What is a Mental Health Wellness Examination?
The law identifies that “mental health wellness examination” means a “screening or assessment that seeks to identify any behavioral or mental health needs and appropriate resources for treatment. The examination may include: (i) observation, a behavioral health screening, education and consultation on healthy lifestyle changes, referrals to ongoing treatment, mental health services and other necessary supports, and discussion of potential options for medication; and (ii) age-appropriate screenings or observations to understand a covered person’s mental health history, personal history and mental or cognitive state and, when appropriate, relevant adult input through screenings, interviews and questions.”
Individual or group insured health coverage “that is issued or renewed within or without the commonwealth shall provide coverage for an annual mental health wellness examination that is performed by a licensed mental health professional or primary care provider, which may be provided by the primary care provider as part of [the] annual preventive visit.” Bulletin 2023-05 further explains how these examinations are to be covered without cost-sharing.
Additional Resources
Information Sessions Regarding Wellness Exams
Following discussions with interested parties, the Division has convened a group of providers to consider further clarification about what is to be part of the annual behavioral health examination. The Division has requested that interested parties forward their comments so that they may be considered when providing further guidance about what is part of such examinations and the ways to bill for services provided. This website will include submitted information so it can be stored in one place.