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HOUSE DOCKET, NO. 866 FILED ON: 1/13/2025
HOUSE . . . . . . . . . . . . . . . No. 1151
The Commonwealth of Massachusetts
_________________
PRESENTED BY:
Kimberly N. Ferguson
_________________
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 relative to cognitive rehabilitation for individuals with an acquired brain injury.
_______________
PETITION OF:
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
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
HOUSE DOCKET, NO. 866 FILED ON: 1/13/2025
HOUSE . . . . . . . . . . . . . . . No. 1151
By Representative Ferguson of Holden, a petition (accompanied by bill, House, No. 1151) of
Kimberly N. Ferguson and others relative to healthcare insurance coverage for cognitive
rehabilitation for individuals with an acquired brain injury. Financial Services.
The Commonwealth of Massachusetts
_______________
In the One Hundred and Ninety-Fourth General Court
(2025-2026)
_______________
An Act relative to cognitive rehabilitation for individuals with an acquired brain injury.
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. Chapter 32A of the General Laws, as appearing in the 2020 Official
2Edition, is hereby amended by inserting after section 17R the following section:-
3 Section 17S. (a) For purposes of this section, the following terms shall have the following
4meanings:-
5 “Acquired brain injury (ABI)” is any injury to the brain which occurs after birth and can
6be caused by infectious diseases, metabolic disorders, endocrine disorders or diminished oxygen,
7brain tumors, toxins, disease that affects the blood supply to the brain, stroke or a traumatic brain
8injury.
9 “Cognitive communication therapy” treats problems with communication which have an
10underlying cause in a cognitive deficit rather than a primary language or speech deficit. 2 of 19
11 “Cognitive rehabilitation therapy (CRT)” is a process of re-learning cognitive skills
12essential for daily living through the coordinated specialized, integrated therapeutic treatments
13which are provided in dynamic settings designed for efficient and effective re-learning following
14damage to brain cells or brain chemistry due to brain injury.
15 “Community reintegration services” provide incremental guided real-world therapeutic
16training to develop skills essential for an individual to participate in life: to re-enter employment;
17to go to school and engage in other productive activity; to safely live independently; and to
18participate in their community while avoiding re-hospitalization and long-term support needs.
19 “Functional rehabilitation therapy and remediation” is a structured approach to
20rehabilitation for brain disorders which emphasizes learning by doing, and focuses re-learning a
21specific task in a prescribed format, with maximum opportunity for repeated correct practice.
22Compensatory strategies are developed for those skills which are persistently impaired and
23individuals are trained on daily implementation. To ensure acquisition and use, focus is set on re-
24learning those skills essential for safe daily living in the environment in which they will be used:
25home and community settings.
26 “Medical necessity” or “medically necessary,” health care services that are consistent
27with generally accepted principles of professional medical practice.
28 “Neurobehavioral therapy” is a set of medical and therapeutic assessment and treatments
29focused on behavioral impairments associated with brain disease or injury and the amelioration
30of these impairments through the development of pro-social behavior. 3 of 19
31 “Neurocognitive therapy” is treatment of disorders in which the primary clinical deficit is
32in cognitive function which has not been present since birth and is a decline from a previously
33attained level of function.
34 “Neurofeedback therapy” is a direct training of brain function to enhance self-regulatory
35capacity or an individual’s ability to exert control over behavior, thoughts and feelings. It is a
36form of biofeedback whereby a patient can learn to control brain activity that is measured and
37recorded by an electroencephalogram.
38 “Neuropsychological testing” is a set of medical and therapeutic assessment and
39treatments focused on amelioration of cognitive, emotional, psychosocial and behavioral deficits
40caused by brain injury.
41 “Psychophysiological testing and treatment” is a set of medical and therapeutic
42assessment and treatments focused on psychophysiological disorders or physical disorders with
43psychological overlay.
44 “Post-acute residential treatment” includes integrated medical and therapeutic services,
45treatment, education, and skills training within a 24/7 real-world environment of care- a home
46and community setting. Maximum opportunity to for correct practice of skill in the context of
47use develops new neural pathways which ensure ongoing skill use and avoidance of re-
48hospitalization and long-term care.
49 (b) Any coverage offered by the commission to an active or retired employee of the
50commonwealth insured under the group insurance commission shall provide coverage for
51medically necessary treatment related to or as a result of an acquired brain injury. Medically
52necessary treatment shall include, but is not limited to, cognitive rehabilitation therapy; cognitive 4 of 19
53communication therapy; neurocognitive therapy and rehabilitation; neurobehavioral,
54neurophysiological, neuropsychological and psychophysiological testing and treatment;
55neurofeedback therapy; functional rehabilitation therapy and remediation; community
56reintegration services; post-acute residential treatment services; inpatient services; outpatient and
57day treatment services; home and community based treatment. The benefits in this section shall
58not include any lifetime limitation or unreasonable annual limitation of the number of days or
59sessions of treatment services. A health benefit plan may not deny benefits for the coverage
60required based solely on the fact that the treatment or services are provided at a facility other
61than a hospital. Any limitations shall be separately stated by the commission. The benefits in this
62section shall not be subject to any greater deductible, coinsurance, copayments, or out-of-pocket
63limits than any other benefit provided by the commission.
64 (c) The commissioner of insurance shall require a health benefit plan issuer to provide
65adequate training to personnel responsible for preauthorization of coverage or utilization review
66for services under this section, in consultation with the Brain Injury Association of
67Massachusetts.
68 (d) Individual practitioners and treatment facilities shall be qualified to provide acute care
69and post-acute care rehabilitation services through possession of the appropriate licenses,
70accreditation, training and experience deemed customary and routine in the trade practice,
71including programs, regulated by the Executive Office of Health and Human Services, which
72provide services for people with brain injury and accredited programs by the Commission on
73Rehabilitation Facilities (CARF) Medical Rehabilitation with a Brain Injury Specialty Program. 5 of 19
74 SECTION 2. Chapter 175 of the General Laws, as appearing in the 2020 Official Edition,
75is hereby amended by inserting after section 47QQ, the following section:-
76 Section 47RR. (a) For purposes of this section, the following terms shall have the
77following meanings:-
78 “Acquired brain injury (ABI)” is any injury to the brain which occurs after birth and can
79be caused by infectious diseases, metabolic disorders, endocrine disorders or diminished oxygen,
80brain tumors, toxins, disease that affects the blood supply to the brain, stroke or a traumatic brain
81injury.
82 “Cognitive communication therapy” treats problems with communication which have an
83underlying cause in a cognitive deficit rather than a primary language or speech deficit.
84 “Cognitive rehabilitation therapy (CRT)” is a process of relearning cognitive skills
85essential for daily living through the coordinated specialized, integrated therapeutic treatments
86which are provided in dynamic settings designed for efficient and effective re-learning following
87damage to brain cells or brain chemistry due to brain injury.
88 “Community reintegration services” provide incremental guided real-world therapeutic
89training to develop skills essential for an individual to participate in life: to re-enter employment;
90to go to school and engage in other productive activity; to safely live independently; and to
91participate in their community while avoiding re-hospitalization and long-term support needs.
92 “Functional rehabilitation therapy and remediation” is a structured approach to
93rehabilitation for brain disorders which emphasizes learning by doing, and focuses relearning a
94specific task in a prescribed format, with maximum opportunity for repeated correct practice. 6 of 19
95Compensatory strategies are developed for those skills which are persistently impaired and
96individuals are trained on daily implementation. To ensure acquisition and use, focus is set on re-
97learning those skills essential for safe daily living in the environment in which they will be used:
98home and community settings.
99 “Medical necessity” or “medically necessary,” health care services that are consistent
100with generally accepted principles of professional medical practice.
101 “Neurobehavioral therapy” is a set of medical and therapeutic assessment and treatments
102focused on behavioral impairments associated with brain disease or injury and the amelioration
103of these impairments through the development of pro-social behavior.
104 “Neurocognitive therapy” is treatment of disorders in which the primary clinical deficit is
105in cognitive function which has not been present since birth and is a decline from a previously
106attained level of function.
107 “Neurofeedback therapy” is a direct training of brain function to enhance self-regulatory
108capacity or an individual’s ability to exert control over behavior, thoughts and feelings. It is a
109form of biofeedback whereby a patient can learn to control brain activity that is measured and
110recorded by an electroencephalogram.
111 “Neuropsychological testing” is a set of medical and therapeutic assessment and
112treatments focused on amelioration of cognitive, emotional, psychosocial and behavioral deficits
113caused by brain injury. 7 of 19
114 “Psychophysiological testing and treatment” is a set of medical and therapeutic
115assessment and treatments focused on psychophysiological disorders or physical disorders with
116psychological overlay.
117 “Post-acute residential treatment” includes integrated medical and therapeutic services,
118treatment, education, and skills training within a 24/7 real-world environment of care - a home
119and community setting. Maximum opportunity for correct practice of skill in the context of use
120develops new neural pathways which ensure ongoing skill use and avoidance of re-
121hospitalization and long-term care.
122 (b) The following shall provide coverage for medically necessary treatment related to or
123as a result of an acquired brain injury: (ii)any policy of accident and sickness insurance, as
124described in section 108, which provides hospital expense and surgical expense insurance and
125which is delivered, issued or subsequently renewed by agreement between the insurer and
126policyholder in the commonwealth; (ii) any blanket or general policy of insurance described in
127subdivision (A), (C) or (D) of section 110 which provides hospital expense and surgical expense
128insurance and which is delivered, issued or subsequently renewed by agreement between the
129insurer and the policyholder in or outside of the commonwealth; or (iii) any employees’ health
130and welfare fund which provides hospital expense and surgical expense benefits and which is
131delivered, issued or renewed to any person or group of persons in the commonwealth. Medically
132necessary treatment shall include, but is not limited to, cognitive rehabilitation therapy; cognitive
133communication therapy; neurocognitive therapy and rehabilitation; neurobehavioral,
134neurophysiological, neuropsychological and psychophysiological testing and treatment;
135neurofeedback therapy; functional rehabilitation therapy and remediation; community
136reintegration services; post-acute residential treatment services; inpatient services; outpatient and 8 of 19
137day treatment services; home and community based treatment. The benefits in this section shall
138not include any lifetime limitation or unreasonable annual limitation of the number of days or
139sessions of treatment services. A health benefit plan may not deny benefits for the coverage
140required based solely on the fact that the treatment or services are provided at a facility other
141than a hospital. Any limitations shall be separately stated by the insurer. The benefits in this
142section shall not be subject to any greater deductible, coinsurance, copayments, or out-of-pocket
143limits than any other benefit provided by the insurer.
144 (c) The commissioner of insurance shall require a health benefit plan issuer to provide
145adequate training to personnel responsible for preauthorization of coverage or utilization review
146for services under this section, in consultation with the Brain Injury Association of
147Massachusetts.
148 (d) Individual practitioners and treatment facilities shall be qualified to provide acute care
149and post-acute care rehabilitation services through possession of the appropriate licenses,
150accreditation, training and experience deemed customary and routine in the trade practice,
151including programs, regulated by the Executive Office of Health and Human Services, which
152provide services for people with brain injury and accredited programs by the Commission on
153Rehabilitation Facilities (CARF) Medical Rehabilitation with a Brain Injury Specialty Program.
154 SECTION 3. Chapter 176A of the General Law, as appearing in the 2020 Official
155Edition, is hereby amended by inserting after section 8QQ the following section:-
156 Section 8RR. (a) For purposes of this section, the following terms shall have the
157following meanings:- 9 of 19
158 “Acquired brain injury (ABI)” is any injury to the brain which occurs after birth and can
159be caused by infectious diseases, metabolic disorders, endocrine disorders or diminished oxygen,
160brain tumors, toxins, disease that affects the blood supply to the brain, stroke or a traumatic brain
161injury.
162 “Cognitive communication therapy” treats problems with communication which have an
163underlying cause in a cognitive deficit rather than a primary language or speech deficit.
164 “Cognitive rehabilitation therapy (CRT)” is a process of re-learning cognitive skills
165essential for daily living through the coordinated specialized, integrated therapeutic treatments
166which are provided in dynamic settings designed for efficient and effective re-learning following
167damage to brain cells or brain chemistry due to brain injury.
168 “Community reintegration services” provide incremental guided real-world therapeutic
169training to develop skills essential for an individual to participate in life: to re-enter employment;
170to go to school and engage in other productive activity; to safely live independently; and to
171participate in their community while avoiding re-hospitalization and long-term support needs.
172 “Functional rehabilitation therapy and remediation” is a structured approach to
173rehabilitation for brain disorders which emphasizes learning by doing, and focuses re-learning a
174specific task in a prescribed format with maximum opportunity for repeated correct practice.
175Compensatory strategies are developed for those skills which are persistently impaired and
176individuals are trained on daily implementation. To ensure acquisition and use, focus is set on re-
177learning those skills essential for safe daily living in the environment in which they will be used:
178home and community settings. 10 of 19
179 “Medical necessity” or “medically necessary,” health care services that are consistent
180with generally accepted principles of professional medical practice.
181 “Neurobehavioral therapy” is a set of medical and therapeutic assessment and treatments
182focused on behavioral impairments associated with brain disease or injury and the amelioration
183of these impairments through the development of pro-social behavior.
184 “Neurocognitive therapy” is treatment of disorders in which the primary clinical deficit is
185in cognitive function which has not been present since birth and is a decline from a previously
186attained level of function.
187 “Neurofeedback therapy” is a direct training of brain function to enhance self-regulatory
188capacity or an individual’s ability to exert control over behavior, thoughts and feelings. It is a
189form of biofeedback whereby a patient can learn to control brain activity that is measured and
190recorded by an electroencephalogram.
191 “Neuropsychological testing” is a set of medical and therapeutic assessment and
192treatments focused on amelioration of cognitive, emotional, psychosocial and behavioral deficits
193caused by brain injury.
194 “Psychophysiological testing and treatment” is a set of medical and therapeutic
195assessment and treatments focused on psychophysiological disorders or physical disorders with
196psychological overlay.
197 “Post-acute residential treatment” includes integrated medical and therapeutic services,
198treatment, education, and skills training within a 24/7 real-world environment of care- a home
199and community setting. Maximum opportunity for correct practice of skill in the context of use 11 of 19
200develops new neural pathways which ensure ongoing skill use and avoidance of re-
201hospitalization and long-term care.
202 (b) Any contract between a subscriber and the corporation under an individual or group
203hospital service plan which is delivered, issued or renewed within the commonwealth shall
204provide coverage for medically necessary treatment related to or as a result of an acquired brain
205injury. Medically necessary treatment shall include, but is not limited to, cognitive rehabilitation
206therapy; cognitive communication therapy; neurocognitive therapy and rehabilitation;
207neurobehavioral, neurophysiological, neuropsychological and psychophysiological testing and
208treatment; neurofeedback therapy; functional rehabilitation therapy and remediation; community
209reintegration services; post-acute residential treatment services; inpatient services; outpatient and
210day treatment services; home and community based treatment. The benefits in this section shall
211not include any lifetime limitation or unreasonable annual limitation of the number of days or
212sessions of treatment services. A health benefit plan may not deny benefits for the coverage
213required based solely on the fact that the treatment or services are provided at a facility other
214than a hospital. Any limitations shall be separately stated by the insurer. The benefits in this
215section shall not be subject to any greater deductible, coinsurance, copayments, or out-of-pocket
216limits than any other benefit provided by the insurer.
217 (c) The commissioner of insurance shall require a health benefit plan issuer to provide
218adequate training to personnel responsible for preauthorization of coverage or utilization review
219for services under this section, in consultation with the Brain Injury Association of
220Massachusetts. 12 of 19
221 (d) Individual practitioners and treatment facilities shall be qualified to provide acute care
222and post-acute care rehabilitation services through possession of the appropriate licenses,
223accreditation, training and experience deemed customary and routine in the trade practice,
224including programs, regulated by the Executive Office of Health and Human Services, which
225provide services for people with brain injury and accredited programs by the Commission on
226Rehabilitation Facilities (CARF) Medical Rehabilitation with a Brain Injury Specialty Program.
227 SECTION 4. Chapter 176B of the General Laws, as appearing in the 2020 Official
228Edition, is hereby amended by inserting after section 4QQ the following section:-
229 Section 4RR. (a) For purposes of this section, the following terms shall have the
230following meanings:-
231 “Acquired brain injury (ABI)” is any injury to the brain which occurs after birth and can
232be caused by infectious diseases, metabolic disorders, endocrine disorders or diminished oxygen,
233brain tumors, toxins, disease that affects the blood supply to the brain, stroke or a traumatic brain
234injury.
235 “Cognitive communication therapy” treats problems with communication which have an
236underlying cause in a cognitive deficit rather than a primary language or speech deficit.
237 “Cognitive rehabilitation therapy (CRT)” is a process of relearning cognitive skills
238essential for daily living through the coordinated specialized, integrated therapeutic treatments
239which are provided in dynamic settings designed for efficient and effective re-learning following
240damage to brain cells or brain chemistry due to brain injury. 13 of 19
241 “Community reintegration services” provide incremental guided real-world therapeutic
242training to develop skills essential for an individual to participate in life: to re-enter employment;
243to go to school and engage in other productive activity; to safely live independently; and to
244participate in their community while avoiding re-hospitalization and long-term support needs.
245 “Functional rehabilitation therapy and remediation” is a structured approach to
246rehabilitation for brain disorders which emphasizes learning by doing, and focuses re-learning a
247specific task in a prescribed format, with maximum opportunity for repeated correct practice.
248Compensatory strategies are developed for those skills which are persistently impaired and
249individuals are trained on daily implementation. To ensure acquisition and use, focus is set on re-
250learning those skills essential for safe on daily living in the environment in which they will be
251used: home and community settings.
252 “Medical necessity” or “medically necessary,” health care services that are consistent
253with generally accepted principles of professional medical practice.
254 “Neurobehavioral therapy” is a set of medical and therapeutic assessment and treatments
255focused on behavioral impairments associated with brain disease or injury and the amelioration
256of these impairments through the development of pro-social behavior.
257 “Neurocognitive therapy” is treatment of disorders in which the primary clinical deficit is
258in cognitive function which has not been present since birth and is a decline from a previously
259attained level of function.
260 “Neurofeedback therapy” is a direct training of brain function to enhance self-regulatory
261capacity or an individual’s ability to exert control over behavior, thoughts and feelings. It is a 14 of 19
262form of biofeedback whereby a patient can learn to control brain activity that is measured and
263recorded by an electroencephalogram.
264 “Neuropsychological testing” is a set of medical and therapeutic assessment and
265treatments focused on amelioration of cognitive, emotional, psychosocial and behavioral deficits
266caused by brain injury;
267 “Psychophysiological testing and treatment” is a set of medical and therapeutic
268assessment and treatments focused on psychophysiological disorders or physical disorders with
269psychological overlay.
270 “Post-acute residential treatment” includes integrated medical and therapeutic services,
271treatment, education, and skills training within a 24/7 real-world environment of care, – a home
272and community setting. Maximum opportunity for correct practice of skill in the context of use
273develops new neural pathways which ensure ongoing skill use and avoidance of re-
274hospitalization and long-term care.
275 (b) Any subscription certificate under an individual or group medical service agreement
276delivered, issued or renewed within the commonwealth shall provide coverage for medically
277necessary treatment related to or as a result of an acquired brain injury. Medically necessary
278treatment shall include, but is not limited to, cognitive rehabilitation therapy; cognitive
279communication therapy; neurocognitive therapy and rehabilitation; neurobehavioral,
280neurophysiological, neuropsychological and psychophysiological testing and treatment;
281neurofeedback therapy; functional rehabilitation therapy and remediation; community
282reintegration services; post-acute residential treatment services; inpatient services; outpatient and
283day treatment services; home and community based treatment. The benefits in this section shall 15 of 19
284not include any lifetime limitation or unreasonable annual limitation of the number of days or
285sessions of treatment services. A health benefit plan may not deny benefits for the coverage
286required based solely on the fact that the treatment or services are provided at a facility other
287than a hospital. Any limitations shall be separately stated by the insurer. The benefits in this
288section shall not be subject to any greater deductible, coinsurance, copayments, or out-of-pocket
289limits than any other benefit provided by the insurer.
290 (c) The commissioner of insurance shall require a health benefit plan issuer to provide
291adequate training to personnel responsible for preauthorization of coverage or utilization review
292for services under this section, in consultation with the Brain Injury Association of
293Massachusetts.
294 (d) Individual practitioners and treatment facilities shall be qualified to provide acute care
295and post-acute care rehabilitation services through possession of the appropriate licenses,
296accreditation, training and experience deemed customary and routine in the trade practice,
297including programs, regulated by the Executive Office of Health and Human Services, which
298provide services for people with brain injury and accredited programs by the Commission on
299Rehabilitation Facilities (CARF) Medical Rehabilitation with a Brain Injury Specialty Program.
300 SECTION 5. Chapter 176G of the General Laws, as appearing in the 2020 Official
301Edition, is hereby amended by inserting after section 4GG the following section:-
302 Section 4II. (a) For purposes of this section, the following terms shall have the following
303meanings:-
304 “Acquired brain injury (ABI)” is any injury to the brain which occurs after birth and can
305be caused by infectious diseases, metabolic disorders, endocrine disorders or diminished oxygen, 16 of 19
306brain tumors, toxins, disease that affects the blood supply to the brain, stroke or a traumatic brain
307injury.
308 “Cognitive communication therapy” treats problems with communication which have an
309underlying cause in a cognitive deficit rather than a primary language or speech deficit.
310 “Cognitive rehabilitation therapy (CRT)” is a process of relearning cognitive skills
311essential for daily living through the coordinated specialized, integrated therapeutic treatments
312which are provided in dynamic settings designed for efficient and effective re-learning following
313damage to brain cells or brain chemistry due to brain injury.
314 “Community reintegration services” provide incremental guided real-world therapeutic
315training to develop skills essential for an individual to participate in life: to re-enter employment;
316to go to school or engage in other productive activity; to safely live independently; and to
317participate in their community while avoiding re-hospitalization and long-term support needs.
318 “Functional rehabilitation therapy and remediation” is a structured approach to
319rehabilitation for brain disorders which emphasizes learning by doing, and focuses re-learning a
320specific task in a prescribed format, with maximum opportunity for repeated correct practice.
321Compensatory strategies are developed for those skills which are persistently impaired and
322individuals are trained on daily implementation. To ensure acquisition and use, focus is set on re-
323learning those skills essential for safe daily living in the environment in which they will be used:
324home and community settings.
325 “Medical necessity” or “medically necessary,” health care services that are consistent
326with generally accepted principles of professional medical practice. 17 of 19
327 “Neurobehavioral therapy” is a set of medical and therapeutic assessment and treatments
328focused on behavioral impairments associated with brain disease or injury and the amelioration
329of these impairments through the development of pro-social behavior.
330 “Neurocognitive therapy” is treatment of disorders in which the primary clinical deficit is
331in cognitive function which has not been present since birth and is a decline from a previously
332attained level of function.
333 “Neurofeedback therapy” is a direct training of brain function to enhance self-regulatory
334capacity or an individual’s ability to exert control over behavior, thoughts and feelings. It is a
335form of biofeedback whereby a patient can learn to control brain activity that is measured and
336recorded by an electroencephalogram.
337 “Neuropsychological testing” is a set of medical and therapeutic assessment and
338treatments focused on amelioration of cognitive, emotional, psychosocial and behavioral deficits
339caused by brain injury.
340 “Psychophysiological testing and treatment” is a set of medical and therapeutic
341assessment and treatments focused on psychophysiological disorders or physical disorders with
342psychological overlay.
343 “Post-acute residential treatment” includes integrated medical and therapeutic services,
344treatment, education, and skills training within a 24/7 real-world environment of care – a home
345and community setting. Maximum opportunity for correct practice of skill in the context of use
346develops new neural pathways which ensure ongoing skill use and avoidance of re-
347hospitalization and long-term care. 18 of 19
348 (b) Any individual or group health maintenance contract shall provide coverage for
349medically necessary treatment related to or as a result of an acquired brain injury. Medically
350necessary treatment shall include, but is not limited to, cognitive rehabilitation therapy; cognitive
351communication therapy; neurocognitive therapy and rehabilitation; neurobehavioral,
352neurophysiological, neuropsychological and psychophysiological testing and treatment;
353neurofeedback therapy; functional rehabilitation therapy and remediation; community
354reintegration services; post-acute residential treatment services; inpatient services; outpatient and
355day treatment services; home and community based treatment. The benefits in this section shall
356not include any lifetime limitation or unreasonable annual limitation of the number of days or
357sessions of treatment services. A health benefit plan may not deny benefits for the coverage
358required based solely on the fact that the treatment or services are provided at a facility other
359than a hospital. Any limitations shall be separately stated by the insurer. The benefits in this
360section shall not be subject to any greater deductible, coinsurance, copayments, or out-of-pocket
361limits than any other benefit provided by the insurer.
362 (c) The commissioner of insurance shall require a health benefit plan issuer to provide
363adequate training to personnel responsible for preauthorization of coverage or utilization review
364for services under this section, in consultation with the Brain Injury Association of
365Massachusetts.
366 (d) Individual practitioners and treatment facilities shall be qualified to provide acute care
367and post-acute care rehabilitation services through possession of the appropriate licenses,
368accreditation, training and experience deemed customary and routine in the trade practice,
369including programs, regulated by the Executive Office of Health and Human Services, which 19 of 19
370provide services for people with brain injury and accredited programs by the Commission on
371Rehabilitation Facilities (CARF) Medical Rehabilitation with a Brain Injury Specialty Program.