The bill seeks to improve supportive care for individuals with serious mental illnesses by mandating insurance coverage for specific mental health services, particularly targeting those experiencing first-episode psychosis and serious emotional disturbances. It amends various chapters of the General Laws to require qualifying student health insurance plans and individual and group health insurance policies to cover coordinated specialty care services and assertive community treatment. The legislation ensures that there are no limits on the number of visits to providers and establishes a bundled payment model for these services, moving away from a fee-for-service approach. Additionally, it presumes medical necessity for treatment based on licensed mental health professionals' recommendations, without the need for proof of disability or functional impairment.

The bill also introduces definitions for key mental health treatment terms and outlines the responsibilities of insurance carriers to maintain adequate provider networks. It mandates the formation of a working group within six months of enactment to develop a coding solution for bundled treatment models and requires insurance carriers to demonstrate the adequacy of their networks, with penalties for non-compliance. An independent analysis of the impact of these treatment models on hospitalization costs and overall expenses will be conducted five years post-implementation. The act is set to take effect one year after its passage.

Statutes affected:
Bill Text: 15A-18