Massachusetts governor signs law to overhaul mental health coverage, reform prior authorization

Massachusetts Gov. Charlie Baker signed legislation Aug. 10 that overhauls the state's mental/behavioral healthcare delivery system and reforms prior authorization practices within the specialty. 

Eight insurance provisions in the new law:

  1. Payers are now required to cover an annual mental health wellness exam.

  2. State agencies now have more tools to implement and enforce mental health parity laws. 

  3. The law creates an equitable base reimbursement rate between mental health and primary care providers. 

  4. Payers must cover mental health acute treatments and stabilization services. Prior authorization is also eliminated for these services. If an insurer decides to change policies around what is considered medically necessary, that change must be easily found on the insurer's website.

  5. Payers must cover emergency service programs, community-based and recovery programs for behavioral crisis assessments, interventions and stabilization services.

  6. State-contracted and commercial payers must cover mental health and substance abuse benefits under the psychiatric collaborative care model, an integrated behavioral health service delivery method.

  7. The Health Policy Commission and the Massachusetts Division of Insurance must study and provide recent data about "carve-outs," or when payers contract with behavioral health benefit managers.

  8. Any individual with disabilities who is 26 and older can stay on their parents' health plan.

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