Be it enacted by the Senate and House
of Representatives in General Court assembled, and by the authority of the
same, as follows:
SECTION 1. Chapter 32A of the General Laws is hereby amended by striking out section 22, as appearing in the 2006 Official Edition, and inserting in place thereof the following section:—
Section 22. (a) For the purposes of this section, the following words shall have the following meanings:—
“Licensed mental health professional”, a licensed physician who specializes in the practice of psychiatry, a licensed psychologist, a licensed independent clinical social worker, a licensed mental health counselor, or a licensed nurse mental health clinical specialist.
“Nondiscriminatory coverage”, coverage that does not contain any annual or lifetime dollar or unit of service limitation for the diagnosis and treatment of mental disorders that is less than any annual or lifetime dollar or unit of service limitation imposed for the diagnosis and treatment of physical conditions.
(b) The commission shall provide health plans to any active or retired employee of the commonwealth insured under the commission that include nondiscriminatory coverage for the diagnosis and medically necessary and active treatment of mental disorders and alcoholism and other drug abuse and dependence disorders, as described in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association.
(c) In addition to the coverage established pursuant to this section, any health plan offered by the commission shall also provide coverage on a non-discriminatory basis for the diagnosis and treatment of rape-related mental or emotional disorders to victims of a rape or victims of an assault with intent to commit rape, as defined by sections 22 and 24 of chapter 265, whenever the costs of such diagnosis and treatment exceed the maximum compensation awarded to such victims pursuant to subparagraph (C) of paragraph (2) of subsection (b) of section 3 of chapter 258C.
(d) Coverage provided under this section shall: (i) consist of a range of inpatient, intermediate, and outpatient services; and (ii) permit noncustodial treatment to take place in the least restrictive, clinically appropriate setting.
Inpatient services may be provided in a general hospital licensed to provide such services, in a facility under the direction and supervision of the department of mental health, in a private mental hospital licensed by the department of mental health, or in a substance abuse facility licensed by the department of public health.
Intermediate services shall include, but need not be limited to, community-based detoxification, acute residential treatment, partial hospitalization, day treatment and crisis stabilization licensed or approved by the department of public health or the department of mental health.
Outpatient services may be provided in a licensed hospital, a mental health or substance abuse clinic licensed by the department of public health, a public community mental health center, a professional office, or as home-based services; provided, however, these services are provided by a licensed mental health professional acting within the scope of license.
(e) The commission may, as a condition of providing coverage under this section, require consent to the disclosure of information for mental disorders only to the extent required for other medical conditions.
(f) Coverage provided under this section may be denied only by licensed mental health professionals. This subsection shall not apply to denials due to the insured’s lack of insurance coverage or use of a facility or professional that has not entered into a negotiated agreement with the health plan.
(g) Coverage provided under this section shall meet all other terms and conditions of the health plan not inconsistent with this section.
(h) The commission shall not be required under this section to pay for: (i) services provided to a person who is presently incarcerated, confined or committed to a jail, house of correction or prison, or custodial facility in the department of youth services; (ii) special education services provided by a school committee under section 5 of chapter 71B; or (iii) services provided by the department of mental health.
(i) Psychopharmacological services and neuropsychological assessment services shall be treated as a medical benefit and shall be covered in a manner identical to all other medical services.
SECTION 2. Chapter 175 of the General Laws is hereby amended by striking out section 47B, as so appearing, and inserting in place thereof the following section:—
Section 47B. (a) For the purposes of this section, the following words shall have the following meanings:—
“Licensed mental health professional”, a licensed physician who specializes in the practice of psychiatry, a licensed psychologist, a licensed independent clinical social worker, a licensed mental health counselor, or a licensed nurse mental health clinical specialist.
“Nondiscriminatory coverage”, coverage that does not contain any annual or lifetime dollar or unit of service limitation for the diagnosis and treatment of mental disorders that is less than any annual or lifetime dollar or unit of service limitation imposed for the diagnosis and treatment of physical conditions.
(b) Any 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, which is issued or renewed within or without the commonwealth, shall provide to residents of the commonwealth and to all policyholders having a principal place of employment in the commonwealth nondiscriminatory coverage for the diagnosis and medically necessary and active treatment of mental disorders and alcoholism and other drug abuse and dependence disorders, as described in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association.
(c) In addition to the mental health benefits established pursuant to this section, any such policy shall also provide benefits on a non-discriminatory basis for the diagnosis and treatment of rape-related mental or emotional disorders to victims of a rape or victims of an assault with intent to commit rape, as defined by sections 22 and 24 of chapter 265, whenever the costs of such diagnosis and treatment exceed the maximum compensation awarded to such victims pursuant to subparagraph (C) of paragraph (2) of subsection (b) of section 3 of chapter 258C.
(d) Coverage provided under this section shall: (i) consist of a range of inpatient, intermediate, and outpatient services; and (ii) permit noncustodial treatment to take place in the least restrictive, clinically appropriate setting.
Inpatient services may be provided in a general hospital licensed to provide such services, in a facility under the direction and supervision of the department of mental health, in a private mental hospital licensed by the department of mental health, or in a substance abuse facility licensed by the department of public health.
Intermediate services shall include, but need not be limited to, community-based detoxification, acute residential treatment, partial hospitalization, day treatment and crisis stabilization licensed or approved by the department of public health or the department of mental health.
Outpatient services may be provided in a licensed hospital, a mental health or substance abuse clinic licensed by the department of public health, a public community mental health center, a professional office, or as home-based services; provided, however, these services are provided by a licensed mental health professional acting within the scope of license.
(e) An insurer may, as a condition of providing coverage under this section, require consent to the disclosure of information for mental disorders only to the extent required for other medical conditions.
(f) Coverage provided under this section may be denied only by licensed mental health professionals. This subsection shall not apply to denials due to the insured's lack of insurance coverage or use of a facility or professional that has not entered into a negotiated agreement with the insurer.
(g) Coverage provided under this section shall meet all other terms and conditions of the policy not inconsistent with this section.
(h) An insurer shall not be required under this section to pay for: (i) services provided to a person who is presently incarcerated, confined or committed to a jail, house of correction or prison, or custodial facility in the department of youth services; (ii) special education services provided by a school committee under section 5 of chapter 71B; or (iii) services provided by the department of mental health.
(i) Psychopharmacological services and neuropsychological assessment services shall be treated as a medical benefit and shall be covered in a manner identical to all other medical services.
SECTION 3. Section 110 of said chapter 175, as so appearing, is hereby amended by striking out subdivision (H).
SECTION 4. Chapter 176A of the General Laws is hereby amended by striking out section 8A, as so appearing, and inserting in place thereof the following section:—
Section 8A. (a) For the purposes of this section, the following words shall have the following meanings:—
“Licensed mental health professional”, a licensed physician who specializes in the practice of psychiatry, a licensed psychologist, a licensed independent clinical social worker, a licensed mental health counselor, or a licensed nurse mental health clinical specialist.
“Nondiscriminatory coverage”, coverage that does not contain any annual or lifetime dollar or unit of service limitation for the diagnosis and treatment of mental disorders that is less than any annual or lifetime dollar or unit of service limitation imposed for the diagnosis and treatment of physical conditions.
(b) Any contract between a subscriber and the corporation under an individual or group hospital service plan which is issued or renewed within or without the commonwealth shall provide to residents of the commonwealth and to all individual subscribers and members and group members having a principal place of employment in the commonwealth nondiscriminatory coverage for the diagnosis and medically necessary and active treatment of mental disorders and alcoholism and other drug abuse and dependence disorders, as described in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association.
(c) In addition to the mental health benefits established pursuant to this section, any such contract shall also provide benefits on a non-discriminatory basis for the diagnosis and treatment of rape-related mental or emotional disorders to victims of a rape or victims of an assault with intent to commit rape, as defined by sections 22 and 24 of chapter 265, whenever the costs of such diagnosis and treatment exceed the maximum compensation awarded to such victims pursuant to subparagraph (C) of paragraph (2) of subsection (b) of section 3 of chapter 258C.
(d) Coverage provided under this section shall: (i) consist of a range of inpatient, intermediate, and outpatient services; and (ii) permit noncustodial treatment to take place in the least restrictive, clinically appropriate setting.
Inpatient services may be provided in a general hospital licensed to provide such services, in a facility under the direction and supervision of the department of mental health, in a private mental hospital licensed by the department of mental health, or in a substance abuse facility licensed by the department of public health.
Intermediate services shall include, but need not be limited to, community-based detoxification, acute residential treatment, partial hospitalization, day treatment and crisis stabilization licensed or approved by the department of public health or the department of mental health.
Outpatient services may be provided in a licensed hospital, a mental health or substance abuse clinic licensed by the department of public health, a public community mental health center, a professional office, or as home-based services; provided, however, these services are provided by a licensed mental health professional acting within the scope of license.
(e) A nonprofit hospital service corporation may, as a condition of providing coverage under this section, require consent to the disclosure of information for mental disorders only to the extent required for other medical conditions.
(f) Coverage provided under this section may be denied only by licensed mental health professionals. This subsection shall not apply to denials due to the insured’s lack of insurance coverage or use of a facility or professional that has not entered into a negotiated agreement with the hospital service corporation.
(g) Coverage provided under this section shall meet all other terms and conditions of the contract not inconsistent with this section.
(h) A non-profit hospital service corporation shall not be required under this section to pay for: (i) services provided to a person who is presently incarcerated, confined or committed to a jail, house of correction or prison, or custodial facility in the department of youth services; (ii) special education services provided by a school committee under section 5 of chapter 71B; or (iii) services provided by the department of mental health.
(i) Psychopharmacological services and neuropsychological assessment services shall be treated as a medical benefit and shall be covered in a manner identical to all other medical services.
SECTION 5. Section 10 of said chapter 176A, as so appearing, is hereby further amended by striking out the fourth paragraph.
SECTION 6. Chapter 176B of the General Laws is hereby amended by striking out section 4A, as so appearing, and inserting in place thereof the following section:—
Section 4A. (a) For the purposes of this section, the following words shall have the following meanings:—
“Licensed mental health professional”, a licensed physician who specializes in the practice of psychiatry, a licensed psychologist, a licensed independent clinical social worker, a licensed mental health counselor, or a licensed nurse mental health clinical specialist.
“Nondiscriminatory coverage”, coverage that does not contain any annual or lifetime dollar or unit of service limitation for the diagnosis and treatment of mental disorders that is less than any annual or lifetime dollar or unit of service limitation imposed for the diagnosis and treatment of physical conditions.
(b) Any subscription certificate under an individual or group medical service agreement which is issued or renewed within or without the commonwealth shall provide to residents of the commonwealth and to all individual subscribers and members within the commonwealth and to all group members having a principal place of employment in the commonwealth nondiscriminatory coverage for the diagnosis and medically necessary and active treatment of mental disorders and alcoholism and other drug abuse and dependence disorders, as described in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association.
(c) In addition to the mental health benefits established pursuant to this section, any such subscription certificate shall also provide benefits on a non-discriminatory basis for the diagnosis and treatment of rape-related mental or emotional disorders to victims of a rape or victims of an assault with intent to commit rape, as defined by sections 22 and 24 of chapter 265, whenever the costs of such diagnosis and treatment exceed the maximum compensation awarded to such victims pursuant to subparagraph (C) of paragraph (2) of subsection (b) of section 3 of chapter 258C.
(d) Coverage provided under this section shall: (i) consist of a range of inpatient, intermediate, and outpatient services; and (ii) permit noncustodial treatment to take place in the least restrictive, clinically appropriate setting.
Inpatient services may be provided in a general hospital licensed to provide such services, in a facility under the direction and supervision of the department of mental health, in a private mental hospital licensed by the department of mental health, or in a substance abuse facility licensed by the department of public health.
Intermediate services shall include, but need not be limited to, community-based detoxification, acute residential treatment, partial hospitalization, day treatment and crisis stabilization licensed or approved by the department of public health or the department of mental health.
Outpatient services may be provided in a licensed hospital, a mental health or substance abuse clinic licensed by the department of public health, a public community mental health center, a professional office, or as home-based services; provided, however, these services are provided by a licensed mental health professional acting within the scope of license.
(e) A nonprofit medical service corporation may, as a condition of providing coverage under this section, require consent to the disclosure of information for mental disorders only to the extent required for other medical conditions.
(f) Coverage provided under this section may be denied only by licensed mental health professionals. This subsection shall not apply to denials due to the insured's lack of insurance coverage or use of a facility or professional that has not entered into a negotiated agreement with the medical service corporation.
(g) Coverage provided under this section shall meet all other terms and conditions of the subscription certificate not inconsistent with this section.
(h) A non-profit medical service corporation shall not be required under this section to pay for: (i) services provided to a person who is presently incarcerated, confined or committed to a jail, house of correction or prison, or custodial facility in the department of youth services; (ii) special education services provided by a school committee under section 5 of chapter 71B; or (iii) services provided by the department of mental health.
(i) Psychopharmacological services and neuropsychological assessment services shall be treated as a medical benefit and shall be covered in a manner identical to all other medical services.
SECTION 7. Section 4A ½ of said chapter 176B is hereby repealed.
SECTION 8. Section 4 of chapter 176G of the General Laws, as so appearing, is hereby amended by striking out the first paragraph and inserting in place thereof the following paragraph:—
Any health maintenance contract shall provide coverage for: (i) pregnant women, infants and children as set forth in section 47C of chapter 175; (ii) cardiac rehabilitation as set forth in section 47D of chapter 175; (iii) prenatal care, childbirth and postpartum care as set forth in section 47F of chapter 175; (iv) cytologic screening and mammographic examination as set forth in section 47G of chapter 175; (v) diagnosis and treatment of infertility as set forth in section 47H of chapter 175; and (vi) services rendered by a certified registered nurse anesthetist or nurse practitioner as set forth in section 47Q of chapter 175, subject to the terms of a negotiated agreement between the health maintenance organization and the provider of health care services.
SECTION 9. Said chapter 176G is hereby further amended by striking out section 4M, as so appearing, and inserting in place thereof the following section:—
Section 4M. (a) For the purposes of this section, the following words shall have the following meanings:—
“Licensed mental health professional”, a licensed physician who specializes in the practice of psychiatry, a licensed psychologist, a licensed independent clinical social worker, a licensed mental health counselor, or a licensed nurse mental health clinical specialist.
“Nondiscriminatory coverage”, coverage that does not contain any annual or lifetime dollar or unit of service limitation for the diagnosis and treatment of mental disorders that is less than any annual or lifetime dollar or unit of service limitation imposed for the diagnosis and treatment of physical conditions.
(b) A health maintenance contract issued or renewed within or without the commonwealth shall provide to residents of the commonwealth and to all members or enrollees having a principal place of employment in the commonwealth nondiscriminatory coverage for the diagnosis and medically necessary and active treatment of mental disorders and alcoholism and other drug abuse and dependence disorders, as described in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association.
(c) In addition to the mental health benefits established pursuant to this section, any such health maintenance contract shall also provide benefits on a non-discriminatory basis for the diagnosis and treatment of rape-related mental or emotional disorders to victims of a rape or victims of an assault with intent to commit rape, as defined by sections 22 and 24 of chapter 265, whenever the costs of such diagnosis and treatment exceed the maximum compensation awarded to such victims pursuant to subparagraph (C) of paragraph (2) of subsection (b) of section 3 of chapter 258C.
(d) Coverage provided under this section shall: (i) consist of a range of inpatient, intermediate, and outpatient services; and (ii) permit noncustodial treatment to take place in the least restrictive, clinically appropriate setting.
Inpatient services may be provided in a general hospital licensed to provide such services, in a facility under the direction and supervision of the department of mental health, in a private mental hospital licensed by the department of mental health, or in a substance abuse facility licensed by the department of public health.
Intermediate services shall include, but need not be limited to, community-based detoxification, acute residential treatment, partial hospitalization, day treatment and crisis stabilization licensed or approved by the department of public health or the department of mental health.
Outpatient services may be provided in a licensed hospital, a mental health or substance abuse clinic licensed by the department of public health, a public community mental health center, a professional office, or as home-based services; provided, however, these services are provided by a licensed mental health professional acting within the scope of license.
(e) A health maintenance organization may, as a condition of providing coverage under this section, require consent to the disclosure of information for mental disorders only to the extent required for other medical conditions.
(f) Coverage provided under this section may be denied only by licensed mental health professionals. This subsection shall not apply to denials due to the insured’s lack of insurance coverage or use of a facility or professional that has not entered into a negotiated agreement with the health maintenance organization.
(g) Coverage provided under this section shall meet all other terms and conditions of the health maintenance contract not inconsistent with this section.
(h) A health maintenance organization shall not be required under this section to pay for: (i) services provided to a person who is presently incarcerated, confined or committed to a jail, house of correction or prison, or custodial facility in the department of youth services; (ii) special education services provided by a school committee under section 5 of chapter 71B; or (iii) services provided by the department of mental health.
(i) Psychopharmacological services and neuropsychological assessment services shall be treated as a medical benefit and shall be covered in a manner identical to all other medical services.
SECTION 10. The coverage of mental disorders required under section 47B of chapter 175 of the General Laws shall apply to small group health benefit plans subject to chapter 176J of the General Laws and nongroup health benefit plans subject to chapter 176M of the General Laws.
SECTION 11. All policies, contracts and certificates of health insurance subject to section 22 of chapter 32, section 47B of chapter 175, section 8A of chapter 176A, section 4A of chapter 176B, or section 4M of chapter 176G of the General Laws that are delivered, issued, or renewed on or after January 1, 2009 shall conform with this act. Form filings implementing this act shall be subject to the approval of the commissioner of insurance.
SECTION 12. This act shall take effect on January 1, 2009.