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SENATE DOCKET, NO. 2391 FILED ON: 1/20/2023
SENATE . . . . . . . . . . . . . . No. 1253
The Commonwealth of Massachusetts
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PRESENTED BY:
John F. Keenan
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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 to remove administrative barriers to behavioral health services.
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PETITION OF:
NAME:DISTRICT/ADDRESS :John F. KeenanNorfolk and PlymouthAdam Scanlon14th Bristol1/24/2023James B. EldridgeMiddlesex and Worcester3/6/2023 1 of 6
SENATE DOCKET, NO. 2391 FILED ON: 1/20/2023
SENATE . . . . . . . . . . . . . . No. 1253
By Mr. Keenan, a petition (accompanied by bill, Senate, No. 1253) of John F. Keenan, Adam
Scanlon and James B. Eldridge for legislation to remove administrative barriers to behavioral
health services. Mental Health, Substance Use and Recovery.
[SIMILAR MATTER FILED IN PREVIOUS SESSION
SEE SENATE, NO. 1295 OF 2021-2022.]
The Commonwealth of Massachusetts
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In the One Hundred and Ninety-Third General Court
(2023-2024)
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An Act to remove administrative barriers to behavioral health services.
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 17S of chapter 32A of the General Laws, as inserted by Chapter
2177 of the acts of 2022, is hereby amended by striking out subsection (b) and inserting in place
3thereof the following subsection:-
4 (b) The commission shall provide to any active or retired employee of the
5commonwealth who is insured under the group insurance commission coverage for medically
6necessary mental health services within an inpatient psychiatric facility, a community health
7center, a community behavioral health center, a community mental health center, an outpatient
8substance use disorder provider, a hospital outpatient department, a community based acute
9treatment program or an intensive community based acute treatment program and shall not
10require a preauthorization before obtaining treatment; provided, however, that the facility shall 2 of 6
11notify the carrier of the admission and the initial treatment plan not more than three business
12days of admission; provided further, that notification shall be limited to patient’s name, facility
13name, time of admission, diagnosis and initial treatment plan; and, provided further, that services
14administered prior to notification must be covered. Medical necessity shall be determined by the
15treating clinician in consultation with the patient and noted in the member’s medical record.
16 SECTION 2. Section 10O of chapter 118E of the General Laws, as so appearing, is
17hereby amended by striking out the last paragraph and inserting in place thereof the following
18new paragraph:-
19 The division and its contracted health insurers, health plans, health maintenance
20organizations, behavioral health management firms and third-party administrators under contract
21to a Medicaid managed care organization or primary care clinician plan shall cover the cost of
22medically necessary mental health services within an inpatient psychiatric facility, a community
23health center, a community mental health center, a community behavioral health center, an
24outpatient substance use disorder provider, a hospital outpatient department, a community based
25acute treatment program or an intensive community based acute treatment program and shall not
26require a preauthorization before obtaining treatment; provided, however, that the facility shall
27notify the carrier of the admission and the initial treatment plan within three business days of
28admission; provided further, that notification shall be limited to patient’s name, facility name,
29time of admission, diagnosis and initial treatment plan; and, provided further, that services
30administered prior to notification must be covered. Medical necessity shall be determined by the
31treating clinician in consultation with the patient and noted in the member’s medical record. 3 of 6
32 SECTION 3. Section 24B of chapter 175 of the General Laws, as appearing in the 2020
33Official Edition, is hereby amended by inserting after the first paragraph the following
34paragraph:
35 A carrier, as defined in section 1 of chapter 176O, shall be required to pay for health care
36services ordered by the treating health care provider if (1) the services are a covered benefit
37under the insured’s health benefit plan and (2) the services follow the carrier’s clinical review
38criteria; provided, however, a claim for treatment of medically necessary services may not be
39denied if the treating health care provider follows the carrier’s approved method for securing
40authorization for a covered service for the insured at the time the service was provided. A carrier
41shall have no more than twelve months after the original payment was received by the provider
42to recoup a full or partial payment for a claim for services rendered, or to adjust a subsequent
43payment to reflect a recoupment of a full or partial payment; provided, however, a carrier shall
44not recoup payments more than ninety days after the original payment was received by a
45provider for services provided to an insured that the carrier deems ineligible for coverage
46because the insured was retroactively terminated or retroactively disenrolled for services;
47provided further, that the provider can document that it received verification of an insured’s
48eligibility status using the carrier's approved method for verifying eligibility at the time service
49was provided. Claims may also not be recouped for utilization review purposes if the services
50were already deemed medically necessary or the manner in which the services were accessed or
51provided were previously approved by the carrier or its contractor. A carrier that seeks to make
52an adjustment pursuant to this section shall provide the health care provider with written notice
53that explains in detail the reasons for the recoupment, identifies each previously paid claim for
54which a recoupment is sought and provides the health care provider with thirty days to challenge 4 of 6
55the request for recoupment. Such written notice shall be made to the health provider not less than
56thirty days prior to the seeking of a recoupment or the making of an adjustment.
57 SECTION 4. Section 47SS of chapter 175 of the General Laws, as inserted by chapter
58177 of the acts of 2022, is hereby amended by striking out subsection (b) and inserting in place
59thereof the following subsection:-
60 (b) A policy, contract, agreement, plan or certificate of insurance issued, delivered or
61renewed within or without the commonwealth, which is considered creditable coverage under
62section 1 of chapter 111M, shall provide coverage for medically necessary mental health services
63within an inpatient psychiatric facility, a community health center, a community mental health
64center, a community behavioral health center, an outpatient substance use disorder provider, a
65hospital outpatient department, a community based acute treatment program or an intensive
66community based acute treatment program and shall not require a preauthorization before the
67administration of such treatment; provided, however, that the facility shall notify the carrier of
68the admission and the initial treatment plan within three business days of admission; provided
69further, that notification shall be limited to patient’s name, facility name, time of admission,
70diagnosis and initial treatment plan; and, provided further, that services administered prior to
71notification must be covered. Medical necessity shall be determined by the treating clinician in
72consultation with the patient and noted in the patient’s medical record.
73 SECTION 5. Section 8SS of chapter 176A of the General Laws, as inserted by chapter
74177 of the acts of 2022, is hereby amended by striking out subsection (b) and inserting in place
75thereof the following subsection:- 5 of 6
76 (b) A contract between a subscriber and the corporation under an individual or group
77hospital service plan that is delivered, issued or renewed within the commonwealth shall provide
78coverage for medically necessary mental health services within an inpatient psychiatric facility, a
79community health center, a community mental health center, an outpatient substance use disorder
80provider, a hospital outpatient department, a community based acute treatment program or an
81intensive community based acute treatment program and shall not require a preauthorization
82before the administration of any such treatment; provided, however, that the facility shall notify
83the carrier of the admission and the initial treatment plan within three business days of
84admission; provided further, that notification shall be limited to patient’s name, facility name,
85time of admission, diagnosis and initial treatment plan; and, provided further, that services
86administered prior to notification must be covered. Medical necessity shall be determined by the
87treating clinician in consultation with the patient and noted in the patient’s medical record.
88 SECTION 6. Section 4SS of chapter 176B of the General Laws, as inserted by chapter
89177 of the acts of 2022, is hereby amended by striking out subsection (b) and inserting in place
90thereof the following subsection:-
91 (b) A subscription certificate under an individual or group medical service agreement
92delivered, issued or renewed within the commonwealth shall provide coverage for medically
93necessary mental health services within an inpatient psychiatric facility, a community health
94center, a community mental health center, an outpatient substance use disorder provider, a
95hospital outpatient department, a community based acute treatment program or an intensive
96community based acute treatment program and shall not require a preauthorization before
97obtaining treatment; provided, however, that the facility shall notify the carrier of the admission
98and the initial treatment plan within three business days of admission; provided further, that 6 of 6
99notification shall be limited to patient’s name, facility name, time of admission, diagnosis and
100initial treatment plan; and, provided further, that services administered prior to notification must
101be covered. Medical necessity shall be determined by the treating clinician in consultation with
102the patient and noted in the patient’s medical record.
103 SECTION 7. Section 4KK of chapter 176G of said General Laws, as inserted by chapter
104177 of the acts of 2022, is hereby amended by striking out subsection (b) and inserting in place
105thereof the following subsection:-
106 (b) An individual or group health maintenance contract that is issued or renewed within
107or without the commonwealth shall provide coverage for medically necessary mental health
108services within an inpatient psychiatric facility, a community health center, a community mental
109health center, an outpatient substance use disorder provider, a hospital outpatient department, a
110community based acute treatment program, or an intensive community based acute treatment
111program and shall not require a preauthorization before obtaining treatment; provided, however,
112that the facility shall notify the carrier of the admission and the initial treatment plan within three
113business days of admission; provided further, that notification shall be limited to patient’s name,
114facility name, time of admission, diagnosis and initial treatment plan; and, provided further, that
115services administered prior to notification must be covered. Medical necessity shall be
116determined by the treating clinician in consultation with the patient and noted in the patient’s
117medical record.