For purposes of this section, the following terms shall have the
244	244	215following meanings:-
245	245	216 “Acquired brain injury (ABI)” is any injury to the brain which occurs after birth and can
246	246	217be caused by infectious diseases, metabolic disorders, endocrine disorders or diminished oxygen,
247	247	218brain tumors, toxins, disease that affects the blood supply to the brain, stroke or a traumatic brain
248	248	219injury.
249	249	220 “Cognitive communication therapy” treats problems with communication which have an
250	250	221underlying cause in a cognitive deficit rather than a primary language or speech deficit.
251	251	222 “Cognitive rehabilitation therapy (CRT)” is a process of relearning cognitive skills
252	252	223essential for daily living through the coordinated specialized, integrated therapeutic treatments 12 of 17
253	253	224which are provided in dynamic settings designed for efficient and effective re-learning following
254	254	225damage to brain cells or brain chemistry due to brain injury.
255	255	226 “Community reintegration services” provide incremental guided real-world therapeutic
256	256	227training to develop skills essential for an individual to participate in life: to re-enter employment;
257	257	228to go to school and engage in other productive activity; to safely live independently; and to
258	258	229participate in their community while avoiding re-hospitalization and long-term support needs.
259	259	230 “Functional rehabilitation therapy and remediation” is a structured approach to
260	260	231rehabilitation for brain disorders which emphasizes learning by doing, and focuses re-learning a
261	261	232specific task in a prescribed format, with maximum opportunity for repeated correct practice.
262	262	233Compensatory strategies are developed for those skills which are persistently impaired and
263	263	234individuals are trained on daily implementation. To ensure acquisition and use, focus is set on re-
264	264	235learning those skills essential for safe on daily living in the environment in which they will be
265	265	236used: home and community settings.
266	266	237 “Medical necessity” or “medically necessary,” health care services that are consistent
267	267	238with generally accepted principles of professional medical practice.
268	268	239 “Neurobehavioral therapy” is a set of medical and therapeutic assessment and treatments
269	269	240focused on behavioral impairments associated with brain disease or injury and the amelioration
270	270	241of these impairments through the development of pro-social behavior.
271	271	242 “Neurocognitive therapy” is treatment of disorders in which the primary clinical deficit is
272	272	243in cognitive function which has not been present since birth and is a decline from a previously
273	273	244attained level of function. 13 of 17
274	274	245 “Neurofeedback therapy” is a direct training of brain function to enhance self-regulatory
275	275	246capacity or an individual’s ability to exert control over behavior, thoughts and feelings. It is a
276	276	247form of biofeedback whereby a patient can learn to control brain activity that is measured and
277	277	248recorded by an electroencephalogram.
278	278	249 “Neuropsychological testing” is a set of medical and therapeutic assessment and
279	279	250treatments focused on amelioration of cognitive, emotional, psychosocial and behavioral deficits
280	280	251caused by brain injury;
281	281	252 “Psychophysiological testing and treatment” is a set of medical and therapeutic
282	282	253assessment and treatments focused on psychophysiological disorders or physical disorders with
283	283	254psychological overlay.
284	284	255 “Post-acute residential treatment” includes integrated medical and therapeutic services,
285	285	256treatment, education, and skills training within a 24/7 real-world environment of care, – a home
286	286	257and community setting. Maximum opportunity for correct practice of skill in the context of use
287	287	258develops new neural pathways which ensure ongoing skill use and avoidance of re-
288	288	259hospitalization and long-term care.
289	289	260 (b) Any subscription certificate under an individual or group medical service agreement
290	290	261delivered, issued or renewed within the commonwealth shall provide coverage for medically
291	291	262necessary treatment related to or as a result of an acquired brain injury. Medically necessary
292	292	263treatment shall include, but is not limited to, cognitive rehabilitation therapy; cognitive
293	293	264communication therapy; neurocognitive therapy and rehabilitation; neurobehavioral,
294	294	265neurophysiological, neuropsychological and psychophysiological testing and treatment;
295	295	266neurofeedback therapy; functional rehabilitation therapy and remediation; community 14 of 17
296	296	267reintegration services; post-acute residential treatment services; inpatient services; outpatient and
297	297	268day treatment services; home and community based treatment. The benefits in this section shall
298	298	269not include any lifetime limitation or unreasonable annual limitation of the number of days or
299	299	270sessions of treatment services. Any limitations shall be separately stated by the insurer. The
300	300	271benefits in this section shall not be subject to any greater deductible, coinsurance, copayments, or
301	301	272out-of-pocket limits than any other benefit provided by the insurer.
302	302	273 (c) The commissioner of insurance shall require a health benefit plan issuer to provide
303	303	274adequate training to personnel responsible for preauthorization of coverage or utilization review
304	304	275for services under this section, in consultation with the Brain Injury Association of
305	305	276Massachusetts.
306	306	277 (d) Individual practitioners and treatment facilities shall be qualified to provide acute care
307	307	278and post-acute care rehabilitation services through possession of the appropriate licenses,
308	308	279accreditation, training and experience deemed customary and routine in the trade practice.
309	309	280 SECTION 5. Chapter 176G of the General Laws, as appearing in the 2020 Official
310	310	281Edition, is hereby amended by inserting after section 4GG the following section:-
311	311	282 Section 4II. (a) For purposes of this section, the following terms shall have the following
312	312	283meanings:-
313	313	284 “Acquired brain injury (ABI)” is any injury to the brain which occurs after birth and can
314	314	285be caused by infectious diseases, metabolic disorders, endocrine disorders or diminished oxygen,
315	315	286brain tumors, toxins, disease that affects the blood supply to the brain, stroke or a traumatic brain
316	316	287injury. 15 of 17
317	317	288 “Cognitive communication therapy” treats problems with communication which have an
318	318	289underlying cause in a cognitive deficit rather than a primary language or speech deficit.
319	319	290 “Cognitive rehabilitation therapy (CRT)” is a process of relearning cognitive skills
320	320	291essential for daily living through the coordinated specialized, integrated therapeutic treatments
321	321	292which are provided in dynamic settings designed for efficient and effective re-learning following
322	322	293damage to brain cells or brain chemistry due to brain injury.
323	323	294 “Community reintegration services” provide incremental guided real-world therapeutic
324	324	295training to develop skills essential for an individual to participate in life: to re-enter employment;
325	325	296to go to school or engage in other productive activity; to safely live independently; and to
326	326	297participate in their community while avoiding re-hospitalization and long-term support needs.
327	327	298 “Functional rehabilitation therapy and remediation” is a structured approach to
328	328	299rehabilitation for brain disorders which emphasizes learning by doing, and focuses re-learning a
329	329	300specific task in a prescribed format, with maximum opportunity for repeated correct practice.
330	330	301Compensatory strategies are developed for those skills which are persistently impaired and
331	331	302individuals are trained on daily implementation. To ensure acquisition and use, focus is set on re-
332	332	303learning those skills essential for safe daily living in the environment in which they will be used:
333	333	304home and community settings.
334	334	305 “Medical necessity” or “medically necessary,” health care services that are consistent
335	335	306with generally accepted principles of professional medical practice.
336	336	307 “Neurobehavioral therapy” is a set of medical and therapeutic assessment and treatments
337	337	308focused on behavioral impairments associated with brain disease or injury and the amelioration
338	338	309of these impairments through the development of pro-social behavior. 16 of 17
339	339	310 “Neurocognitive therapy” is treatment of disorders in which the primary clinical deficit is
340	340	311in cognitive function which has not been present since birth and is a decline from a previously
341	341	312attained level of function.
342	342	313 “Neurofeedback therapy” is a direct training of brain function to enhance self-regulatory
343	343	314capacity or an individual’s ability to exert control over behavior, thoughts and feelings. It is a
344	344	315form of biofeedback whereby a patient can learn to control brain activity that is measured and
345	345	316recorded by an electroencephalogram.
346	346	317 “Neuropsychological testing” is a set of medical and therapeutic assessment and
347	347	318treatments focused on amelioration of cognitive, emotional, psychosocial and behavioral deficits
348	348	319caused by brain injury.
349	349	320 “Psychophysiological testing and treatment” is a set of medical and therapeutic
350	350	321assessment and treatments focused on psychophysiological disorders or physical disorders with
351	351	322psychological overlay.
352	352	323 “Post-acute residential treatment” includes integrated medical and therapeutic services,
353	353	324treatment, education, and skills training within a 24/7 real-world environment of care – a home
354	354	325and community setting. Maximum opportunity for correct practice of skill in the context of use
355	355	326develops new neural pathways which ensure ongoing skill use and avoidance of re-
356	356	327hospitalization and long-term care.
357	357	328 (b) Any individual or group health maintenance contract shall provide coverage for
358	358	329medically necessary treatment related to or as a result of an acquired brain injury. Medically
359	359	330necessary treatment shall include, but is not limited to, cognitive rehabilitation therapy; cognitive
360	360	331communication therapy; neurocognitive therapy and rehabilitation; neurobehavioral, 17 of 17
361	361	332neurophysiological, neuropsychological and psychophysiological testing and treatment;
362	362	333neurofeedback therapy; functional rehabilitation therapy and remediation; community
363	363	334reintegration services; post-acute residential treatment services; inpatient services; outpatient and
364	364	335day treatment services; home and community based treatment. The benefits in this section shall
365	365	336not include any lifetime limitation or unreasonable annual limitation of the number of days or
366	366	337sessions of treatment services. Any limitations shall be separately stated by the insurer. The
367	367	338benefits in this section shall not be subject to any greater deductible, coinsurance, copayments, or
368	368	339out-of-pocket limits than any other benefit provided by the insurer.
369	369	340 (c) The commissioner of insurance shall require a health benefit plan issuer to provide
370	370	341adequate training to personnel responsible for preauthorization of coverage or utilization review
371	371	342for services under this section, in consultation with the Brain Injury Association of
372	372	343Massachusetts.
373	373	344 (d) Individual practitioners and treatment facilities shall be qualified to provide acute care
374	374	345and post-acute care rehabilitation services through possession of the appropriate licenses,
375	375	346accreditation, training and experience deemed customary and routine in the trade practice.