H1135 — An Act for supportive care for serious mental illness

Summary

An Act for supportive care for serious mental illness

Bill Text

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• Section 18 of chapter 15A

  Notwithstanding any general or special law to the contrary, any qualifying student health insurance plan authorized under this chapter shall provide coverage for coordinated specialty care services and assertive community treatment service as described under section 4FF of chapter 176G.

  This adds a requirement for student health insurance plans to cover specific mental health services.

• Chapter 32A

  Section 34. (a) For the purposes of this section, the following words shall have the following meanings unless the context clearly requires otherwise: ... [Definitions for Assertive Community Treatment, Behavioral health services, Coordinated Specialty Care, Evidence-based practice, First episode psychosis treatment, Serious emotional disturbance, Serious mental illness] ... (b) Coverage offered by the commission to an active or retired employee of the commonwealth insured under the group insurance commission shall provide coverage for wrap-around coordinated specialty care services for first episode psychosis treatment and assertive community treatment for early or ongoing treatment of a person with a previous episode of psychosis who has a serious mental illness or serious emotional disturbance. Coverage under this section shall not be construed as imposing a limit on the number of visits an individual may make to a provider of any of the services under this section. (c) Payment for the services performed under the treatment models listed in this section shall be based on a bundled treatment model or payment, rather than fee-for-service payment for each separate service delivered by a treatment team member. (d) To determine medical necessity for the treatment approaches under this section, neither disability nor functional impairment shall be a precondition to receive the treatment. Medical necessity shall be presumed following a recommendation by a licensed physician, licensed clinical psychologist, licensed professional clinical counselor or licensed clinical social worker.

  This creates new sections in Chapter 32A establishing definitions and coverage requirements for mental health treatment services.

• Chapter 112

  Section 9L. To credential the mental health professionals and other members of the multidisciplinary coordinated specialty care treatment team or an assertive community treatment team as described under section 32 of chapter 32A, section 39 of chapter 176A, section 26 of chapter 176B, section 34 of chapter 176G and section 14 of chapter 176I, the credentialing of the psychiatrist or the licensed clinical leader of the treatment team shall qualify all members of the treatment team to be credentialed with the insurer.

  This requires credentialing standards for mental health treatment teams to ensure all members are recognized by insurers.

• Chapter 175

  Section 47OO. (a) For the purposes of this section, the following words shall have the following meanings unless the context clearly requires otherwise: ... [Definitions for Assertive Community Treatment, Behavioral health services, Coordinated Specialty Care, Evidence-based practice, First episode psychosis treatment, Serious emotional disturbance, Serious mental illness] ... (b) An individual policy of accident and sickness insurance issued under section 108 that provides hospital expense and surgical expense insurance and any group blanket or general policy of accident and sickness insurance issued under section 110 that provides hospital expense and surgical expense insurance that is issued or renewed within or without the commonwealth shall provide coverage for wrap-around coordinated specialty care services for first episode psychosis treatment and assertive community treatment for early or ongoing treatment of person with a previous episode of psychosis who has a serious mental illness or serious emotional disturbance. Coverage under this section shall not be construed as imposing a limit on the number of visits an individual may make to a provider of any of the services under this section. (c) Payment for the services performed under the treatment models listed in this section shall be based on a bundled treatment model or payment, rather than fee-for-service payment for each separate service delivered by a treatment team member. (d) To determine medical necessity for the treatment approaches under this section, neither disability nor functional impairment shall be a precondition to receive the treatment. Medical necessity shall be presumed following a recommendation by a licensed physician, licensed clinical psychologist, licensed professional clinical counselor or licensed clinical social worker.

  This establishes similar mental health service coverage and definitions in Chapter 175 for insurance policies.

• Chapter 176A

  Section 39. (a) For the purposes of this section, the following words shall have the following meanings unless the context clearly requires otherwise: ... [Definitions for Assertive Community Treatment, Behavioral health services, Coordinated Specialty Care, Evidence-based practice, First episode psychosis treatment, Serious emotional disturbance, Serious mental illness] ... (b) A contract between a subscriber and a nonprofit hospital service corporation under an individual or group hospital service plan shall provide coverage for wrap-around coordinated specialty care services for first-episode psychosis treatment and assertive community treatment for early or ongoing treatment of person with a previous episode of psychosis who has a serious mental illness or serious emotional disturbance. Coverage under this section shall not be construed as imposing a limit on the number of visits an individual may make to a provider of any of the services under this section.

  This introduces new requirements for nonprofit hospital service corporation contracts to cover specified mental health services.

Sponsors

• Marjorie C. Decker · Primary

Subjects