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