Massachusetts 2025-2026 Regular Session

Massachusetts House Bill H1228 Compare Versions

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

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2	2	HOUSE DOCKET, NO. 2507 FILED ON: 1/16/2025
3	3	HOUSE . . . . . . . . . . . . . . . No. 1228
4	4	The Commonwealth of Massachusetts
5	5	_________________
6	6	PRESENTED BY:
7	7	Michael P. Kushmerek
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 support behavioral health prevention for children.
13	13	_______________
14	14	PETITION OF:
15	15	NAME:DISTRICT/ADDRESS :DATE ADDED:Michael P. Kushmerek3rd Worcester1/16/2025 1 of 7
16	16	HOUSE DOCKET, NO. 2507 FILED ON: 1/16/2025
17	17	HOUSE . . . . . . . . . . . . . . . No. 1228
18	18	By Representative Kushmerek of Fitchburg, a petition (accompanied by bill, House, No. 1228)
19	19	of Michael P. Kushmerek relative to behavioral health prevention for children. Financial
20	20	Services.
21	21	The Commonwealth of Massachusetts
22	22	_______________
23	23	In the One Hundred and Ninety-Fourth General Court
24	24	(2025-2026)
25	25	_______________
26	26	An Act to support behavioral health prevention for children.
27	27	Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
28	28	of the same, as follows:
29	29	1 SECTION 1. Chapter 32A of the General Laws, is hereby amended by inserting after
30	30	2section 33 the following section:-
31	31	3 Section 34. (a) For the purpose of this section, the following term shall have the
32	32	4following meaning:
33	33	5 “Preventive behavioral health services”, short-term interventions in supportive group,
34	34	6individual, or family settings that cultivate coping skills and strategies for symptoms of
35	35	7depression, anxiety, and other social and emotional concerns, which may prevent the
36	36	8development of behavioral health conditions for members who are under 21 years old who have
37	37	9a positive behavioral health screening, or, in the case of an infant, a caregiver with a positive
38	38	10post-partum depression screening, even if the individual does not meet criteria for behavioral
39	39	11health diagnosis. 2 of 7
40	40	12 (b)(1) Any coverage offered by the commission to an active or retired employee of the
41	41	13commonwealth under the group insurance commission shall provide coverage for no fewer than
42	42	14six sessions of preventive behavioral health services provided by a qualified licensed behavioral
43	43	15health clinician, or a non-licensed clinician or trainee under supervision, without requiring prior
44	44	16authorization. Coverage shall include individual, family and group sessions when delivered by a
45	45	17behavioral health clinician practicing in an integrated pediatric primary care setting and group
46	46	18sessions when delivered in community-based outpatient and school settings. Preventive
47	47	19behavioral health services shall be covered with no patient cost-sharing; provided, however, that
48	48	20cost-sharing shall be required if the applicable plan is governed by the Federal Internal Revenue
49	49	21Code and would lose its tax-exempt status as a result of the prohibition on cost-sharing for this
50	50	22service.
51	51	23 (2) The commission and its contracted carriers shall accept an alternative diagnosis code,
52	52	24including a Social Determinants of Health Z-code, as the primary diagnosis from eligible
53	53	25providers submitting claims for preventive behavioral health services.
54	54	26 SECTION 2. Chapter 175 of the General Laws, is hereby amended by inserting after
55	55	27section 47UU the following section:-
56	56	28 Section 47VV. (a) For the purpose of this section, the following term shall have the
57	57	29following meaning:
58	58	30 “Preventive behavioral health services”, short-term interventions in supportive group,
59	59	31individual, or family settings that cultivate coping skills and strategies for symptoms of
60	60	32depression, anxiety, and other social and emotional concerns, which may prevent the
61	61	33development of behavioral health conditions for members who are under 21 years old who have 3 of 7
62	62	34a positive behavioral health screening, or, in the case of an infant, a caregiver with a positive
63	63	35post-partum depression screening, even if the individual does not meet criteria for behavioral
64	64	36health diagnosis.
65	65	37 (b)(1) A policy, contract, agreement, plan or certificate of insurance issued, delivered or
66	66	38renewed within the commonwealth shall provide coverage for no fewer than six sessions of
67	67	39preventive behavioral health services provided by a qualified licensed behavioral health
68	68	40clinician, or a non-licensed clinician or trainee under supervision, without requiring prior
69	69	41authorization. Coverage shall include individual, family and group sessions when delivered by a
70	70	42behavioral health clinician practicing in an integrated pediatric primary care setting and group
71	71	43sessions when delivered in community-based outpatient and school settings. Preventive
72	72	44behavioral health services shall be covered with no patient cost-sharing; provided, however, that
73	73	45cost-sharing shall be required if the applicable plan is governed by the Federal Internal Revenue
74	74	46Code and would lose its tax-exempt status as a result of the prohibition on cost-sharing for this
75	75	47service.
76	76	48 (2) Payers covered under this section shall accept an alternative diagnosis code, including
77	77	49a Social Determinants of Health Z-code, as the primary diagnosis from eligible providers
78	78	50submitting claims for preventive behavioral health services.
79	79	51 SECTION 3. Chapter 176A of the General Laws, is hereby amended by inserting after
80	80	52section 8VV the following section:-
81	81	53 Section 8WW. (a) For the purpose of this section, the following term shall have the
82	82	54following meaning: 4 of 7
83	83	55 “Preventive behavioral health services”, short-term interventions in supportive group,
84	84	56individual, or family settings that cultivate coping skills and strategies for symptoms of
85	85	57depression, anxiety, and other social and emotional concerns, which may prevent the
86	86	58development of behavioral health conditions for members who are under 21 years old who have
87	87	59a positive behavioral health screening, or, in the case of an infant, a caregiver with a positive
88	88	60post-partum depression screening, even if the individual does not meet criteria for behavioral
89	89	61health diagnosis.
90	90	62 (b)(1) Any contract between a subscriber and a corporation subject to this chapter,
91	91	63pursuant to an individual or group hospital service plan that is delivered, issued or renewed
92	92	64within or without the commonwealth shall provide coverage for no fewer than six sessions of
93	93	65preventive behavioral health services provided by a qualified licensed behavioral health
94	94	66clinician, or a non-licensed clinician or trainee under supervision, without requiring prior
95	95	67authorization. Coverage shall include individual, family and group sessions when delivered by a
96	96	68behavioral health clinician practicing in an integrated pediatric primary care setting and group
97	97	69sessions when delivered in community-based outpatient and school settings. Preventive
98	98	70behavioral health services shall be covered with no patient cost-sharing; provided, however, that
99	99	71cost-sharing shall be required if the applicable plan is governed by the Federal Internal Revenue
100	100	72Code and would lose its tax-exempt status as a result of the prohibition on cost-sharing for this
101	101	73service.
102	102	74 (2) Payers covered under this section shall accept an alternative diagnosis code, including
103	103	75a Social Determinants of Health Z-code, as the primary diagnosis from eligible providers
104	104	76submitting claims for preventive behavioral health services. 5 of 7
105	105	77 SECTION 4. Chapter 176B of the General Laws, is hereby amended by inserting after
106	106	78section 4VV the following section:-
107	107	79 Section 4WW. (a) For the purpose of this section, the following term shall have the
108	108	80following meaning:
109	109	81 “Preventive behavioral health services”, short-term interventions in supportive group,
110	110	82individual, or family settings that cultivate coping skills and strategies for symptoms of
111	111	83depression, anxiety, and other social and emotional concerns, which may prevent the
112	112	84development of behavioral health conditions for members who are under 21 years old who have
113	113	85a positive behavioral health screening, or, in the case of an infant, a caregiver with a positive
114	114	86post-partum depression screening, even if the individual does not meet criteria for behavioral
115	115	87health diagnosis.
116	116	88 (b)(1) Any subscription certificate under an individual or group medical service
117	117	89agreement that is delivered, issued or renewed within or without the commonwealth shall
118	118	90provide coverage for no fewer than six sessions of preventive behavioral health services
119	119	91provided by a qualified licensed behavioral health clinician, or a non-licensed clinician or trainee
120	120	92under supervision, without requiring prior authorization. Coverage shall include individual,
121	121	93family and group sessions when delivered by a behavioral health clinician practicing in an
122	122	94integrated pediatric primary care setting and group sessions when delivered in community-based
123	123	95outpatient and school settings. Preventive behavioral health services shall be covered with no
124	124	96patient cost-sharing; provided, however, that cost-sharing shall be required if the applicable plan
125	125	97is governed by the Federal Internal Revenue Code and would lose its tax-exempt status as a
126	126	98result of the prohibition on cost-sharing for this service. 6 of 7
127	127	99 (2) Payers covered under this section shall accept an alternative diagnosis code, including
128	128	100a Social Determinants of Health Z-code, as the primary diagnosis from eligible providers
129	129	101submitting claims for preventive behavioral health services.
130	130	102 SECTION 5. Chapter 176G of the General Laws, is hereby amended by inserting after
131	131	103section 4NN the following section:-
132	132	104 Section 4OO. (a) For the purpose of this section, the following term shall have the
133	133	105following meaning:
134	134	106 “Preventive behavioral health services”, short-term interventions in supportive group,
135	135	107individual, or family settings that cultivate coping skills and strategies for symptoms of
136	136	108depression, anxiety, and other social and emotional concerns, which may prevent the
137	137	109development of behavioral health conditions for members who are under 21 years old who have
138	138	110a positive behavioral health screening, or, in the case of an infant, a caregiver with a positive
139	139	111post-partum depression screening, even if the individual does not meet criteria for behavioral
140	140	112health diagnosis.
141	141	113 (b)(1) Any individual or group health maintenance contract that is issued or renewed
142	142	114within or without the commonwealth shall provide coverage for no fewer than six sessions of
143	143	115preventive behavioral health services provided by a qualified licensed behavioral health
144	144	116clinician, or a non-licensed clinician or trainee under supervision, without requiring prior
145	145	117authorization. Coverage shall include individual, family and group sessions when delivered by a
146	146	118behavioral health clinician practicing in an integrated pediatric primary care setting and group
147	147	119sessions when delivered in community-based outpatient and school settings. Preventive
148	148	120behavioral health services shall be covered with no patient cost-sharing; provided, however, that 7 of 7
149	149	121cost-sharing shall be required if the applicable plan is governed by the Federal Internal Revenue
150	150	122Code and would lose its tax-exempt status as a result of the prohibition on cost-sharing for this
151	151	123service.
152	152	124 (2) Payers covered under this section shall accept an alternative diagnosis code, including
153	153	125a Social Determinants of Health Z-code, as the primary diagnosis from eligible providers
154	154	126submitting claims for preventive behavioral health services.
155	155	127 SECTION 6. The division of insurance, in consultation with the office of Medicaid, shall
156	156	128develop guidance to implement coverage of preventive behavioral health services