Massachusetts 2023-2024 Regular Session

Massachusetts Senate Bill S1253 Compare Versions

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

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1	1	1 of 1
2	2	SENATE DOCKET, NO. 2391 FILED ON: 1/20/2023
3	3	SENATE . . . . . . . . . . . . . . No. 1253
4	4	The Commonwealth of Massachusetts
5	5	_________________
6	6	PRESENTED BY:
7	7	John F. Keenan
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 to remove administrative barriers to behavioral health services.
13	13	_______________
14	14	PETITION OF:
15	15	NAME:DISTRICT/ADDRESS :John F. KeenanNorfolk and PlymouthAdam Scanlon14th Bristol1/24/2023James B. EldridgeMiddlesex and Worcester3/6/2023 1 of 6
16	16	SENATE DOCKET, NO. 2391 FILED ON: 1/20/2023
17	17	SENATE . . . . . . . . . . . . . . No. 1253
18	18	By Mr. Keenan, a petition (accompanied by bill, Senate, No. 1253) of John F. Keenan, Adam
19	19	Scanlon and James B. Eldridge for legislation to remove administrative barriers to behavioral
20	20	health services. Mental Health, Substance Use and Recovery.
21	21	[SIMILAR MATTER FILED IN PREVIOUS SESSION
22	22	SEE SENATE, NO. 1295 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 to remove administrative barriers to behavioral health services.
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 17S of chapter 32A of the General Laws, as inserted by Chapter
32	32	2177 of the acts of 2022, is hereby amended by striking out subsection (b) and inserting in place
33	33	3thereof the following subsection:-
34	34	4 (b) The commission shall provide to any active or retired employee of the
35	35	5commonwealth who is insured under the group insurance commission coverage for medically
36	36	6necessary mental health services within an inpatient psychiatric facility, a community health
37	37	7center, a community behavioral health center, a community mental health center, an outpatient
38	38	8substance use disorder provider, a hospital outpatient department, a community based acute
39	39	9treatment program or an intensive community based acute treatment program and shall not
40	40	10require a preauthorization before obtaining treatment; provided, however, that the facility shall 2 of 6
41	41	11notify the carrier of the admission and the initial treatment plan not more than three business
42	42	12days of admission; provided further, that notification shall be limited to patient’s name, facility
43	43	13name, time of admission, diagnosis and initial treatment plan; and, provided further, that services
44	44	14administered prior to notification must be covered. Medical necessity shall be determined by the
45	45	15treating clinician in consultation with the patient and noted in the member’s medical record.
46	46	16 SECTION 2. Section 10O of chapter 118E of the General Laws, as so appearing, is
47	47	17hereby amended by striking out the last paragraph and inserting in place thereof the following
48	48	18new paragraph:-
49	49	19 The division and its contracted health insurers, health plans, health maintenance
50	50	20organizations, behavioral health management firms and third-party administrators under contract
51	51	21to a Medicaid managed care organization or primary care clinician plan shall cover the cost of
52	52	22medically necessary mental health services within an inpatient psychiatric facility, a community
53	53	23health center, a community mental health center, a community behavioral health center, an
54	54	24outpatient substance use disorder provider, a hospital outpatient department, a community based
55	55	25acute treatment program or an intensive community based acute treatment program and shall not
56	56	26require a preauthorization before obtaining treatment; provided, however, that the facility shall
57	57	27notify the carrier of the admission and the initial treatment plan within three business days of
58	58	28admission; provided further, that notification shall be limited to patient’s name, facility name,
59	59	29time of admission, diagnosis and initial treatment plan; and, provided further, that services
60	60	30administered prior to notification must be covered. Medical necessity shall be determined by the
61	61	31treating clinician in consultation with the patient and noted in the member’s medical record. 3 of 6
62	62	32 SECTION 3. Section 24B of chapter 175 of the General Laws, as appearing in the 2020
63	63	33Official Edition, is hereby amended by inserting after the first paragraph the following
64	64	34paragraph:
65	65	35 A carrier, as defined in section 1 of chapter 176O, shall be required to pay for health care
66	66	36services ordered by the treating health care provider if (1) the services are a covered benefit
67	67	37under the insured’s health benefit plan and (2) the services follow the carrier’s clinical review
68	68	38criteria; provided, however, a claim for treatment of medically necessary services may not be
69	69	39denied if the treating health care provider follows the carrier’s approved method for securing
70	70	40authorization for a covered service for the insured at the time the service was provided. A carrier
71	71	41shall have no more than twelve months after the original payment was received by the provider
72	72	42to recoup a full or partial payment for a claim for services rendered, or to adjust a subsequent
73	73	43payment to reflect a recoupment of a full or partial payment; provided, however, a carrier shall
74	74	44not recoup payments more than ninety days after the original payment was received by a
75	75	45provider for services provided to an insured that the carrier deems ineligible for coverage
76	76	46because the insured was retroactively terminated or retroactively disenrolled for services;
77	77	47provided further, that the provider can document that it received verification of an insured’s
78	78	48eligibility status using the carrier's approved method for verifying eligibility at the time service
79	79	49was provided. Claims may also not be recouped for utilization review purposes if the services
80	80	50were already deemed medically necessary or the manner in which the services were accessed or
81	81	51provided were previously approved by the carrier or its contractor. A carrier that seeks to make
82	82	52an adjustment pursuant to this section shall provide the health care provider with written notice
83	83	53that explains in detail the reasons for the recoupment, identifies each previously paid claim for
84	84	54which a recoupment is sought and provides the health care provider with thirty days to challenge 4 of 6
85	85	55the request for recoupment. Such written notice shall be made to the health provider not less than
86	86	56thirty days prior to the seeking of a recoupment or the making of an adjustment.
87	87	57 SECTION 4. Section 47SS of chapter 175 of the General Laws, as inserted by chapter
88	88	58177 of the acts of 2022, is hereby amended by striking out subsection (b) and inserting in place
89	89	59thereof the following subsection:-
90	90	60 (b) A policy, contract, agreement, plan or certificate of insurance issued, delivered or
91	91	61renewed within or without the commonwealth, which is considered creditable coverage under
92	92	62section 1 of chapter 111M, shall provide coverage for medically necessary mental health services
93	93	63within an inpatient psychiatric facility, a community health center, a community mental health
94	94	64center, a community behavioral health center, an outpatient substance use disorder provider, a
95	95	65hospital outpatient department, a community based acute treatment program or an intensive
96	96	66community based acute treatment program and shall not require a preauthorization before the
97	97	67administration of such treatment; provided, however, that the facility shall notify the carrier of
98	98	68the admission and the initial treatment plan within three business days of admission; provided
99	99	69further, that notification shall be limited to patient’s name, facility name, time of admission,
100	100	70diagnosis and initial treatment plan; and, provided further, that services administered prior to
101	101	71notification must be covered. Medical necessity shall be determined by the treating clinician in
102	102	72consultation with the patient and noted in the patient’s medical record.
103	103	73 SECTION 5. Section 8SS of chapter 176A of the General Laws, as inserted by chapter
104	104	74177 of the acts of 2022, is hereby amended by striking out subsection (b) and inserting in place
105	105	75thereof the following subsection:- 5 of 6
106	106	76 (b) A contract between a subscriber and the corporation under an individual or group
107	107	77hospital service plan that is delivered, issued or renewed within the commonwealth shall provide
108	108	78coverage for medically necessary mental health services within an inpatient psychiatric facility, a
109	109	79community health center, a community mental health center, an outpatient substance use disorder
110	110	80provider, a hospital outpatient department, a community based acute treatment program or an
111	111	81intensive community based acute treatment program and shall not require a preauthorization
112	112	82before the administration of any such treatment; provided, however, that the facility shall notify
113	113	83the carrier of the admission and the initial treatment plan within three business days of
114	114	84admission; provided further, that notification shall be limited to patient’s name, facility name,
115	115	85time of admission, diagnosis and initial treatment plan; and, provided further, that services
116	116	86administered prior to notification must be covered. Medical necessity shall be determined by the
117	117	87treating clinician in consultation with the patient and noted in the patient’s medical record.
118	118	88 SECTION 6. Section 4SS of chapter 176B of the General Laws, as inserted by chapter
119	119	89177 of the acts of 2022, is hereby amended by striking out subsection (b) and inserting in place
120	120	90thereof the following subsection:-
121	121	91 (b) A subscription certificate under an individual or group medical service agreement
122	122	92delivered, issued or renewed within the commonwealth shall provide coverage for medically
123	123	93necessary mental health services within an inpatient psychiatric facility, a community health
124	124	94center, a community mental health center, an outpatient substance use disorder provider, a
125	125	95hospital outpatient department, a community based acute treatment program or an intensive
126	126	96community based acute treatment program and shall not require a preauthorization before
127	127	97obtaining treatment; provided, however, that the facility shall notify the carrier of the admission
128	128	98and the initial treatment plan within three business days of admission; provided further, that 6 of 6
129	129	99notification shall be limited to patient’s name, facility name, time of admission, diagnosis and
130	130	100initial treatment plan; and, provided further, that services administered prior to notification must
131	131	101be covered. Medical necessity shall be determined by the treating clinician in consultation with
132	132	102the patient and noted in the patient’s medical record.
133	133	103 SECTION 7. Section 4KK of chapter 176G of said General Laws, as inserted by chapter
134	134	104177 of the acts of 2022, is hereby amended by striking out subsection (b) and inserting in place
135	135	105thereof the following subsection:-
136	136	106 (b) An individual or group health maintenance contract that is issued or renewed within
137	137	107or without the commonwealth shall provide coverage for medically necessary mental health
138	138	108services within an inpatient psychiatric facility, a community health center, a community mental
139	139	109health center, an outpatient substance use disorder provider, a hospital outpatient department, a
140	140	110community based acute treatment program, or an intensive community based acute treatment
141	141	111program and shall not require a preauthorization before obtaining treatment; provided, however,
142	142	112that the facility shall notify the carrier of the admission and the initial treatment plan within three
143	143	113business days of admission; provided further, that notification shall be limited to patient’s name,
144	144	114facility name, time of admission, diagnosis and initial treatment plan; and, provided further, that
145	145	115services administered prior to notification must be covered. Medical necessity shall be
146	146	116determined by the treating clinician in consultation with the patient and noted in the patient’s
147	147	117medical record.