Massachusetts 2023-2024 Regular Session

Massachusetts House Bill H989 Compare Versions

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

Old	New	Differences
1	1	1 of 1
2	2	HOUSE DOCKET, NO. 2334 FILED ON: 1/19/2023
3	3	HOUSE . . . . . . . . . . . . . . . No. 989
4	4	The Commonwealth of Massachusetts
5	5	_________________
6	6	PRESENTED BY:
7	7	Marjorie C. Decker
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 for supportive care for serious mental illness.
13	13	_______________
14	14	PETITION OF:
15	15	NAME:DISTRICT/ADDRESS :DATE ADDED:Marjorie C. Decker25th Middlesex1/19/2023 1 of 14
16	16	HOUSE DOCKET, NO. 2334 FILED ON: 1/19/2023
17	17	HOUSE . . . . . . . . . . . . . . . No. 989
18	18	By Representative Decker of Cambridge, a petition (accompanied by bill, House, No. 989) of
19	19	Marjorie C. Decker relative to healthcare insurance coverage for supportive care for serious
20	20	mental illness. Financial Services.
21	21	[SIMILAR MATTER FILED IN PREVIOUS SESSION
22	22	SEE HOUSE, NO. 1062 OF 2021-2022.]
23	23	The Commonwealth of Massachusetts
24	24	_______________
25	25	In the One Hundred and Ninety-Third General Court
26	26	(2023-2024)
27	27	_______________
28	28	An Act for supportive care for serious mental illness.
29	29	Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
30	30	of the same, as follows:
31	31	1 SECTION 1. Section 18 of chapter 15A of the General Laws, as appearing in the 2020
32	32	2Official Edition, is hereby amended by adding the following paragraph:-
33	33	3 Notwithstanding any general or special law to the contrary, any qualifying student health
34	34	4insurance plan authorized under this chapter shall provide coverage for coordinated specialty
35	35	5care services and assertive community treatment service as described under section 4FF of
36	36	6chapter 176G.
37	37	7 SECTION 2. Chapter 32A of the General Laws is hereby amended by adding the
38	38	8following section:- 2 of 14
39	39	9 Section 32. (a) For the purposes of this section, the following words shall have the
40	40	10following meanings unless the context clearly requires otherwise:
41	41	11 “Assertive Community Treatment”, a team-based, evidenced-based treatment practice
42	42	12that offers treatment, rehabilitation, and support services, using a person-centered, recovery-
43	43	13based flexible treatment program, as defined by evidence-based standards, including, but not
44	44	14limited to, the most current guidelines issued by the federal Substance Abuse and Mental Health
45	45	15Services Administration.
46	46	16 “Behavioral health services”, care and services for the evaluation, diagnosis, treatment or
47	47	17management of patients with mental health, developmental or substance use disorders.
48	48	18 “Coordinated Specialty Care”,  a recovery-oriented treatment program for people with
49	49	19first-episode psychosis,  as defined by evidence-based standards, including, but not limited to the
50	50	20most current guidelines issued by the  National Institute of Mental Health.
51	51	21 “Evidence-based practice”, treatments that are supported by clinical research.
52	52	22 “First episode psychosis treatment”, treatment initiated within 74 weeks of the first time
53	53	23an individual experiences an episode of psychosis.
54	54	24 “Serious emotional disturbance”, mental, behavioral or emotional disorders in children or
55	55	25adolescents under age 19 that have resulted in functional impairment that substantially interferes
56	56	26with or limits the child’s role or functioning in family, school or community activities.
57	57	27 “Serious mental illness”, mental, behavioral or emotional disorders resulting in serious
58	58	28functional impairment that substantially interferes with or limits at least 1 major life activity for 3 of 14
59	59	29an individual not less than 19 years old with a psychiatric diagnosis as defined in the American
60	60	30Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders.
61	61	31 (b) Coverage offered by the commission to an active or retired employee of the
62	62	32commonwealth insured under the group insurance commission shall provide coverage for wrap-
63	63	33around coordinated specialty care services for first episode psychosis treatment and assertive
64	64	34community treatment for early or ongoing treatment of person with a previous episode of
65	65	35psychosis who has a serious mental illness or serious emotional disturbance. Coverage under this
66	66	36section shall not be construed as imposing a limit on the number of visits an individual may
67	67	37make to a provider of any of the services under this section.
68	68	38 (c) Payment for the services performed under the treatment models listed in this section
69	69	39shall be based on a bundled treatment model or payment, rather than fee for service payment for
70	70	40each separate service delivered by a treatment team member.
71	71	41 (d) To determine medical necessity for the treatment approaches under this section,
72	72	42neither disability nor functional impairment shall be a precondition to receive the treatment.
73	73	43Medical necessity shall be presumed following a recommendation by a licensed physician,
74	74	44licensed clinical psychologist, licensed professional clinical counselor or licensed clinical social
75	75	45worker.
76	76	46 SECTION 3. Chapter 112 of the General Laws is hereby amended by inserting after
77	77	47section 9K the following section:-
78	78	48 Section 9L. To credential the mental health professionals and other members of the
79	79	49multidisciplinary coordinated specialty care treatment team or an assertive community treatment
80	80	50team as described under section 32 of chapter 32A, section 39 of chapter 176A, section 26 of 4 of 14
81	81	51chapter 176B, section 34 of chapter 176G and section 14 of chapter 176I, the credentialing of the
82	82	52psychiatrist or the licensed clinical leader of the treatment team shall qualify all members of the
83	83	53treatment team to be credentialed with the insurer.
84	84	54 SECTION 4. Chapter 175 of the General Laws is hereby amended by inserting after
85	85	55section 47NN the following section:-
86	86	56 Section 47OO. (a) For the purposes of this section, the following words shall have the
87	87	57following meanings unless the context clearly requires otherwise:
88	88	58 “Assertive Community Treatment”, a team-based, evidenced-based treatment practice
89	89	59that offers treatment, rehabilitation, and support services, using a person-centered, recovery-
90	90	60based flexible treatment program, as defined by evidence-based standards, including, but not
91	91	61limited to, the most current guidelines issued by the federal Substance Abuse and Mental Health
92	92	62Services Administration.
93	93	63 “Behavioral health services”, care and services for the evaluation, diagnosis, treatment or
94	94	64management of patients with mental health, developmental or substance use disorders.
95	95	65 “Coordinated Specialty Care”,  a recovery-oriented treatment program for people with
96	96	66first-episode psychosis,  as defined by evidence-based standards, including, but not limited to the
97	97	67most current guidelines issued by the  National Institute of Mental Health.
98	98	68 “Evidence-based practice”, treatments that are supported by clinical research.
99	99	69 “First episode psychosis treatment”, treatment initiated within 74 weeks of the first time
100	100	70an individual experiences an episode of psychosis. 5 of 14
101	101	71 “Serious emotional disturbance”, mental, behavioral or emotional disorders in children or
102	102	72adolescents under age 19 that have resulted in functional impairment that substantially interferes
103	103	73with or limits the child’s role or functioning in family, school or community activities.
104	104	74 “Serious mental illness”, mental, behavioral or emotional disorders resulting in serious
105	105	75functional impairment that substantially interferes with or limits at least 1 major life activity for
106	106	76an individual not less than 19 years old with a psychiatric diagnosis as defined in the American
107	107	77Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders.
108	108	78 (b) An individual policy of accident and sickness insurance issued under section 108 that
109	109	79provides hospital expense and surgical expense insurance and any group blanket or general
110	110	80policy of accident and sickness insurance issued under section 110 that provides hospital expense
111	111	81and surgical expense insurance that is issued or renewed within or without the commonwealth
112	112	82shall provide coverage for wrap-around coordinated specialty care services for first episode
113	113	83psychosis treatment and assertive community treatment for early or ongoing treatment of person
114	114	84with a previous episode of psychosis who has a serious mental illness or serious emotional
115	115	85disturbance. Coverage under this section shall not be construed as imposing a limit on the
116	116	86number of visits an individual may make to a provider of any of the services under this section.
117	117	87 (c) Payment for the services performed under the treatment models listed in this section
118	118	88shall be based on a bundled treatment model or payment, rather than fee for service payment for
119	119	89each separate service delivered by a treatment team member.
120	120	90 (d) To determine medical necessity for the treatment approaches under this section,
121	121	91neither disability nor functional impairment shall be a precondition to receive the treatment.
122	122	92Medical necessity shall be presumed following a recommendation by a licensed physician, 6 of 14
123	123	93licensed clinical psychologist, licensed professional clinical counselor or licensed clinical social
124	124	94worker.
125	125	95 SECTION 5. Chapter 176A of the General Laws is hereby amended by adding the
126	126	96following section:-
127	127	97 Section 39. (a) For the purposes of this section, the following words shall
128	128	98 have the following meanings unless the context clearly requires otherwise:
129	129	99 “Assertive Community Treatment”, a team-based, evidenced-based treatment practice
130	130	100that offers treatment, rehabilitation, and support services, using a person-centered, recovery-
131	131	101based flexible treatment program, as defined by evidence-based standards, including, but not
132	132	102limited to, the most current guidelines issued by the federal Substance Abuse and Mental Health
133	133	103Services Administration.
134	134	104 “Behavioral health services”, care and services for the evaluation, diagnosis, treatment or
135	135	105management of patients with mental health, developmental or substance use disorders.
136	136	106 “Coordinated Specialty Care”,  a recovery-oriented treatment program for people with
137	137	107first-episode psychosis,  as defined by evidence-based standards, including, but not limited to the
138	138	108most current guidelines issued by the  National Institute of Mental Health.
139	139	109 “Evidence-based practice”, treatments that are supported by clinical research.
140	140	110 “First episode psychosis treatment”, treatment initiated within 74 weeks of the first time
141	141	111an individual experiences an episode of psychosis. 7 of 14
142	142	112 “Serious emotional disturbance”, mental, behavioral or emotional disorders in children or
143	143	113adolescents under age 19 that have resulted in functional impairment that substantially interferes
144	144	114with or limits the child’s role or functioning in family, school or community activities.
145	145	115 “Serious mental illness”, mental, behavioral or emotional disorders resulting in serious
146	146	116functional impairment that substantially interferes with or limits at least 1 major life activity for
147	147	117an individual not less than 19 years old with a psychiatric diagnosis as defined in the American
148	148	118Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders.
149	149	119 (b) A contract between a subscriber and a nonprofit hospital service corporation under an
150	150	120individual or group hospital service plan shall provide coverage for wrap-around coordinated
151	151	121specialty care services for first episode psychosis treatment and assertive community treatment
152	152	122for early or ongoing treatment of person with a previous episode of psychosis who has a serious
153	153	123mental illness or serious emotional disturbance. Coverage under this section shall not be
154	154	124construed as imposing a limit on the number of visits an individual may make to a provider of
155	155	125any of the services under this section.
156	156	126 (c) Payment for the services performed under the treatment models listed in this section
157	157	127shall be based on a bundled treatment model or payment, rather than fee for service payment for
158	158	128each separate service delivered by a treatment team member.
159	159	129 (d) To determine medical necessity for the treatment approaches under this section,
160	160	130neither disability nor functional impairment shall be a precondition to receive the treatment.
161	161	131Medical necessity shall be presumed following a recommendation by a licensed physician,
162	162	132licensed clinical psychologist, licensed professional clinical counselor or licensed clinical social
163	163	133worker. 8 of 14
164	164	134 SECTION 6. Chapter 176B of the General Laws is hereby amended by adding the
165	165	135following section:-
166	166	136 Section 26. (a) For the purposes of this section, the following words shall have the
167	167	137following meanings unless the context clearly requires otherwise:
168	168	138 “Assertive Community Treatment”, a team-based, evidenced-based treatment practice
169	169	139that offers treatment, rehabilitation, and support services, using a person-centered, recovery-
170	170	140based flexible treatment program, as defined by evidence-based standards, including, but not
171	171	141limited to, the most current guidelines issued by the federal Substance Abuse and Mental Health
172	172	142Services Administration.
173	173	143 “Behavioral health services”, care and services for the evaluation, diagnosis, treatment or
174	174	144management of patients with mental health, developmental or substance use disorders.
175	175	145 “Coordinated Specialty Care”,  a recovery-oriented treatment program for people with
176	176	146first-episode psychosis,  as defined by evidence-based standards, including, but not limited to the
177	177	147most current guidelines issued by the  National Institute of Mental Health.
178	178	148 “Evidence-based practice”, treatments that are supported by clinical research.
179	179	149 “First episode psychosis treatment”, treatment initiated within 74 weeks of the first time
180	180	150an individual experiences an episode of psychosis.
181	181	151 “Serious emotional disturbance”, mental, behavioral or emotional disorders in children or
182	182	152adolescents under age 19 that have resulted in functional impairment that substantially interferes
183	183	153with or limits the child’s role or functioning in family, school or community activities.   9 of 14
184	184	154 “Serious mental illness”, mental, behavioral or emotional disorders resulting in serious
185	185	155functional impairment that substantially interferes with or limits at least 1 major life activity for
186	186	156an individual not less than 19 years old with a psychiatric diagnosis as defined in the American
187	187	157Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders.
188	188	158 (b) A contract between a subscriber and a medical service corporation shall provide
189	189	159coverage for wrap-around coordinated specialty care services for first episode psychosis
190	190	160treatment and assertive community treatment for early or ongoing treatment of person with a
191	191	161previous episode of psychosis who has a serious mental illness or serious emotional disturbance.
192	192	162Coverage under this section shall not be construed as imposing a limit on the number of visits an
193	193	163individual may make to a provider of any of the services under this section.
194	194	164 (c) Payment for the services performed under the treatment models listed in this section
195	195	165shall be based on a bundled treatment model or payment, rather than fee for service payment for
196	196	166each separate service delivered by a treatment team member.
197	197	167 (d) To determine medical necessity for the treatment approaches under this section,
198	198	168neither disability nor functional impairment shall be a precondition to receive the treatment.
199	199	169Medical necessity shall be presumed following a recommendation by a licensed physician,
200	200	170licensed clinical psychologist, licensed professional clinical counselor or licensed clinical social
201	201	171worker.
202	202	172 SECTION 7. Chapter 176G of the General Laws is hereby amended by adding the
203	203	173following section:-
204	204	174 Section 34. (a) For the purposes of this section, the following words shall have the
205	205	175following meanings unless the context clearly requires otherwise: 10 of 14
206	206	176 “Assertive Community Treatment”, a team-based, evidenced-based treatment practice
207	207	177that offers treatment, rehabilitation, and support services, using a person-centered, recovery-
208	208	178based flexible treatment program, as defined by evidence-based standards, including, but not
209	209	179limited to, the most current guidelines issued by the federal Substance Abuse and Mental Health
210	210	180Services Administration.
211	211	181 “Behavioral health services”, care and services for the evaluation, diagnosis, treatment or
212	212	182management of patients with mental health, developmental or substance use disorders.
213	213	183 “Coordinated Specialty Care”,  a recovery-oriented treatment program for people with
214	214	184first-episode psychosis,  as defined by evidence-based standards, including, but not limited to the
215	215	185most current guidelines issued by the  National Institute of Mental Health.
216	216	186 “Evidence-based practice”, treatments that are supported by clinical research.
217	217	187 “First episode psychosis treatment”, treatment initiated within 74 weeks of the first time
218	218	188an individual experiences an episode of psychosis.
219	219	189 “Serious emotional disturbance”, mental, behavioral or emotional disorders in children or
220	220	190adolescents under age 19 that have resulted in functional impairment that substantially interferes
221	221	191with or limits the child’s role or functioning in family, school or community activities.
222	222	192 “Serious mental illness”, mental, behavioral or emotional disorders resulting in serious
223	223	193functional impairment that substantially interferes with or limits at least 1 major life activity for
224	224	194an individual not less than 19 years old with a psychiatric diagnosis as defined in the American
225	225	195Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders. 11 of 14
226	226	196 (b) A contract between a member and a health maintenance organization shall provide
227	227	197coverage for wrap-around coordinated specialty care services for first episode psychosis
228	228	198treatment and assertive community treatment for early or ongoing treatment of person with a
229	229	199previous episode of psychosis who has a serious mental illness or serious emotional disturbance.
230	230	200Coverage under this section shall not be construed as imposing a limit on the number of visits an
231	231	201individual may make to a provider of any of the services under this section.
232	232	202 (c) Payment for the services performed under the treatment models listed in this section
233	233	203shall be based on a bundled treatment model or payment, rather than fee for service payment for
234	234	204each separate service delivered by a treatment team member.
235	235	205 (d) To determine medical necessity for the treatment approaches under this section,
236	236	206neither disability nor functional impairment shall be a precondition to receive the treatment.
237	237	207Medical necessity shall be presumed following a recommendation by a licensed physician,
238	238	208licensed clinical psychologist, licensed professional clinical counselor or licensed clinical social
239	239	209worker.
240	240	210 SECTION 8. Chapter 176I of the General Laws is hereby amended by adding the
241	241	211following section:-
242	242	212 Section 14. (a) For the purposes of this section, the following words shall have the
243	243	213following meanings unless the context clearly requires otherwise:
244	244	214 “Assertive Community Treatment”, a team-based, evidenced-based treatment practice
245	245	215that offers treatment, rehabilitation, and support services, using a person-centered, recovery-
246	246	216based flexible treatment program, as defined by evidence-based standards, including, but not 12 of 14
247	247	217limited to, the most current guidelines issued by the federal Substance Abuse and Mental Health
248	248	218Services Administration.
249	249	219 “Behavioral health services”, care and services for the evaluation, diagnosis, treatment or
250	250	220management of patients with mental health, developmental or substance use disorders.
251	251	221 “Coordinated Specialty Care”,  a recovery-oriented treatment program for people with
252	252	222first-episode psychosis,  as defined by evidence-based standards, including, but not limited to the
253	253	223most current guidelines issued by the  National Institute of Mental Health.
254	254	224 “Evidence-based practice”, treatments that are supported by clinical research.
255	255	225 “First episode psychosis treatment”, treatment initiated within 74 weeks of the first time
256	256	226an individual experiences an episode of psychosis.
257	257	227 “Serious emotional disturbance”, mental, behavioral or emotional disorders in children or
258	258	228adolescents under age 19 that have resulted in functional impairment that substantially interferes
259	259	229with or limits the child’s role or functioning in family, school or community activities.
260	260	230 “Serious mental illness”, mental, behavioral or emotional disorders resulting in serious
261	261	231functional impairment that substantially interferes with or limits at least 1 major life activity for
262	262	232an individual not less than 19 years old with a psychiatric diagnosis as defined in the American
263	263	233Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders.
264	264	234 (b) A preferred provider contract between a covered person and an organization shall
265	265	235provide coverage for wrap-around coordinated specialty care services for first episode psychosis
266	266	236treatment and assertive community treatment for early or ongoing treatment of person with a
267	267	237previous episode of psychosis who has a serious mental illness or serious emotional disturbance. 13 of 14
268	268	238Coverage under this section shall not be construed as imposing a limit on the number of visits an
269	269	239individual may make to a provider of any of the services under this section.
270	270	240 (c) Payment for the services performed under the treatment models listed in this section
271	271	241shall be based on a bundled treatment model or payment, rather than fee for service payment for
272	272	242each separate service delivered by a treatment team member.
273	273	243 (d) To determine medical necessity for the treatment approaches under this section,
274	274	244neither disability nor functional impairment shall be a precondition to receive the treatment.
275	275	245Medical necessity shall be presumed following a recommendation by a licensed physician,
276	276	246licensed clinical psychologist, licensed professional clinical counselor or licensed clinical social
277	277	247worker.
278	278	248 SECTION 9. Not later than 6 months after the effective date of this act, the division of
279	279	249insurance shall convene a working group of insurance companies and mental health treatment
280	280	250providers that deliver the bundled treatment approaches listed in section 32 of chapter 32A,
281	281	251section 39 of chapter 176A, section 26 of chapter 176B, section 34 of chapter 176G and section
282	282	25214 of chapter 176I to determine a coding solution to allow the bundled treatment models to be
283	283	253coded and paid for as a bundle of services, similar to bundled payments under a single billing
284	284	254code for physical health care.
285	285	255 SECTION 10. The group insurance commission, the division of insurance and the health
286	286	256connector shall promulgate any regulations necessary to implement this section not later than six
287	287	257months after enactment.
288	288	258 SECTION 11. 14 of 14
289	289	259 All carriers must implement these benefits and demonstrate to the division of insurance
290	290	260the adequacy of their provider networks for these services by the effective date of this act. Any
291	291	261carrier that fails to demonstrate adequate networks of providers of these services by the effective
292	292	262date shall:
293	293	263 (a) assist any plan member to find an out-of-network CSC program or ACT program and
294	294	264to cover those services as if they were furnished in network; and
295	295	265 (b) report monthly to the division of insurance on the status of their networks, and pay a
296	296	266fine of $50,000 per month.
297	297	267 SECTION 12. After 5 years following full implementation of this act, the health policy
298	298	268commission, the division of insurance and the group insurance commission shall collaborate to
299	299	269perform an independent analysis of the impact of the coverage of the team-based treatment
300	300	270models provided under this section upon savings in hospitalization costs or other costs and on
301	301	271any increase in cost to the group insurance commission, the division of insurance or group
302	302	272insurance commission members. The analysis shall review claims payment and plan and
303	303	273consumer cost data for the largest group insurance commission plans that comprise at least 80
304	304	274per cent of the covered lives at the time of the study.
305	305	275 SECTION 13. This act shall take effect 1 year after its passage.