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SENATE DOCKET, NO. 1323 FILED ON: 1/16/2025
SENATE . . . . . . . . . . . . . . No. 709
The Commonwealth of Massachusetts
_________________
PRESENTED BY:
John J. Cronin
_________________
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 for supportive care for serious mental illness.
_______________
PETITION OF:
NAME:DISTRICT/ADDRESS :John J. CroninWorcester and Middlesex 1 of 16
SENATE DOCKET, NO. 1323 FILED ON: 1/16/2025
SENATE . . . . . . . . . . . . . . No. 709
By Mr. Cronin, a petition (accompanied by bill, Senate, No. 709) of John J. Cronin for
legislation relative to supportive care for serious mental illness. Financial Services.
[SIMILAR MATTER FILED IN PREVIOUS SESSION
SEE SENATE, NO. 610 OF 2023-2024.]
The Commonwealth of Massachusetts
_______________
In the One Hundred and Ninety-Fourth General Court
(2025-2026)
_______________
An Act for supportive care for serious mental illness.
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. Section 18 of chapter 15A of the General Laws, as appearing in the 2018
2Official Edition, is hereby amended by adding the following paragraph:-
3 Notwithstanding any general or special law to the contrary, any qualifying student health
4insurance plan authorized under this chapter shall provide coverage for coordinated specialty
5care services and assertive community treatment service as described under section 4FF of
6chapter 176G.
7 SECTION 2. Chapter 32A of the General Laws is hereby amended by adding the
8following section:-
9 Section 32. (a) For the purposes of this section, the following words shall have the
10following meanings unless the context clearly requires otherwise: 2 of 16
11 “Assertive Community Treatment”, a team-based, evidenced-based treatment practice
12that offers treatment, rehabilitation, and support services, using a person-centered, recovery-
13based flexible treatment program, as defined by evidence-based standards, including, but not
14limited to, the most current guidelines issued by the federal Substance Abuse and Mental Health
15Services Administration. Practice may also include those modalities specifically designed for
16pediatric patients under the age of 19 that have been adapted from guidelines issued by the
17federal Substance Abuse and Mental Health Services Administration or the National Institute of
18Health.
19 “Behavioral health services”, care and services for the evaluation, diagnosis, treatment or
20management of patients with mental health, developmental or substance use disorders.
21 “Coordinated Specialty Care”, a recovery-oriented treatment program for people with
22first-episode psychosis, as defined by evidence-based standards, including, but not limited to the
23most current guidelines issued by the National Institute of Mental Health. Programs may also
24include those specifically designed for pediatric patients under the age of 19 that have been
25adapted from guidelines issued by the federal Substance Abuse and Mental Health Services
26Administration or the National Institute of Mental Health.
27 “Evidence-based practice”, treatments that are supported by clinical research, including,
28but not limited to, research supporting practice modifications relevant to the treatment of
29pediatric patients.
30 “First episode psychosis treatment”, treatment initiated within 74 weeks of the first time
31an individual experiences an episode of psychosis. 3 of 16
32 “Serious emotional disturbance”, mental, behavioral or emotional disorders in children or
33adolescents under age 19 that have resulted in functional impairment that substantially interferes
34with or limits the child’s role or functioning in family, school or community activities.
35 “Serious mental illness”, mental, behavioral or emotional disorders resulting in serious
36functional impairment that substantially interferes with or limits at least 1 major life activity for
37an individual not less than 19 years old with a psychiatric diagnosis as defined in the American
38Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders.
39 (b) Coverage offered by the commission to an active or retired employee of the
40commonwealth insured under the group insurance commission shall provide coverage for wrap-
41around coordinated specialty care services for first episode psychosis treatment and assertive
42community treatment for early or ongoing treatment of person with a previous episode of
43psychosis who has a serious mental illness or serious emotional disturbance. Coverage under this
44section shall not be construed as imposing a limit on the number of visits an individual may
45make to a provider of any of the services under this section.
46 (c) Payment for the services performed under the treatment models listed in this section
47shall be based on a bundled treatment model or payment, rather than fee-for-service payment for
48each separate service delivered by a treatment team member.
49 (d) To determine medical necessity for the treatment approaches under this section,
50neither disability nor functional impairment shall be a precondition to receive the treatment.
51Medical necessity shall be presumed following a recommendation by a licensed physician,
52licensed clinical psychologist, licensed professional clinical counselor or licensed clinical social
53worker. 4 of 16
54 SECTION 3. Chapter 112 of the General Laws is hereby amended by inserting after
55section 9K the following section:-
56 Section 9L. To credential the mental health professionals and other members of the
57multidisciplinary coordinated specialty care treatment team or an assertive community treatment
58team as described under section 32 of chapter 32A, section 39 of chapter 176A, section 26 of
59chapter 176B, section 34 of chapter 176G and section 14 of chapter 176I, the credentialing of the
60psychiatrist or the licensed clinical leader of the treatment team shall qualify all members of the
61treatment team to be credentialed with the insurer.
62 SECTION 4. Chapter 175 of the General Laws is hereby amended by inserting after
63section 47NN the following section:-
64 Section 47OO. (a) For the purposes of this section, the following words shall have the
65following meanings unless the context clearly requires otherwise:
66 “Assertive Community Treatment”, a team-based, evidenced-based treatment practice
67that offers treatment, rehabilitation, and support services, using a person-centered, recovery-
68based flexible treatment program, as defined by evidence-based standards, including, but not
69limited to, the most current guidelines issued by the federal Substance Abuse and Mental Health
70Services Administration. Practice may also include those modalities specifically designed for
71pediatric patients under the age of 19 that have been adapted from guidelines issued by the
72federal Substance Abuse and Mental Health Services Administration or the National Institute of
73Health.
74 “Behavioral health services”, care and services for the evaluation, diagnosis, treatment or
75management of patients with mental health, developmental or substance use disorders. 5 of 16
76 “Coordinated Specialty Care”, a recovery-oriented treatment program for people with
77first-episode psychosis, as defined by evidence-based standards, including, but not limited to the
78most current guidelines issued by the National Institute of Mental Health. Programs may also
79include those specifically designed for pediatric patients under the age of 19 that have been
80adapted from guidelines issued by the federal Substance Abuse and Mental Health Services
81Administration or the National Institute of Mental Health.
82 “Evidence-based practice”, treatments that are supported by clinical research, including,
83but not limited to, research supporting practice modifications relevant to the treatment of
84pediatric patients.
85 “First episode psychosis treatment”, treatment initiated within 74 weeks of the first time
86an individual experiences an episode of psychosis.
87 “Serious emotional disturbance”, mental, behavioral or emotional disorders in children or
88adolescents under age 19 that have resulted in functional impairment that substantially interferes
89with or limits the child’s role or functioning in family, school or community activities.
90 “Serious mental illness”, mental, behavioral or emotional disorders resulting in serious
91functional impairment that substantially interferes with or limits at least 1 major life activity for
92an individual not less than 19 years old with a psychiatric diagnosis as defined in the American
93Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders.
94 (b) An individual policy of accident and sickness insurance issued under section 108 that
95provides hospital expense and surgical expense insurance and any group blanket or general
96policy of accident and sickness insurance issued under section 110 that provides hospital expense
97and surgical expense insurance that is issued or renewed within or without the commonwealth 6 of 16
98shall provide coverage for wrap-around coordinated specialty care services for first episode
99psychosis treatment and assertive community treatment for early or ongoing treatment of person
100with a previous episode of psychosis who has a serious mental illness or serious emotional
101disturbance. Coverage under this section shall not be construed as imposing a limit on the
102number of visits an individual may make to a provider of any of the services under this section.
103 (c) Payment for the services performed under the treatment models listed in this section
104shall be based on a bundled treatment model or payment, rather than fee-for-service payment for
105each separate service delivered by a treatment team member.
106 (d) To determine medical necessity for the treatment approaches under this section,
107neither disability nor functional impairment shall be a precondition to receive the treatment.
108Medical necessity shall be presumed following a recommendation by a licensed physician,
109licensed clinical psychologist, licensed professional clinical counselor or licensed clinical social
110worker.
111 SECTION 5. Chapter 176A of the General Laws is hereby amended by adding the
112following section:-
113 Section 39. (a) For the purposes of this section, the following words shall have the
114following meanings unless the context clearly requires otherwise:
115 “Assertive Community Treatment”, a team-based, evidenced-based treatment practice
116that offers treatment, rehabilitation, and support services, using a person-centered, recovery-
117based flexible treatment program, as defined by evidence-based standards, including, but not
118limited to, the most current guidelines issued by the federal Substance Abuse and Mental Health
119Services Administration. Practice may also include those modalities specifically designed for 7 of 16
120pediatric patients under the age of 19 that have been adapted from guidelines issued by the
121federal Substance Abuse and Mental Health Services Administration or the National Institute of
122Health.
123 “Behavioral health services”, care and services for the evaluation, diagnosis, treatment or
124management of patients with mental health, developmental or substance use disorders.
125 “Coordinated Specialty Care”, a recovery-oriented treatment program for people with
126first-episode psychosis, as defined by evidence-based standards, including, but not limited to the
127most current guidelines issued by the National Institute of Mental Health. Programs may also
128include those specifically designed for pediatric patients under the age of 19 that have been
129adapted from guidelines issued by the federal Substance Abuse and Mental Health Services
130Administration or the National Institute of Mental Health.
131 “Evidence-based practice”, treatments that are supported by clinical research, including,
132but not limited to, research supporting practice modifications relevant to the treatment of
133pediatric patients.
134 “First episode psychosis treatment”, treatment initiated within 74 weeks of the first time
135an individual experiences an episode of psychosis.
136 “Serious emotional disturbance”, mental, behavioral or emotional disorders in children or
137adolescents under age 19 that have resulted in functional impairment that substantially interferes
138with or limits the child’s role or functioning in family, school or community activities.
139 “Serious mental illness”, mental, behavioral or emotional disorders resulting in serious
140functional impairment that substantially interferes with or limits at least 1 major life activity for 8 of 16
141an individual not less than 19 years old with a psychiatric diagnosis as defined in the American
142Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders.
143 (b) A contract between a subscriber and a nonprofit hospital service corporation under an
144individual or group hospital service plan shall provide coverage for wrap-around coordinated
145specialty care services for first-episode psychosis treatment and assertive community treatment
146for early or ongoing treatment of person with a previous episode of psychosis who has a serious
147mental illness or serious emotional disturbance. Coverage under this section shall not be
148construed as imposing a limit on the number of visits an individual may make to a provider of
149any of the services under this section.
150 (c) Payment for the services performed under the treatment models listed in this section
151shall be based on a bundled treatment model or payment, rather than fee for service payment for
152each separate service delivered by a treatment team member.
153 (d) To determine medical necessity for the treatment approaches under this section,
154neither disability nor functional impairment shall be a precondition to receive the treatment.
155Medical necessity shall be presumed following a recommendation by a licensed physician,
156licensed clinical psychologist, licensed professional clinical counselor or licensed clinical social
157worker.
158 SECTION 6. Chapter 176B of the General Laws is hereby amended by adding the
159following section:-
160 Section 26. (a) For the purposes of this section, the following words shall have the
161following meanings unless the context clearly requires otherwise: 9 of 16
162 “Assertive Community Treatment”, a team-based, evidenced-based treatment practice
163that offers treatment, rehabilitation, and support services, using a person-centered, recovery-
164based flexible treatment program, as defined by evidence-based standards, including, but not
165limited to, the most current guidelines issued by the federal Substance Abuse and Mental Health
166Services Administration. Practice may also include those modalities specifically designed for
167pediatric patients under the age of 19 that have been adapted from guidelines issued by the
168federal Substance Abuse and Mental Health Services Administration or the National Institute of
169Health.
170 “Behavioral health services”, care and services for the evaluation, diagnosis, treatment or
171management of patients with mental health, developmental or substance use disorders.
172 “Coordinated Specialty Care”, a recovery-oriented treatment program for people with
173first-episode psychosis, as defined by evidence-based standards, including, but not limited to the
174most current guidelines issued by the National Institute of Mental Health. Programs may also
175include those specifically designed for pediatric patients under the age of 19 that have been
176adapted from guidelines issued by the federal Substance Abuse and Mental Health Services
177Administration or the National Institute of Mental Health.
178 “Evidence-based practice”, treatments that are supported by clinical research, including,
179but not limited to, research supporting practice modifications relevant to the treatment of
180pediatric patients.
181 “First episode psychosis treatment”, treatment initiated within 74 weeks of the first time
182an individual experiences an episode of psychosis. 10 of 16
183 “Serious emotional disturbance”, mental, behavioral or emotional disorders in children or
184adolescents under age 19 that have resulted in functional impairment that substantially interferes
185with or limits the child’s role or functioning in family, school or community activities.
186 “Serious mental illness”, mental, behavioral or emotional disorders resulting in serious
187functional impairment that substantially interferes with or limits at least 1 major life activity for
188an individual not less than 19 years old with a psychiatric diagnosis as defined in the American
189Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders.
190 (b) A contract between a subscriber and a medical service corporation shall provide
191coverage for wrap-around coordinated specialty care services for first episode psychosis
192treatment and assertive community treatment for early or ongoing treatment of person with a
193previous episode of psychosis who has a serious mental illness or serious emotional disturbance.
194Coverage under this section shall not be construed as imposing a limit on the number of visits an
195individual may make to a provider of any of the services under this section.
196 (c) Payment for the services performed under the treatment models listed in this section
197shall be based on a bundled treatment model or payment, rather than fee for service payment for
198each separate service delivered by a treatment team member.
199 (d) To determine medical necessity for the treatment approaches under this section,
200neither disability nor functional impairment shall be a precondition to receive the treatment.
201Medical necessity shall be presumed following a recommendation by a licensed physician,
202licensed clinical psychologist, licensed professional clinical counselor or licensed clinical social
203worker. 11 of 16
204 SECTION 7. Chapter 176G of the General Laws is hereby amended by adding the
205following section:-
206 Section 34. (a) For the purposes of this section, the following words shall have the
207following meanings unless the context clearly requires otherwise:
208 “Assertive Community Treatment”, a team-based, evidenced-based treatment practice
209that offers treatment, rehabilitation, and support services, using a person-centered, recovery-
210based flexible treatment program, as defined by evidence-based standards, including, but not
211limited to, the most current guidelines issued by the federal Substance Abuse and Mental Health
212Services Administration. Practice may also include those modalities specifically designed for
213pediatric patients under the age of 19 that have been adapted from guidelines issued by the
214federal Substance Abuse and Mental Health Services Administration or the National Institute of
215Health.
216 “Behavioral health services”, care and services for the evaluation, diagnosis, treatment or
217management of patients with mental health, developmental or substance use disorders.
218 “Coordinated Specialty Care”, a recovery-oriented treatment program for people with
219first-episode psychosis, as defined by evidence-based standards, including, but not limited to the
220most current guidelines issued by the National Institute of Mental Health. Programs may also
221include those specifically designed for pediatric patients under the age of 19 that have been
222adapted from guidelines issued by the federal Substance Abuse and Mental Health Services
223Administration or the National Institute of Mental Health. 12 of 16
224 “Evidence-based practice”, treatments that are supported by clinical research, including,
225but not limited to, research supporting practice modifications relevant to the treatment of
226pediatric patients.
227 “First episode psychosis treatment”, treatment initiated within 74 weeks of the first time
228an individual experiences an episode of psychosis.
229 “Serious emotional disturbance”, mental, behavioral or emotional disorders in children or
230adolescents under age 19 that have resulted in functional impairment that substantially interferes
231with or limits the child’s role or functioning in family, school or community activities.
232 “Serious mental illness”, mental, behavioral or emotional disorders resulting in serious
233functional impairment that substantially interferes with or limits at least 1 major life activity for
234an individual not less than 19 years old with a psychiatric diagnosis as defined in the American
235Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders.
236 (b) A contract between a member and a health maintenance organization shall provide
237coverage for wrap-around coordinated specialty care services for first episode psychosis
238treatment and assertive community treatment for early or ongoing treatment of person with a
239previous episode of psychosis who has a serious mental illness or serious emotional disturbance.
240Coverage under this section shall not be construed as imposing a limit on the number of visits an
241individual may make to a provider of any of the services under this section.
242 (c) Payment for the services performed under the treatment models listed in this section
243shall be based on a bundled treatment model or payment, rather than fee for service payment for
244each separate service delivered by a treatment team member. 13 of 16
245 (d) To determine medical necessity for the treatment approaches under this section,
246neither disability nor functional impairment shall be a precondition to receive the treatment.
247Medical necessity shall be presumed following a recommendation by a licensed physician,
248licensed clinical psychologist, licensed professional clinical counselor or licensed clinical social
249worker.
250 SECTION 8. Chapter 176I of the General Laws is hereby amended by adding the
251following section:-
252 Section 14. (a) For the purposes of this section, the following words shall have the
253following meanings unless the context clearly requires otherwise:
254 “Assertive Community Treatment”, a team-based, evidenced-based treatment practice
255that offers treatment, rehabilitation, and support services, using a person-centered, recovery-
256based flexible treatment program, as defined by evidence-based standards, including, but not
257limited to, the most current guidelines issued by the federal Substance Abuse and Mental Health
258Services Administration. Practice may also include those modalities specifically designed for
259pediatric patients under the age of 19 that have been adapted from guidelines issued by the
260federal Substance Abuse and Mental Health Services Administration or the National Institute of
261Health.
262 “Behavioral health services”, care and services for the evaluation, diagnosis, treatment or
263management of patients with mental health, developmental or substance use disorders.
264 “Coordinated Specialty Care”, a recovery-oriented treatment program for people with
265first-episode psychosis, as defined by evidence-based standards, including, but not limited to the
266most current guidelines issued by the National Institute of Mental Health. Programs may also 14 of 16
267include those specifically designed for pediatric patients under the age of 19 that have been
268adapted from guidelines issued by the federal Substance Abuse and Mental Health Services
269Administration or the National Institute of Mental Health.
270 “Evidence-based practice”, treatments that are supported by clinical research, including,
271but not limited to, research supporting practice modifications relevant to the treatment of
272pediatric patients.
273 “First episode psychosis treatment”, treatment initiated within 74 weeks of the first time
274an individual experiences an episode of psychosis.
275 “Serious emotional disturbance”, mental, behavioral or emotional disorders in children or
276adolescents under age 19 that have resulted in functional impairment that substantially interferes
277with or limits the child’s role or functioning in family, school or community activities.
278 “Serious mental illness”, mental, behavioral or emotional disorders resulting in serious
279functional impairment that substantially interferes with or limits at least 1 major life activity for
280an individual not less than 19 years old with a psychiatric diagnosis as defined in the American
281Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders.
282 (b) A preferred provider contract between a covered person and an organization shall
283provide coverage for wrap-around coordinated specialty care services for first episode psychosis
284treatment and assertive community treatment for early or ongoing treatment of person with a
285previous episode of psychosis who has a serious mental illness or serious emotional disturbance.
286Coverage under this section shall not be construed as imposing a limit on the number of visits an
287individual may make to a provider of any of the services under this section. 15 of 16
288 (c) Payment for the services performed under the treatment models listed in this section
289shall be based on a bundled treatment model or payment, rather than fee for service payment for
290each separate service delivered by a treatment team member.
291 (d) To determine medical necessity for the treatment approaches under this section,
292neither disability nor functional impairment shall be a precondition to receive the treatment.
293Medical necessity shall be presumed following a recommendation by a licensed physician,
294licensed clinical psychologist, licensed professional clinical counselor or licensed clinical social
295worker.
296 SECTION 9. Not later than 6 months after the effective date of this act, the division of
297insurance shall convene a working group of insurance companies and mental health treatment
298providers that deliver the bundled treatment approaches listed in section 32 of chapter 32A,
299section 39 of chapter 176A, section 26 of chapter 176B, section 34 of chapter 176G and section
30014 of chapter 176I to determine a coding solution to allow the bundled treatment models to be
301coded and paid for as a bundle of services, similar to bundled payments under a single billing
302code for physical health care.
303 SECTION 10. The group insurance commission, the division of insurance and the health
304connector shall promulgate any regulations necessary to implement this section not later than six
305months after enactment.
306 SECTION 11. All carriers must implement these benefits and demonstrate to the
307Division of Insurance the adequacy of their provider networks for these services by the effective
308date of this act. Any carrier that fails to demonstrate adequate networks of providers of these
309services by the effective date shall: 16 of 16
310 (a) assist any plan member to find an out-of-network CSC program or ACT program and
311to cover those services as if they were furnished in network; and
312 (b) report monthly to the Division of Insurance on the status of their networks, and pay a
313fine of $50,000 per month.
314 SECTION 12. After 5 years following full implementation of this act, the health policy
315commission, the division of insurance and the group insurance commission shall collaborate to
316perform an independent analysis of the impact of the coverage of the team-based treatment
317models provided under this section upon savings in hospitalization costs or other costs and on
318any increase in cost to the group insurance commission, the division of insurance or group
319insurance commission members. The analysis shall review claims payment and plan and
320consumer cost data for the largest group insurance commission plans that comprise at least 80
321per cent of the covered lives at the time of the study.
322 SECTION 13. This act shall take effect 1 year after its passage.