Massachusetts 2025-2026 Regular Session

Massachusetts House Bill H1151 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. 866 FILED ON: 1/13/2025
3	3	HOUSE . . . . . . . . . . . . . . . No. 1151
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 Worcester1/13/2025James C. Arena-DeRosa8th Middlesex2/12/2025Michael D. BradySecond Plymouth and Norfolk2/27/2025David F. DeCoste5th Plymouth1/22/2025James B. EldridgeMiddlesex and Worcester1/27/2025Rodney M. Elliott16th Middlesex1/31/2025Paul K. Frost7th Worcester2/3/2025Sean Garballey23rd Middlesex2/4/2025Colleen M. Garry36th Middlesex1/25/2025Carmine Lawrence Gentile13th Middlesex1/21/2025Natalie M. Higgins4th Worcester1/24/2025Vanna Howard17th Middlesex2/14/2025Steven S. Howitt4th Bristol2/10/2025Hannah Kane11th Worcester1/16/2025Sally P. Kerans13th Essex2/4/2025David Paul Linsky5th Middlesex1/22/2025Joseph D. McKenna18th Worcester1/31/2025Paul McMurtry11th Norfolk2/18/2025 2 of 2
16	16	Jacob R. OliveiraHampden, Hampshire and Worcester2/7/2025Steven Owens29th Middlesex1/30/2025Steven Ultrino33rd Middlesex3/5/2025Marcus S. Vaughn9th Norfolk1/31/2025David T. Vieira3rd Barnstable2/5/2025Susannah M. Whipps2nd Franklin1/31/2025 1 of 19
17	17	HOUSE DOCKET, NO. 866 FILED ON: 1/13/2025
18	18	HOUSE . . . . . . . . . . . . . . . No. 1151
19	19	By Representative Ferguson of Holden, a petition (accompanied by bill, House, No. 1151) 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-Fourth General Court
25	25	(2025-2026)
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 19
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 19
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 19
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. A health benefit plan may not deny benefits for the coverage
89	89	60required based solely on the fact that the treatment or services are provided at a facility other
90	90	61than a hospital. Any limitations shall be separately stated by the commission. The benefits in this
91	91	62section shall not be subject to any greater deductible, coinsurance, copayments, or out-of-pocket
92	92	63limits than any other benefit provided by the commission.
93	93	64 (c) The commissioner of insurance shall require a health benefit plan issuer to provide
94	94	65adequate training to personnel responsible for preauthorization of coverage or utilization review
95	95	66for services under this section, in consultation with the Brain Injury Association of
96	96	67Massachusetts.
97	97	68 (d) Individual practitioners and treatment facilities shall be qualified to provide acute care
98	98	69and post-acute care rehabilitation services through possession of the appropriate licenses,
99	99	70accreditation, training and experience deemed customary and routine in the trade practice,
100	100	71including programs, regulated by the Executive Office of Health and Human Services, which
101	101	72provide services for people with brain injury and accredited programs by the Commission on
102	102	73Rehabilitation Facilities (CARF) Medical Rehabilitation with a Brain Injury Specialty Program. 5 of 19
103	103	74 SECTION 2. Chapter 175 of the General Laws, as appearing in the 2020 Official Edition,
104	104	75is hereby amended by inserting after section 47QQ, the following section:-
105	105	76 Section 47RR. (a) For purposes of this section, the following terms shall have the
106	106	77following meanings:-
107	107	78 “Acquired brain injury (ABI)” is any injury to the brain which occurs after birth and can
108	108	79be caused by infectious diseases, metabolic disorders, endocrine disorders or diminished oxygen,
109	109	80brain tumors, toxins, disease that affects the blood supply to the brain, stroke or a traumatic brain
110	110	81injury.
111	111	82 “Cognitive communication therapy” treats problems with communication which have an
112	112	83underlying cause in a cognitive deficit rather than a primary language or speech deficit.
113	113	84 “Cognitive rehabilitation therapy (CRT)” is a process of relearning cognitive skills
114	114	85essential for daily living through the coordinated specialized, integrated therapeutic treatments
115	115	86which are provided in dynamic settings designed for efficient and effective re-learning following
116	116	87damage to brain cells or brain chemistry due to brain injury.
117	117	88 “Community reintegration services” provide incremental guided real-world therapeutic
118	118	89training to develop skills essential for an individual to participate in life: to re-enter employment;
119	119	90to go to school and engage in other productive activity; to safely live independently; and to
120	120	91participate in their community while avoiding re-hospitalization and long-term support needs.
121	121	92 “Functional rehabilitation therapy and remediation” is a structured approach to
122	122	93rehabilitation for brain disorders which emphasizes learning by doing, and focuses relearning a
123	123	94specific task in a prescribed format, with maximum opportunity for repeated correct practice. 6 of 19
124	124	95Compensatory strategies are developed for those skills which are persistently impaired and
125	125	96individuals are trained on daily implementation. To ensure acquisition and use, focus is set on re-
126	126	97learning those skills essential for safe daily living in the environment in which they will be used:
127	127	98home and community settings.
128	128	99 “Medical necessity” or “medically necessary,” health care services that are consistent
129	129	100with generally accepted principles of professional medical practice.
130	130	101 “Neurobehavioral therapy” is a set of medical and therapeutic assessment and treatments
131	131	102focused on behavioral impairments associated with brain disease or injury and the amelioration
132	132	103of these impairments through the development of pro-social behavior.
133	133	104 “Neurocognitive therapy” is treatment of disorders in which the primary clinical deficit is
134	134	105in cognitive function which has not been present since birth and is a decline from a previously
135	135	106attained level of function.
136	136	107 “Neurofeedback therapy” is a direct training of brain function to enhance self-regulatory
137	137	108capacity or an individual’s ability to exert control over behavior, thoughts and feelings. It is a
138	138	109form of biofeedback whereby a patient can learn to control brain activity that is measured and
139	139	110recorded by an electroencephalogram.
140	140	111 “Neuropsychological testing” is a set of medical and therapeutic assessment and
141	141	112treatments focused on amelioration of cognitive, emotional, psychosocial and behavioral deficits
142	142	113caused by brain injury. 7 of 19
143	143	114 “Psychophysiological testing and treatment” is a set of medical and therapeutic
144	144	115assessment and treatments focused on psychophysiological disorders or physical disorders with
145	145	116psychological overlay.
146	146	117 “Post-acute residential treatment” includes integrated medical and therapeutic services,
147	147	118treatment, education, and skills training within a 24/7 real-world environment of care - a home
148	148	119and community setting. Maximum opportunity for correct practice of skill in the context of use
149	149	120develops new neural pathways which ensure ongoing skill use and avoidance of re-
150	150	121hospitalization and long-term care.
151	151	122 (b) The following shall provide coverage for medically necessary treatment related to or
152	152	123as a result of an acquired brain injury: (ii)any policy of accident and sickness insurance, as
153	153	124described in section 108, which provides hospital expense and surgical expense insurance and
154	154	125which is delivered, issued or subsequently renewed by agreement between the insurer and
155	155	126policyholder in the commonwealth; (ii) any blanket or general policy of insurance described in
156	156	127subdivision (A), (C) or (D) of section 110 which provides hospital expense and surgical expense
157	157	128insurance and which is delivered, issued or subsequently renewed by agreement between the
158	158	129insurer and the policyholder in or outside of the commonwealth; or (iii) any employees’ health
159	159	130and welfare fund which provides hospital expense and surgical expense benefits and which is
160	160	131delivered, issued or renewed to any person or group of persons in the commonwealth. Medically
161	161	132necessary treatment shall include, but is not limited to, cognitive rehabilitation therapy; cognitive
162	162	133communication therapy; neurocognitive therapy and rehabilitation; neurobehavioral,
163	163	134neurophysiological, neuropsychological and psychophysiological testing and treatment;
164	164	135neurofeedback therapy; functional rehabilitation therapy and remediation; community
165	165	136reintegration services; post-acute residential treatment services; inpatient services; outpatient and 8 of 19
166	166	137day treatment services; home and community based treatment. The benefits in this section shall
167	167	138not include any lifetime limitation or unreasonable annual limitation of the number of days or
168	168	139sessions of treatment services. A health benefit plan may not deny benefits for the coverage
169	169	140required based solely on the fact that the treatment or services are provided at a facility other
170	170	141than a hospital. Any limitations shall be separately stated by the insurer. The benefits in this
171	171	142section shall not be subject to any greater deductible, coinsurance, copayments, or out-of-pocket
172	172	143limits than any other benefit provided by the insurer.
173	173	144 (c) The commissioner of insurance shall require a health benefit plan issuer to provide
174	174	145adequate training to personnel responsible for preauthorization of coverage or utilization review
175	175	146for services under this section, in consultation with the Brain Injury Association of
176	176	147Massachusetts.
177	177	148 (d) Individual practitioners and treatment facilities shall be qualified to provide acute care
178	178	149and post-acute care rehabilitation services through possession of the appropriate licenses,
179	179	150accreditation, training and experience deemed customary and routine in the trade practice,
180	180	151including programs, regulated by the Executive Office of Health and Human Services, which
181	181	152provide services for people with brain injury and accredited programs by the Commission on
182	182	153Rehabilitation Facilities (CARF) Medical Rehabilitation with a Brain Injury Specialty Program.
183	183	154 SECTION 3. Chapter 176A of the General Law, as appearing in the 2020 Official
184	184	155Edition, is hereby amended by inserting after section 8QQ the following section:-
185	185	156 Section 8RR. (a) For purposes of this section, the following terms shall have the
186	186	157following meanings:- 9 of 19
187	187	158 “Acquired brain injury (ABI)” is any injury to the brain which occurs after birth and can
188	188	159be caused by infectious diseases, metabolic disorders, endocrine disorders or diminished oxygen,
189	189	160brain tumors, toxins, disease that affects the blood supply to the brain, stroke or a traumatic brain
190	190	161injury.
191	191	162 “Cognitive communication therapy” treats problems with communication which have an
192	192	163underlying cause in a cognitive deficit rather than a primary language or speech deficit.
193	193	164 “Cognitive rehabilitation therapy (CRT)” is a process of re-learning cognitive skills
194	194	165essential for daily living through the coordinated specialized, integrated therapeutic treatments
195	195	166which are provided in dynamic settings designed for efficient and effective re-learning following
196	196	167damage to brain cells or brain chemistry due to brain injury.
197	197	168 “Community reintegration services” provide incremental guided real-world therapeutic
198	198	169training to develop skills essential for an individual to participate in life: to re-enter employment;
199	199	170to go to school and engage in other productive activity; to safely live independently; and to
200	200	171participate in their community while avoiding re-hospitalization and long-term support needs.
201	201	172 “Functional rehabilitation therapy and remediation” is a structured approach to
202	202	173rehabilitation for brain disorders which emphasizes learning by doing, and focuses re-learning a
203	203	174specific task in a prescribed format with maximum opportunity for repeated correct practice.
204	204	175Compensatory strategies are developed for those skills which are persistently impaired and
205	205	176individuals are trained on daily implementation. To ensure acquisition and use, focus is set on re-
206	206	177learning those skills essential for safe daily living in the environment in which they will be used:
207	207	178home and community settings. 10 of 19
208	208	179 “Medical necessity” or “medically necessary,” health care services that are consistent
209	209	180with generally accepted principles of professional medical practice.
210	210	181 “Neurobehavioral therapy” is a set of medical and therapeutic assessment and treatments
211	211	182focused on behavioral impairments associated with brain disease or injury and the amelioration
212	212	183of these impairments through the development of pro-social behavior.
213	213	184 “Neurocognitive therapy” is treatment of disorders in which the primary clinical deficit is
214	214	185in cognitive function which has not been present since birth and is a decline from a previously
215	215	186attained level of function.
216	216	187 “Neurofeedback therapy” is a direct training of brain function to enhance self-regulatory
217	217	188capacity or an individual’s ability to exert control over behavior, thoughts and feelings. It is a
218	218	189form of biofeedback whereby a patient can learn to control brain activity that is measured and
219	219	190recorded by an electroencephalogram.
220	220	191 “Neuropsychological testing” is a set of medical and therapeutic assessment and
221	221	192treatments focused on amelioration of cognitive, emotional, psychosocial and behavioral deficits
222	222	193caused by brain injury.
223	223	194 “Psychophysiological testing and treatment” is a set of medical and therapeutic
224	224	195assessment and treatments focused on psychophysiological disorders or physical disorders with
225	225	196psychological overlay.
226	226	197 “Post-acute residential treatment” includes integrated medical and therapeutic services,
227	227	198treatment, education, and skills training within a 24/7 real-world environment of care- a home
228	228	199and community setting. Maximum opportunity for correct practice of skill in the context of use 11 of 19
229	229	200develops new neural pathways which ensure ongoing skill use and avoidance of re-
230	230	201hospitalization and long-term care.
231	231	202 (b) Any contract between a subscriber and the corporation under an individual or group
232	232	203hospital service plan which is delivered, issued or renewed within the commonwealth shall
233	233	204provide coverage for medically necessary treatment related to or as a result of an acquired brain
234	234	205injury. Medically necessary treatment shall include, but is not limited to, cognitive rehabilitation
235	235	206therapy; cognitive communication therapy; neurocognitive therapy and rehabilitation;
236	236	207neurobehavioral, neurophysiological, neuropsychological and psychophysiological testing and
237	237	208treatment; neurofeedback therapy; functional rehabilitation therapy and remediation; community
238	238	209reintegration services; post-acute residential treatment services; inpatient services; outpatient and
239	239	210day treatment services; home and community based treatment. The benefits in this section shall
240	240	211not include any lifetime limitation or unreasonable annual limitation of the number of days or
241	241	212sessions of treatment services. A health benefit plan may not deny benefits for the coverage
242	242	213required based solely on the fact that the treatment or services are provided at a facility other
243	243	214than a hospital. Any limitations shall be separately stated by the insurer. The benefits in this
244	244	215section shall not be subject to any greater deductible, coinsurance, copayments, or out-of-pocket
245	245	216limits than any other benefit provided by the insurer.
246	246	217 (c) The commissioner of insurance shall require a health benefit plan issuer to provide
247	247	218adequate training to personnel responsible for preauthorization of coverage or utilization review
248	248	219for services under this section, in consultation with the Brain Injury Association of
249	249	220Massachusetts. 12 of 19
250	250	221 (d) Individual practitioners and treatment facilities shall be qualified to provide acute care
251	251	222and post-acute care rehabilitation services through possession of the appropriate licenses,
252	252	223accreditation, training and experience deemed customary and routine in the trade practice,
253	253	224including programs, regulated by the Executive Office of Health and Human Services, which
254	254	225provide services for people with brain injury and accredited programs by the Commission on
255	255	226Rehabilitation Facilities (CARF) Medical Rehabilitation with a Brain Injury Specialty Program.
256	256	227 SECTION 4. Chapter 176B of the General Laws, as appearing in the 2020 Official
257	257	228Edition, is hereby amended by inserting after section 4QQ the following section:-
258	258	229 Section 4RR. (a) For purposes of this section, the following terms shall have the
259	259	230following meanings:-
260	260	231 “Acquired brain injury (ABI)” is any injury to the brain which occurs after birth and can
261	261	232be caused by infectious diseases, metabolic disorders, endocrine disorders or diminished oxygen,
262	262	233brain tumors, toxins, disease that affects the blood supply to the brain, stroke or a traumatic brain
263	263	234injury.
264	264	235 “Cognitive communication therapy” treats problems with communication which have an
265	265	236underlying cause in a cognitive deficit rather than a primary language or speech deficit.
266	266	237 “Cognitive rehabilitation therapy (CRT)” is a process of relearning cognitive skills
267	267	238essential for daily living through the coordinated specialized, integrated therapeutic treatments
268	268	239which are provided in dynamic settings designed for efficient and effective re-learning following
269	269	240damage to brain cells or brain chemistry due to brain injury. 13 of 19
270	270	241 “Community reintegration services” provide incremental guided real-world therapeutic
271	271	242training to develop skills essential for an individual to participate in life: to re-enter employment;
272	272	243to go to school and engage in other productive activity; to safely live independently; and to
273	273	244participate in their community while avoiding re-hospitalization and long-term support needs.
274	274	245 “Functional rehabilitation therapy and remediation” is a structured approach to
275	275	246rehabilitation for brain disorders which emphasizes learning by doing, and focuses re-learning a
276	276	247specific task in a prescribed format, with maximum opportunity for repeated correct practice.
277	277	248Compensatory strategies are developed for those skills which are persistently impaired and
278	278	249individuals are trained on daily implementation. To ensure acquisition and use, focus is set on re-
279	279	250learning those skills essential for safe on daily living in the environment in which they will be
280	280	251used: home and community settings.
281	281	252 “Medical necessity” or “medically necessary,” health care services that are consistent
282	282	253with generally accepted principles of professional medical practice.
283	283	254 “Neurobehavioral therapy” is a set of medical and therapeutic assessment and treatments
284	284	255focused on behavioral impairments associated with brain disease or injury and the amelioration
285	285	256of these impairments through the development of pro-social behavior.
286	286	257 “Neurocognitive therapy” is treatment of disorders in which the primary clinical deficit is
287	287	258in cognitive function which has not been present since birth and is a decline from a previously
288	288	259attained level of function.
289	289	260 “Neurofeedback therapy” is a direct training of brain function to enhance self-regulatory
290	290	261capacity or an individual’s ability to exert control over behavior, thoughts and feelings. It is a 14 of 19
291	291	262form of biofeedback whereby a patient can learn to control brain activity that is measured and
292	292	263recorded by an electroencephalogram.
293	293	264 “Neuropsychological testing” is a set of medical and therapeutic assessment and
294	294	265treatments focused on amelioration of cognitive, emotional, psychosocial and behavioral deficits
295	295	266caused by brain injury;
296	296	267 “Psychophysiological testing and treatment” is a set of medical and therapeutic
297	297	268assessment and treatments focused on psychophysiological disorders or physical disorders with
298	298	269psychological overlay.
299	299	270 “Post-acute residential treatment” includes integrated medical and therapeutic services,
300	300	271treatment, education, and skills training within a 24/7 real-world environment of care, – a home
301	301	272and community setting. Maximum opportunity for correct practice of skill in the context of use
302	302	273develops new neural pathways which ensure ongoing skill use and avoidance of re-
303	303	274hospitalization and long-term care.
304	304	275 (b) Any subscription certificate under an individual or group medical service agreement
305	305	276delivered, issued or renewed within the commonwealth shall provide coverage for medically
306	306	277necessary treatment related to or as a result of an acquired brain injury. Medically necessary
307	307	278treatment shall include, but is not limited to, cognitive rehabilitation therapy; cognitive
308	308	279communication therapy; neurocognitive therapy and rehabilitation; neurobehavioral,
309	309	280neurophysiological, neuropsychological and psychophysiological testing and treatment;
310	310	281neurofeedback therapy; functional rehabilitation therapy and remediation; community
311	311	282reintegration services; post-acute residential treatment services; inpatient services; outpatient and
312	312	283day treatment services; home and community based treatment. The benefits in this section shall 15 of 19
313	313	284not include any lifetime limitation or unreasonable annual limitation of the number of days or
314	314	285sessions of treatment services. A health benefit plan may not deny benefits for the coverage
315	315	286required based solely on the fact that the treatment or services are provided at a facility other
316	316	287than a hospital. Any limitations shall be separately stated by the insurer. The benefits in this
317	317	288section shall not be subject to any greater deductible, coinsurance, copayments, or out-of-pocket
318	318	289limits than any other benefit provided by the insurer.
319	319	290 (c) The commissioner of insurance shall require a health benefit plan issuer to provide
320	320	291adequate training to personnel responsible for preauthorization of coverage or utilization review
321	321	292for services under this section, in consultation with the Brain Injury Association of
322	322	293Massachusetts.
323	323	294 (d) Individual practitioners and treatment facilities shall be qualified to provide acute care
324	324	295and post-acute care rehabilitation services through possession of the appropriate licenses,
325	325	296accreditation, training and experience deemed customary and routine in the trade practice,
326	326	297including programs, regulated by the Executive Office of Health and Human Services, which
327	327	298provide services for people with brain injury and accredited programs by the Commission on
328	328	299Rehabilitation Facilities (CARF) Medical Rehabilitation with a Brain Injury Specialty Program.
329	329	300 SECTION 5. Chapter 176G of the General Laws, as appearing in the 2020 Official
330	330	301Edition, is hereby amended by inserting after section 4GG the following section:-
331	331	302 Section 4II. (a) For purposes of this section, the following terms shall have the following
332	332	303meanings:-
333	333	304 “Acquired brain injury (ABI)” is any injury to the brain which occurs after birth and can
334	334	305be caused by infectious diseases, metabolic disorders, endocrine disorders or diminished oxygen, 16 of 19
335	335	306brain tumors, toxins, disease that affects the blood supply to the brain, stroke or a traumatic brain
336	336	307injury.
337	337	308 “Cognitive communication therapy” treats problems with communication which have an
338	338	309underlying cause in a cognitive deficit rather than a primary language or speech deficit.
339	339	310 “Cognitive rehabilitation therapy (CRT)” is a process of relearning cognitive skills
340	340	311essential for daily living through the coordinated specialized, integrated therapeutic treatments
341	341	312which are provided in dynamic settings designed for efficient and effective re-learning following
342	342	313damage to brain cells or brain chemistry due to brain injury.
343	343	314 “Community reintegration services” provide incremental guided real-world therapeutic
344	344	315training to develop skills essential for an individual to participate in life: to re-enter employment;
345	345	316to go to school or engage in other productive activity; to safely live independently; and to
346	346	317participate in their community while avoiding re-hospitalization and long-term support needs.
347	347	318 “Functional rehabilitation therapy and remediation” is a structured approach to
348	348	319rehabilitation for brain disorders which emphasizes learning by doing, and focuses re-learning a
349	349	320specific task in a prescribed format, with maximum opportunity for repeated correct practice.
350	350	321Compensatory strategies are developed for those skills which are persistently impaired and
351	351	322individuals are trained on daily implementation. To ensure acquisition and use, focus is set on re-
352	352	323learning those skills essential for safe daily living in the environment in which they will be used:
353	353	324home and community settings.
354	354	325 “Medical necessity” or “medically necessary,” health care services that are consistent
355	355	326with generally accepted principles of professional medical practice. 17 of 19
356	356	327 “Neurobehavioral therapy” is a set of medical and therapeutic assessment and treatments
357	357	328focused on behavioral impairments associated with brain disease or injury and the amelioration
358	358	329of these impairments through the development of pro-social behavior.
359	359	330 “Neurocognitive therapy” is treatment of disorders in which the primary clinical deficit is
360	360	331in cognitive function which has not been present since birth and is a decline from a previously
361	361	332attained level of function.
362	362	333 “Neurofeedback therapy” is a direct training of brain function to enhance self-regulatory
363	363	334capacity or an individual’s ability to exert control over behavior, thoughts and feelings. It is a
364	364	335form of biofeedback whereby a patient can learn to control brain activity that is measured and
365	365	336recorded by an electroencephalogram.
366	366	337 “Neuropsychological testing” is a set of medical and therapeutic assessment and
367	367	338treatments focused on amelioration of cognitive, emotional, psychosocial and behavioral deficits
368	368	339caused by brain injury.
369	369	340 “Psychophysiological testing and treatment” is a set of medical and therapeutic
370	370	341assessment and treatments focused on psychophysiological disorders or physical disorders with
371	371	342psychological overlay.
372	372	343 “Post-acute residential treatment” includes integrated medical and therapeutic services,
373	373	344treatment, education, and skills training within a 24/7 real-world environment of care – a home
374	374	345and community setting. Maximum opportunity for correct practice of skill in the context of use
375	375	346develops new neural pathways which ensure ongoing skill use and avoidance of re-
376	376	347hospitalization and long-term care. 18 of 19
377	377	348 (b) Any individual or group health maintenance contract shall provide coverage for
378	378	349medically necessary treatment related to or as a result of an acquired brain injury. Medically
379	379	350necessary treatment shall include, but is not limited to, cognitive rehabilitation therapy; cognitive
380	380	351communication therapy; neurocognitive therapy and rehabilitation; neurobehavioral,
381	381	352neurophysiological, neuropsychological and psychophysiological testing and treatment;
382	382	353neurofeedback therapy; functional rehabilitation therapy and remediation; community
383	383	354reintegration services; post-acute residential treatment services; inpatient services; outpatient and
384	384	355day treatment services; home and community based treatment. The benefits in this section shall
385	385	356not include any lifetime limitation or unreasonable annual limitation of the number of days or
386	386	357sessions of treatment services. A health benefit plan may not deny benefits for the coverage
387	387	358required based solely on the fact that the treatment or services are provided at a facility other
388	388	359than a hospital. Any limitations shall be separately stated by the insurer. The benefits in this
389	389	360section shall not be subject to any greater deductible, coinsurance, copayments, or out-of-pocket
390	390	361limits than any other benefit provided by the insurer.
391	391	362 (c) The commissioner of insurance shall require a health benefit plan issuer to provide
392	392	363adequate training to personnel responsible for preauthorization of coverage or utilization review
393	393	364for services under this section, in consultation with the Brain Injury Association of
394	394	365Massachusetts.
395	395	366 (d) Individual practitioners and treatment facilities shall be qualified to provide acute care
396	396	367and post-acute care rehabilitation services through possession of the appropriate licenses,
397	397	368accreditation, training and experience deemed customary and routine in the trade practice,
398	398	369including programs, regulated by the Executive Office of Health and Human Services, which 19 of 19
399	399	370provide services for people with brain injury and accredited programs by the Commission on
400	400	371Rehabilitation Facilities (CARF) Medical Rehabilitation with a Brain Injury Specialty Program.