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