MA
Massachusetts House Bill H1229

Massachusetts 2025-2026 Regular Session

Massachusetts House Bill H1229 Compare Versions

Only one version of the bill is available at this time.
OldNewDifferences
11 1 of 1
22 HOUSE DOCKET, NO. 2519 FILED ON: 1/16/2025
33 HOUSE . . . . . . . . . . . . . . . No. 1229
44 The Commonwealth of Massachusetts
55 _________________
66 PRESENTED BY:
77 Michael P. Kushmerek
88 _________________
99 To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
1010 Court assembled:
1111 The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:
1212 An Act to further define medical necessity determinations.
1313 _______________
1414 PETITION OF:
1515 NAME:DISTRICT/ADDRESS :DATE ADDED:Michael P. Kushmerek3rd Worcester1/16/2025 1 of 14
1616 HOUSE DOCKET, NO. 2519 FILED ON: 1/16/2025
1717 HOUSE . . . . . . . . . . . . . . . No. 1229
1818 By Representative Kushmerek of Fitchburg, a petition (accompanied by bill, House, No. 1229)
1919 of Michael P. Kushmerek for legislation to further define medical necessity determinations.
2020 Financial Services.
2121 The Commonwealth of Massachusetts
2222 _______________
2323 In the One Hundred and Ninety-Fourth General Court
2424 (2025-2026)
2525 _______________
2626 An Act to further define medical necessity determinations.
2727 Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
2828 of the same, as follows:
2929 1 SECTION 1. Chapter 32A of the General Laws is hereby amended by inserting after
3030 2section 17R the following section:-
3131 3 Section 17S. For the purposes of this section the following terms shall, unless the context
3232 4clearly requires otherwise, have the following meanings:
3333 5 “Mental health acute treatment”, 24-hour medically supervised mental health services
3434 6provided in an inpatient facility, licensed by the department of mental health, that provides
3535 7psychiatric evaluation, management, treatment and discharge planning in a structured treatment
3636 8milieu.
3737 9 “Mental health crisis stabilization services”, 24-hour clinically managed mental health
3838 10diversionary or step-down services for adults or adolescents, as defined by MassHealth, usually
3939 11provided as an alternative to mental health acute treatment or following mental health acute 2 of 14
4040 12treatment, which may include intensive crisis stabilization counseling, outreach to families and
4141 13significant others and aftercare planning.
4242 14 “Community-based acute treatment (CBAT)”, 24-hour clinically managed mental health
4343 15diversionary or step-down services for children and adolescents, as defined by the department of
4444 16early education and care, usually provided as an alternative to mental health acute treatment.
4545 17 “Intensive community-based acute treatment (ICBAT)”, intensive 24-hour clinically
4646 18managed mental health diversionary or step-down services for children and adolescents, as
4747 19defined by the department of early education and care, usually provided as an alternative to
4848 20mental health acute treatment.
4949 21 The commission shall provide to any active or retired employee of the commonwealth
5050 22who is insured under the group insurance commission coverage for medically necessary mental
5151 23health acute treatment and shall not require a preauthorization prior to obtaining treatment.
5252 24Medical necessity shall be determined by the treating clinician in consultation with the patient
5353 25and noted in the patient’s medical record.
5454 26 The commission shall provide to any active or retired employee of the commonwealth
5555 27who is insured under the group insurance commission coverage for medically necessary mental
5656 28health crisis stabilization services for up to 14 days and shall not require preauthorization prior to
5757 29obtaining such services; provided, that the facility shall provide the carrier both notification of
5858 30admission and the initial treatment plan within 48 hours of admission; provided further, that
5959 31utilization review procedures may be initiated on day 7. Medical necessity shall be determined
6060 32by the treating clinician in consultation with the patient and noted in the patient’s medical record. 3 of 14
6161 33 The commission shall provide to any active or retired employee of the commonwealth
6262 34who is insured under the group insurance commission coverage for medically necessary
6363 35community based acute treatment services for up to 21 days; provided, that the facility shall
6464 36provide the carrier both notification of admission and the initial treatment plan within 48 hours
6565 37of admission; provided further, that utilization review procedures may be initiated on day 10.
6666 38Medical necessity shall be determined by the treating clinician in consultation with the patient
6767 39and noted in the patient’s medical record.
6868 40 The commission shall provide to any active or retired employee of the commonwealth
6969 41who is insured under the group insurance commission coverage for medically necessary
7070 42intensive community based acute treatment services for up to 14 days; provided, that the facility
7171 43shall provide the carrier both notification of admission and the initial treatment plan within 48
7272 44hours of admission; provided further, that utilization review procedures may be initiated on day
7373 457. Medical necessity shall be determined by the treating clinician in consultation with the patient
7474 46and noted in the patient’s medical record.
7575 47 SECTION 2. Chapter 118E of the General Laws is hereby amended by inserting after
7676 48section 10N the following section:-
7777 49 Section 10O. For the purposes of this section the following terms shall, unless the context
7878 50clearly requires otherwise, have the following meanings:
7979 51 “Mental health acute treatment”, 24-hour medically supervised mental health services
8080 52provided in an inpatient facility, licensed by the department of mental health, that provides
8181 53psychiatric evaluation, management, treatment and discharge planning in a structured treatment
8282 54milieu. 4 of 14
8383 55 “Mental health crisis stabilization services”, 24-hour clinically managed mental health
8484 56diversionary or step-down services for adults or adolescents, as defined by MassHealth, usually
8585 57provided as an alternative to mental health acute treatment or following mental health acute
8686 58treatment, which may include intensive crisis stabilization counseling, outreach to families and
8787 59significant others and aftercare planning.
8888 60 “Community-based acute treatment (CBAT)”, 24-hour clinically managed mental health
8989 61diversionary or step-down services for children and adolescents, as defined by the department of
9090 62early education and care, usually provided as an alternative to mental health acute treatment.
9191 63 “Intensive community-based acute treatment (ICBAT)”, intensive 24-hour clinically
9292 64managed mental health diversionary or step-down services for children and adolescents, as
9393 65defined by the department of early education and care, usually provided as an alternative to
9494 66mental health acute treatment.
9595 67 The division and its contracted health insurers, health plans, health maintenance
9696 68organizations, behavioral health management firms and third party administrators under contract
9797 69to a Medicaid managed care organization or primary care clinician plan shall cover the cost of
9898 70medically necessary mental health acute treatment and shall not require a preauthorization prior
9999 71to obtaining treatment. Medical necessity shall be determined by the treating clinician in
100100 72consultation with the patient and noted in the patient’s medical record.
101101 73 The division and its contracted health insurers, health plans, health maintenance
102102 74organizations, behavioral health management firms and third party administrators under contract
103103 75to a Medicaid managed care organization or primary care clinician plan shall cover the cost of
104104 76medically necessary mental health crisis stabilization services for up to 14 days and shall not 5 of 14
105105 77require preauthorization prior to obtaining such services; provided, that the facility shall provide
106106 78the carrier both notification of admission and the initial treatment plan within 48 hours of
107107 79admission; provided further, that utilization review procedures may be initiated on day 7.
108108 80Medical necessity shall be determined by the treating clinician in consultation with the patient
109109 81and noted in the patient’s medical record.
110110 82 The division and its contracted health insurers, health plans, health maintenance
111111 83organizations, behavioral health management firms and third party administrators under contract
112112 84to a Medicaid managed care organization or primary care clinician plan shall cover the cost of
113113 85medically necessary community based acute treatment services for up to 21 days; provided, that
114114 86the facility shall provide the carrier both notification of admission and the initial treatment plan
115115 87within 48 hours of admission; provided further, that utilization review procedures may be
116116 88initiated on day 10. Medical necessity shall be determined by the treating clinician in
117117 89consultation with the patient and noted in the patient’s medical record.
118118 90 The division and its contracted health insurers, health plans, health maintenance
119119 91organizations, behavioral health management firms and third party administrators under contract
120120 92to a Medicaid managed care organization or primary care clinician plan shall cover the cost of
121121 93medically necessary intensive community based acute treatment services for up to 14 days;
122122 94provided, that the facility shall provide the carrier both notification of admission and the initial
123123 95treatment plan within 48 hours of admission; provided further, that utilization review procedures
124124 96may be initiated on day 7. Medical necessity shall be determined by the treating clinician in
125125 97consultation with the patient and noted in the patient’s medical record. 6 of 14
126126 98 SECTION 3. Chapter 175 of the General Laws is hereby amended by inserting after
127127 99section 47NN the following section:-
128128 100 Section 47OO. For the purposes of this section the following terms shall, unless the
129129 101context clearly requires otherwise, have the following meanings:
130130 102 “Mental health acute treatment”, 24-hour medically supervised mental health services
131131 103provided in an inpatient facility, licensed by the department of mental health, that provides
132132 104psychiatric evaluation, management, treatment and discharge planning in a structured treatment
133133 105milieu.
134134 106 “Mental health crisis stabilization services”, 24-hour clinically managed mental health
135135 107diversionary or step-down services for adults or adolescents, as defined by MassHealth, usually
136136 108provided as an alternative to mental health acute treatment or following mental health acute
137137 109treatment, which may include intensive crisis stabilization counseling, outreach to families and
138138 110significant others and aftercare planning.
139139 111 “Community-based acute treatment (CBAT)”, 24-hour clinically managed mental health
140140 112diversionary or step-down services for children and adolescents, as defined by the department of
141141 113early education and care, usually provided as an alternative to mental health acute treatment.
142142 114 “Intensive community-based acute treatment (ICBAT)”, intensive 24-hour clinically
143143 115managed mental health diversionary or step-down services for children and adolescents, as
144144 116defined by the department of early education and care, usually provided as an alternative to
145145 117mental health acute treatment. 7 of 14
146146 118 Any policy, contract, agreement, plan or certificate of insurance issued, delivered or
147147 119renewed within the commonwealth, which is considered creditable coverage under section 1 of
148148 120chapter 111M, shall provide coverage for medically necessary mental health acute treatment and
149149 121shall not require a preauthorization prior to obtaining treatment. Medical necessity shall be
150150 122determined by the treating clinician in consultation with the patient and noted in the patient’s
151151 123medical record.
152152 124 Any policy, contract, agreement, plan or certificate of insurance issued, delivered or
153153 125renewed within the commonwealth, which is considered creditable coverage under section 1 of
154154 126chapter 111M, shall provide coverage for medically necessary mental health crisis stabilization
155155 127services for up to 14 days and shall not require preauthorization prior to obtaining such services;
156156 128provided, that the facility shall provide the carrier both notification of admission and the initial
157157 129treatment plan within 48 hours of admission; provided further, that utilization review procedures
158158 130may be initiated on day 7. Medical necessity shall be determined by the treating clinician in
159159 131consultation with the patient and noted in the patient’s medical record.
160160 132 Any policy, contract, agreement, plan or certificate of insurance issued, delivered or
161161 133renewed within the commonwealth, which is considered creditable coverage under section 1 of
162162 134chapter 111M, shall provide coverage for medically necessary community based acute treatment
163163 135services for up to 21 days; provided, that the facility shall provide the carrier both notification of
164164 136admission and the initial treatment plan within 48 hours of admission; provided further, that
165165 137utilization review procedures may be initiated on day 10. Medical necessity shall be determined
166166 138by the treating clinician in consultation with the patient and noted in the patient’s medical record. 8 of 14
167167 139 Any policy, contract, agreement, plan or certificate of insurance issued, delivered or
168168 140renewed within the commonwealth, which is considered creditable coverage under section 1 of
169169 141chapter 111M, shall provide coverage for medically necessary intensive community based acute
170170 142treatment services for up to 14 days; provided, that the facility shall provide the carrier both
171171 143notification of admission and the initial treatment plan within 48 hours of admission; provided
172172 144further, that utilization review procedures may be initiated on day 7. Medical necessity shall be
173173 145determined by the treating clinician in consultation with the patient and noted in the patient’s
174174 146medical record.
175175 147 SECTION 4. Chapter 176A of the General Laws is hereby amended by inserting after
176176 148section 8OO the following section:-
177177 149 Section 8PP. For the purposes of this section the following terms shall, unless the context
178178 150clearly requires otherwise, have the following meanings:
179179 151 “Mental health acute treatment”, 24-hour medically supervised mental health services
180180 152provided in an inpatient facility, licensed by the department of mental health, that provides
181181 153psychiatric evaluation, management, treatment and discharge planning in a structured treatment
182182 154milieu.
183183 155 “Mental health crisis stabilization services”, 24-hour clinically managed mental health
184184 156diversionary or step-down services for adults or adolescents, as defined by MassHealth, usually
185185 157provided as an alternative to mental health acute treatment or following mental health acute
186186 158treatment, which may include intensive crisis stabilization counseling, outreach to families and
187187 159significant others and aftercare planning. 9 of 14
188188 160 “Community-based acute treatment (CBAT)”, 24-hour clinically managed mental health
189189 161diversionary or step-down services for children and adolescents, as defined by the department of
190190 162early education and care, usually provided as an alternative to mental health acute treatment.
191191 163 “Intensive community-based acute treatment (ICBAT)”, intensive 24-hour clinically
192192 164managed mental health diversionary or step-down services for children and adolescents, as
193193 165defined by the department of early education and care, usually provided as an alternative to
194194 166mental health acute treatment.
195195 167 Any contract between a subscriber and the corporation under an individual or group
196196 168hospital service plan which is delivered, issued or renewed within the commonwealth shall
197197 169provide coverage for medically necessary mental health acute treatment and shall not require a
198198 170preauthorization prior to obtaining treatment. Medical necessity shall be determined by the
199199 171treating clinician in consultation with the patient and noted in the patient’s medical record.
200200 172 Any contract between a subscriber and the corporation under an individual or group
201201 173hospital service plan which is delivered, issued or renewed within the commonwealth shall
202202 174provide coverage for medically necessary mental health crisis stabilization services for up to 14
203203 175days and shall not require preauthorization prior to obtaining such services; provided, that the
204204 176facility shall provide the carrier both notification of admission and the initial treatment plan
205205 177within 48 hours of admission; provided further, that utilization review procedures may be
206206 178initiated on day 7. Medical necessity shall be determined by the treating clinician in consultation
207207 179with the patient and noted in the patient’s medical record.
208208 180 Any contract between a subscriber and the corporation under an individual or group
209209 181hospital service plan which is delivered, issued or renewed within the commonwealth shall 10 of 14
210210 182provide coverage for medically necessary community based acute treatment services for up to 21
211211 183days; provided, that the facility shall provide the carrier both notification of admission and the
212212 184initial treatment plan within 48 hours of admission; provided further, that utilization review
213213 185procedures may be initiated on day 10. Medical necessity shall be determined by the treating
214214 186clinician in consultation with the patient and noted in the patient’s medical record.
215215 187 Any contract between a subscriber and the corporation under an individual or group
216216 188hospital service plan which is delivered, issued or renewed within the commonwealth shall
217217 189provide coverage for medically necessary intensive community based acute treatment services
218218 190for up to 14 days; provided, that the facility shall provide the carrier both notification of
219219 191admission and the initial treatment plan within 48 hours of admission; provided further, that
220220 192utilization review procedures may be initiated on day 7. Medical necessity shall be determined
221221 193by the treating clinician in consultation with the patient and noted in the patient’s medical record.
222222 194 SECTION 5. Chapter 176B of the General Laws is hereby amended by inserting after
223223 195section 4OO the following section:-
224224 196 Section 4PP. For the purposes of this section the following terms shall, unless the context
225225 197clearly requires otherwise, have the following meanings:
226226 198 “Mental health acute treatment”, 24-hour medically supervised mental health services
227227 199provided in an inpatient facility, licensed by the department of mental health, that provides
228228 200psychiatric evaluation, management, treatment and discharge planning in a structured treatment
229229 201milieu.
230230 202 “Mental health crisis stabilization services”, 24-hour clinically managed mental health
231231 203diversionary or step-down services for adults or adolescents, as defined by MassHealth, usually 11 of 14
232232 204provided as an alternative to mental health acute treatment or following mental health acute
233233 205treatment, which may include intensive crisis stabilization counseling, outreach to families and
234234 206significant others and aftercare planning.
235235 207 “Community-based acute treatment (CBAT)”, 24-hour clinically managed mental health
236236 208diversionary or step-down services for children and adolescents, as defined by the department of
237237 209early education and care, usually provided as an alternative to mental health acute treatment.
238238 210 “Intensive community-based acute treatment (ICBAT)”, intensive 24-hour clinically
239239 211managed mental health diversionary or step-down services for children and adolescents, as
240240 212defined by the department of early education and care, usually provided as an alternative to
241241 213mental health acute treatment.
242242 214 Any subscription certificate under an individual or group medical service agreement
243243 215delivered, issued or renewed within the commonwealth shall provide coverage for medically
244244 216necessary mental health acute treatment and shall not require a preauthorization prior to
245245 217obtaining treatment. Medical necessity shall be determined by the treating clinician in
246246 218consultation with the patient and noted in the patient’s medical record.
247247 219 Any subscription certificate under an individual or group medical service agreement
248248 220delivered, issued or renewed within the commonwealth shall provide coverage for medically
249249 221necessary mental health crisis stabilization services for up to 14 days and shall not require
250250 222preauthorization prior to obtaining such services; provided, that the facility shall provide the
251251 223carrier both notification of admission and the initial treatment plan within 48 hours of admission;
252252 224provided further, that utilization review procedures may be initiated on day 7. Medical necessity 12 of 14
253253 225shall be determined by the treating clinician in consultation with the patient and noted in the
254254 226patient’s medical record.
255255 227 Any subscription certificate under an individual or group medical service agreement
256256 228delivered, issued or renewed within the commonwealth shall provide coverage for medically
257257 229necessary community based acute treatment services for up to 21 days; provided, that the facility
258258 230shall provide the carrier both notification of admission and the initial treatment plan within 48
259259 231hours of admission; provided further, that utilization review procedures may be initiated on day
260260 23210. Medical necessity shall be determined by the treating clinician in consultation with the
261261 233patient and noted in the patient’s medical record.
262262 234 Any subscription certificate under an individual or group medical service agreement
263263 235delivered, issued or renewed within the commonwealth shall provide coverage for medically
264264 236necessary intensive community based acute treatment services for up to 14 days; provided, that
265265 237the facility shall provide the carrier both notification of admission and the initial treatment plan
266266 238within 48 hours of admission; provided further, that utilization review procedures may be
267267 239initiated on day 7. Medical necessity shall be determined by the treating clinician in consultation
268268 240with the patient and noted in the patient’s medical record.
269269 241 SECTION 6. Chapter 176G of the General Laws is hereby amended by inserting after
270270 242section 4GG the following section:-
271271 243 Section 4HH. For the purposes of this section the following terms shall, unless the
272272 244context clearly requires otherwise, have the following meanings:
273273 245 “Mental health acute treatment”, 24-hour medically supervised mental health services
274274 246provided in an inpatient facility, licensed by the department of mental health, that provides 13 of 14
275275 247psychiatric evaluation, management, treatment and discharge planning in a structured treatment
276276 248milieu.
277277 249 “Mental health crisis stabilization services”, 24-hour clinically managed mental health
278278 250diversionary or step-down services for adults or adolescents, as defined by MassHealth, usually
279279 251provided as an alternative to mental health acute treatment or following mental health acute
280280 252treatment, which may include intensive crisis stabilization counseling, outreach to families and
281281 253significant others and aftercare planning.
282282 254 “Community-based acute treatment (CBAT)”, 24-hour clinically managed mental health
283283 255diversionary or step-down services for children and adolescents, as defined by the department of
284284 256early education and care, usually provided as an alternative to mental health acute treatment.
285285 257 “Intensive community-based acute treatment (ICBAT)”, intensive 24-hour clinically
286286 258managed mental health diversionary or step-down services for children and adolescents, as
287287 259defined by the department of early education and care, usually provided as an alternative to
288288 260mental health acute treatment.
289289 261 Any individual or group health maintenance contract that is issued or renewed shall
290290 262provide coverage for medically necessary mental health acute treatment and shall not require a
291291 263preauthorization prior to obtaining treatment. Medical necessity shall be determined by the
292292 264treating clinician in consultation with the patient and noted in the patient’s medical record.
293293 265 Any individual or group health maintenance contract that is issued or renewed shall
294294 266provide coverage for medically necessary mental health crisis stabilization services for up to 14
295295 267days and shall not require preauthorization prior to obtaining such services; provided, that the
296296 268facility shall provide the carrier both notification of admission and the initial treatment plan 14 of 14
297297 269within 48 hours of admission; provided further, that utilization review procedures may be
298298 270initiated on day 7. Medical necessity shall be determined by the treating clinician in consultation
299299 271with the patient and noted in the patient’s medical record.
300300 272 Any individual or group health maintenance contract that is issued or renewed shall
301301 273provide coverage for medically necessary community based acute treatment services for up to 21
302302 274days; provided, that the facility shall provide the carrier both notification of admission and the
303303 275initial treatment plan within 48 hours of admission; provided further, that utilization review
304304 276procedures may be initiated on day 10. Medical necessity shall be determined by the treating
305305 277clinician in consultation with the patient and noted in the patient’s medical record.
306306 278 Any individual or group health maintenance contract that is issued or renewed shall
307307 279provide coverage for medically necessary intensive community based acute treatment services
308308 280for up to 14 days; provided, that the facility shall provide the carrier both notification of
309309 281admission and the initial treatment plan within 48 hours of admission; provided further, that
310310 282utilization review procedures may be initiated on day 7. Medical necessity shall be determined
311311 283by the treating clinician in consultation with the patient and noted in the patient’s medical record.