Massachusetts Legislation

HD 1417 amends Chapter 26 and Chapter 118E of the General Laws by inserting a new section to require certain insurers, including Medicaid Managed Care Organizations, that provide mental health and substance use disorder benefits to submit an annual report to the Commissioner of Insurance (excluding Medicaid Managed Care Organizations), the Attorney General, the clerks of the House and the Senate, and the House and Senate Chairs of the Joint Committee on Mental Health,Substance Use and Recovery a report that demonstrates compliance with the parity requirements according to specified guidelines. Additionally, the bill amends Chapter 26 by striking section 8K and replacing with a provision that requires the Commissioner of Insurance to implement and enforce the Federal Parity Law, its implementing regulations, and state parity requirements. Furthermore, the bill amends Section 16C of Chapter 118E of the General Laws as well as another section by inserting a new paragraph to require the Division of Medical Assitance and the Commissioner of Insurance to submit to the clerks of the House and the Senate, and the House and Senate Chairs of the Joint Committee on Mental Health, Substance Use and Recovery an annual Report detailing enforcement activities. The Commissioner of Insurance must make its report available on a public website.

HD 2970 amends Chapter 118E of the General Laws by inserting a new section 10H to requiring group health insurance policies to provide coverage of hospital and medical expenses from the treatment of substance use disorders, including alcoholism. Such coverage must be provided complaint with parity.

Amends Section 13 of Chapter 176O of the General Laws by inserting a new subsection “e” to require that insurance carriers, when dealing with a grievance involving the denial of a mental health or substance use disorder service, must provide to the beneficiary or their representative a statement that certifies the denial, claim processing and utilization review methods are all in compliance with parity requirements, as well as an explanation pertaining to QTL and NQTLs applied during review.

SD 353 amends Section 108 and Section 110 of chapter 175 of the General Laws by adding new subsections to prohibit individual policies or certificates of coverage under a group policy of short term or long term disability insurance from imposing benefit limitations or exclusions on behavioral health disorders that are not equitably imposed on physical disorders.

Section 1 of H.4808 amends Chapter 118E of the General Laws, as appearing in the 2014 Official Edition, by adding section 10K to mandate the Division of Medical Assistance provide coverage for screenings for postpartum depression in mothers of newborns conducted by pediatricians at visits up to one year from the infant’s birth.

Replaced H.1156; On 7/25/2018, read third and passed to be engrossed.

Replaced S.1086; On 5/31/2018, Accompanied study order S.2535

Section 2 of S.2282 amends Section 1 of Chapter 175, as appearing in the 2016 Official Edition, by adding after the definition of “Domestic company,” in lines 14 and 15, the definition for “emergency services programs,” to encompass all programs subject to contract between the MA Behavioral Health Partnership and nonprofit organizations for the provision of emergency psychiatric services.
Section 1 amends Chapter 32A, Chapter 175, Chapter 176A, Chapter 176B, and Chapter 176G of the General Laws, as appearing in the 2016 Official Edition, by adding, respectively, a new Section 28, Section 47CC, Section 8LL, Section 4LL, and Section 4DD to require the following to offer, in a nondiscriminatory manner, the above benefits for emergency service programs: Group Insurance Commission coverage; individual, group blanket, or general policies; individual or group hospital service; individual and group medical service agreements; and health maintenance contracts.

On 5/24/2018, accompanied study order H.4528

H.2214 amends Chapter 118E of the General Laws by adding section 10H to require group health insurance policies providing coverage for medical or hospital expenses to cover services for substance use disorders no more restrictively or limited than is done for other medical conditions.

On 7/18/2018, accompanied study order H.4778

H.3878 amends state insurance code to expand the definition of a “licensed mental health professional” to include licensed rehabilitation counselors acting within their lawful scope of practice.
H.3878 amends Chapter 32A, Chapter 175, Chapter 176A, Chapter 176B, and Chapter 176G of the General Laws by adding respectively a new section to Section 22, Section 47B, Section 8A, Section 4A, and Section 4M to apply the above to the following: Group Insurance Commission coverage; individual, group blanket, or general insurance plans and small group health benefit plans; contracts between a subscriber and the corporation under an individual or group hospital service plan; individual or group medical service agreements; and health maintenance contracts.

On 5/24/2018, accompanied study order H.4528

H.3463 amends Chapter 118E of the General Laws by adding section 10K to require Medicaid coverage for services provided by a nurse specifically assigned to monitor and treat the behavioral and emotional needs of persons younger than 21 when such individual is receiving medically necessary, comprehensive, community-based behavioral health services for a severe emotional disturbance.

H.431/S.2403 amends Chapter 32A of the General Laws by adding Section 4B; Chapter 118E of the General Laws by adding Section 38A; Chapter 175, Section 108; Chapter 176A of the General Laws by adding Section 8A; Chapter 176B of the General Laws, Section 7D; and Chapter 176G of the General Laws, Section 6B to limit and set the circumstances in which retroactive claim denials may be imposed on mental health and substance use disorder services. Additionally, the bills amend Chapter 17 of the General Law, Section 5, to include definitions for “behavioral health” and “retroactive claim denial.” Lastly, the bills authorize and direct the División of Medical Assistance to develop an internal process for the reconciliation of claims due to retroactive eligibility changes and/or duplicate enrollments in qualifying cases. The Division must submit a report to the Senate and House Committees on Ways and Means on this process.

On 4/30/2018, accompanied study order S.2496

Section 1 of S517 amends Section 13 of chapter 176O of the general laws by adding subsection (D) to require insurers, following any grievance involving a denial for a mental health or substance use disorder service, provide to the insured a statement certifying that the denial or utilization review origination, the quantitative and nonquantitative treatment limitations applied during review, and the claim processing and utilization review methods are all compliant with state parity requirements.

On 7/18/18, this bill accompanied a study order and H.4778.

H.2958 amends General Law Chapter 176O by inserting, after section 4, provisions that: 1) require insurers to include in its network any licensed mental health or substance use provider within the geographic coverage area if the provider is willing to meet the insurer’s terms and conditions; 2) prohibit health benefit plans from establishing any rate, term or condition that places a greater financial burden on an insured for access to treatment for a mental health condition than for access to treatment for a physical health condition; and 3) support the right of health care consumers to receive treatment of a mental health condition from a provider of their choice provided that the provider is licensed and certified adequately.

On 4/20/18, S.555 accompanied study order S.2496. On 7/18/18, H.485 accompanied study order H.4778.

Both bills amend Section 108 of Chapter 175 of the General Laws by adding a provision that prohibits individual short term or long-term disability plans providing income replacement benefits from imposing benefit limitations or exclusions on behavioral health disorders that are not equally imposed on physical disorders. Additionally, both bills amend Section 110 of Chapter 175 of the General Laws by prohibiting the same practice within certificates of coverage under group policies for short term or long-term disability insurance plans.

On 3/26/18, H.2179 accompanied a new draft. See H.4332. On 4/17/18, S.1095 accompanied a study order. See S.2439.

H.2179/S.1095 mandates coverage for telemedicine behavioral health services under certain circumstances. Specifically, the bills require: plans under group insurance commission coverage; plans administered by Medicaid managed care organizations; plans issued, delivered or renewed with the commonwealth that provide medical expense coverage; any contract between the subscriber and the corporation under an individual or group hospital service plan; any subscription certificate under an individual or group medical service agreement; or any individual or group health maintenance contract to offer coverage of telemedicine for behavioral health services at a reimbursement rate no less than that for in-person consultation or delivery of services, by adding Chapter 32A, Section 17P; Chapter 118E, Section 10K; Chapter 175, Section 47JJ; Chapter 176A, Section 8LL; Chapter 176B, Section 4LL; and Chapter 176G, Section 4 DD, respectively, as appearing in the 2014 Official Edition.

On 6/4/18, H.2399 accompanied a study order. See H.4557. On 5/31/18, S.624 accompanied a study order. See S.2535.

H.2399/S.624 amend Chapter 118E, Chapter 12 of the General Laws, as appearing in the 2014 Official Edition, by requiring the Division of Medical Assistance to certify all contracted accountable care organizations, contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third party administrators under contract to a Medicaid managed care organization or primary care clinician provide comparable access to behavioral health services, benefits, and medications. Additionally, the Division must obtain approval from the Executive Office of Health and Human Services for all behavioral health services, benefits, and medications, including but not limited to policies, standards, contract specifications, utilization review and utilization management, etc. used by the above entities.

On 5/24/18, this bill accompanied a study order. See H.4528.

Section 1 amends Section 12 of Chapter 118E of the General Laws, as appearing in the 2014 Official Edition, by inserting a new paragraph to require any entity under contract with the Division of Medical Assistance or associated health maintenance organization to provide to the Center for Health Information and Analysis and the Executive Office of Administration and Finance a copy of any sub-contracts or agreements with other entities concerning the administration or management of mental health and substance use disorder benefits. Additionally, such entities and subcontracted entities must also file with the Executive Office of Administration and Finance and submit a statement of the total compensation or income of its ten highest paid executives, employees, partners or shareholders.

On 4/30/2018, accompanied study order S.2496/H.4778

H.488/S.547 amends the General Laws to require the plans listed below to provide comparable coverage for community and home-based services for children under 21 diagnosed with a serious emotional disturbance. Scope and array of these services should reflect the Court’s judgment and remediation plan in the Rosie D. matter.
H.488/S.547 amends Chapter 32A, Chapter 175, Chapter 176A, Chapter 176B,and Chapter 176G of the General Laws by adding, respectively, a new Section 22a, Section 47EE, Section 8GG, Section 4GG, and Section 4Y to require the above for: Group Insurance Commission; individual, group blanket, or general insurance plans and small group health benefit plans for subject to chapter 176J and nongroup health benefit plans subject to chapter 176M, subscription certificates under an individual or group medical service agreements and health maintenance contracts.

On 7/8/2018, accompanied study order H.4778

H.2182 amends state code to require insurers offering coverage for substance use disorder services to provide coverage for such services delivered by a certified addiction recovery coach, defined as those certified by and in good standing with the Massachusetts Board of Substance Abuse Counselor Certification, acting as part of a substance abuse treatment team and under the supervision of qualified supervisory staff.
Section 1 amends Chapter 32A, Chapter 118E, Chapter 175, Chapter 176A, Chapter 176B, and Chapter 176G of the General Laws, as appearing in the 2014 Official edition, by adding a new section 17P, Section 10K, Section 47JJ, Section 8LL, Section 4LL, and Section 4DD to require the above for: Group Insurance Commission coverage; the Division of Health Insurance and its contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third party administrators under contract to a Medicaid managed care organizations or primary care clinician plans; all policies, contracts, agreements, plans or certificates of insurance issued, delivered or renewed within Massachusetts that provides medical expense coverage; any contract between a subscriber and the corporation under an individual or group hospital service plan; any subscription certificate under an individual or group medical service agreement; and any individual or group health maintenance contract.

On 6/18/2018, accompanied study order H.4624

H. 2394 amends the insurance code to require insurers to increase coverage for inpatient substance use disorder treatment from a minimum of 14 days to a minimum of 30 days.
H. 2394 amends sections 9, 19, 21, 23, 25, and 27 of Chapter 258 of the Acts of 2014 to require the above to the following: Group Insurance Commission coverage; the Division of Insurance and its contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third party administrators under contract to a Medicaid managed care organization or primary care clinician plan; any policy, contract, agreement, plan or certificate of insurance which is considered credible coverage; any individual or group hospital service plan; any subscription certificate under an individual or group medical service agreement; individual or group health maintenance contract.

This bill amends state Medicaid law so that Medicaid managed care organizations must provide coverage for mental health and substance use disorder treatment with limitations no more restrictive than those imposed on coverage for medical and surgical conditions. All quantitative and nonquantiative treatment limitations and financial requirements imposed on mental health substance use disorder treatments must be similar to those imposed on other medical conditions.

• The denial is in compliance with state parity requirements
• The quantitative and non-quantitative treatment limitation applied during utilization review, and how they comply with state and federal parity requirements
• A certification that the insurer’s claim processing and utilization review methods are compliant with the parity requirements listed above

• Less than 6 months have passed since the submission of the claim by the provider
• An explanation for the denial and a description of additional documents or corrective actions that could be taken to attain payment are provided
• The claim was fraudulent
• The claim is subject to adjustment due to the expected payment from another payer and more than 12 months have passed
• The claim is subject to legal action

• Provide coverage for buprenorphine, injectable naltrexone, and methadone treatment programs, provided that copayments for methadone treatment program do not exceed 20% of the toal reimbursement paid to the provider
• Provide reimbursement for methadone treatment programs for buprenorphine and injectable naltrexone.

Section 43 requires the Office of Patient Protection to report overturned behavioral health care denials to the Division of Insurance. The Division is then required to review all denials for compliance with the Federal Parity Law and the parity sections of state law. If the Division finds a violation, the Office of Patient Protection must overturn the denial and the insurer will be fined no less than $25,000 per violation. If the department finds a pattern of violations, the fine will increase to $100,000 per occurrence. The bill also requires the Division of Insurance to post a public notice on their website if they find a denial and the Office of Patient Protection to post statistics on behavioral health reviews of insurers. This section is identical to multiple other bills from this legislative session and previous sessions.

• Prohibiting blanket exclusions of intermediate levels of care, such as residential services and requiring benefits consist of a range of inpatient, intermediate, and outpatient services
• Requiring sufficient network adequacy to deliver all range of services in a reasonable period of time
• Prohibiting insurers from using utilization review criteria and guidelines that “unduly” restrict access to mental health and substance use disorder care, as determined by the Commissioner of Insurance. Such criteria and guidelines must be made available upon any request.

This bill seeks to increase substance use disorder prevention efforts. Multiple sections target parity compliance. Section 40 requires that an insurer must provide a statement explaining that any denial for a mental health service is in compliance with the Federal Parity Law and the parity sections of state law, including the application of treatment limitations.
Section 43 requires the Office of Patient Protection to report overturned behavioral health care denials to the Division of Insurance. The Division is then required to review all denials for compliance with the Federal Parity Law and the parity sections of state law. If the Division finds a violation, the Office of Patient Protection must overturn the denial and the insurer will be fined no less than $25,000 per violation. If the Division finds a pattern of violations, the fine will increase to $100,000 per occurrence. The bill also requires the Division of Insurance to post a public notice on their website if they find a denial and the Office of Patient Protection to post statistics on behavioral health reviews of insurers. This section is identical to multiple other bills from this legislative session and previous sessions.

This bill seeks to require insurance plans to disclose several things to consumers in a letter:

Contact information for the Office of Patient Protection
The consumer’s right to file a grievance with that office
How to file a grievance

The bill specifies the Office of Patient Protection should report any overturned or partially overturned denials to the Division of Insurance (DOI) so that the DOI may determine if the denial constitutes a violation of parity laws. If a denial does violate parity laws, the DOI will conduct an investigation.

The bill also mandates the DOI to levy fines of no less than $25,000 for confirmed violations and $100,000 for plans that demonstrate a pattern of violating parity laws.

The bill specifies the Office of Patient Protection will post statistics on its website regarding behavioral health reviews by insurer and plan. The DOI will post notices of insurance plans that have been found to violate parity laws.

Section 43 requires the Office of Patient Protection to report overturned behavioral health care denials to the Division of Insurance. The Division is then required to review all denials for compliance with the Federal Parity Law and the parity sections of state law. If the Division finds a violation, the Office of Patient Protection must overturn the denial and the insurer will be fined no less than $25,000 per violation. If the Division finds a pattern of violations, the fine will increase to $100,000 per occurrence. The bill also requires the Division of Insurance to post a public notice on their website if they find a denial and the Office of Patient Protection to post statistics on behavioral health reviews of insurers. This section is identical to multiple other bills from this legislative session and previous sessions.

This bill tries to require plans to cover medically necessary emergency behavioral health services in a “non-discriminatory basis.”

1. That the denial of coverage complies with state law
2. That quantitative treatment limitations and non-quantitative treatment limitations applied comply with state law and the Federal Parity Law
3. That the plan’s processing and utilization management methods comply with state and federal parity requirements

This bill seeks to provide consumers the opportunity to seek additional legal action for parity violations. This bill is designed to eliminate gaps by allowing individuals to challenge the inequalities in Superior Court, providing legal backing for individuals seeking damages. This bill is the same as S. 1959 from the 2013-14 session, which is listed below.

This bill creates a new division of health insurance with the authority to implement and enforce federal and state mental health parity laws.

This bill seeks to require state Medicaid plans to offer coverage for behavioral health services under the same terms and conditions as coverage for other medical care. The bill specifies that treatment limitations , limits on total payments for treatment, limits on duration of treatment or financial requirements must be the same as what they are for other medical services.

This bill tries to create parity for short-term and long-term disability benefits. This would prohibit insurers from placing limitations and exclusions on income replacement benefits for behavioral health disability claims if those same terms are not in place for other medical disability claims.

This was a proposed appropriations bill with a section on parity enforcement. The bill required the Office of Patient Protection to report overturned behavioral health care denials to the Division of Insurance. The Division is then required to review all denials for compliance with the Federal Parity Law and the parity sections of state law. If the Division finds a violation, the Office of Patient Protection must overturn the denial and the insurer will be fined no less than $25,000 per violation. If the division finds a pattern of violations, the fine will increase to $100,000 per occurrence. The bill also requires the Division of Insurance to post a public notice on their website if they find a denial and the Office of Patient Protection to post statistics on behavioral health reviews of insurers. This section is identical to multiple other bills from this legislative session and previous sessions.

• The costs associated with prohibiting disability plans from imposing benefit treatment limitations for individuals with behavioral health disorders in situations where no such limitation exists for individuals with physical health disorders
• The number of available insurance products that in compliance with the Federal Parity Law and the parity sections of state law
• The feasibility of offering a notification to policyholders explaining benefit limitations

This bill tried to provide consumers the opportunity to seek additional legal action for parity violations. This bill was designed to eliminate gaps by allowing individuals to challenge the inequalities in Superior Court, providing legal backing for individuals seeking damages.

This bill tried to create parity for short-term and long-term disability benefits. This would have prohibited insurers from placing treatment limitations and exclusions on income replacement benefits for behavioral health disability claims if those same terms were not in place for other medical disability claims.

This bill tried to require plans to cover emergency psychiatric services that are medically necessary in a non-discriminatory way.

The first section of this bill tried to require the Office of Medicaid and the Commissioner of Insurance to issue regulations that would eliminate any prior authorization requirements for emergency treatment of a behavioral health condition.
The fourth section of this bill tried to require plans to cover behavioral health evaluation and management services provided in an emergency department to the same extent that they do in another setting, regardless of the specialty of the provider in the emergency department.
The fifth section of this bill tried to require plans to cover telemedicine psychiatric services at the same rate as in-person psychiatric services.

This bill tried to strengthen parity compliance with language that specifically forbade any quantitative treatment limitations and financial requirements for behavioral services if they are not in place for other medical services.

This was an appropriations bill. Section 8 required the Department of Mental Health to hire an independent consultant to evaluate public and private behavioral health care services in many areas, including compliance with the Federal Parity Law and the parity sections of state law.

1. The payment and reimbursement of behavioral health care services
2. The implementation of state and federal mental health parity laws
3. The prior authorization and adverse determination requirements related to the coverage of behavioral health care services

This bill tried to amend the Massachusetts state parity law so that insurers would be required to inform patients of their right to a pre-service review for treatment coverage. A post-service review that denied payment would be considered invalid if the patient had not been told about the pre-service review option.

This bill prohibits both individual and group disability insurance plans from imposing treatment limitations for behavioral health disorders if those limitations are not imposed for physical health disorders. This bill is similar to H.786 introduced during the 2015-2016 legislative cycle.

This bill required the Office of Medicaid to develop regulations on the Federal Parity Law by 10/2011.

This bill tried to amend the the parity sections of state law so insurers would have to provide coverage for any biologically-based mental disorder that is in the Diagnostic and Statistical Manual of Mental Disorders and approved by the commissioners of the Department of Mental Health and the Division of Insurance. Currently, the Massachusetts state parity law does not require insurers to cover certain conditions, such as anxiety disorders.