H 4893

SECTION 1. Chapter 32A of the General Laws, is hereby amended by inserting after section 34 the following section:- Section 35. (a) For the purpose of this section, the following term shall have the following meaning: “Preventive behavioral health services”, short-term interventions in supportive group, individual, or family settings that cultivate coping skills and strategies for symptoms of depression, anxiety, and other social and emotional concerns, which may prevent the development of behavioral health conditions for members who are under 21 years old who have a positive behavioral health screening, or, in the case of an infant, a caregiver with a positive post-partum depression screening, even if the individual does not meet criteria for behavioral health diagnosis. (b)(1) Any coverage offered by the commission to an active or retired employee of the commonwealth under the group insurance commission shall provide coverage for no fewer than six sessions of preventive behavioral health services provided by a qualified licensed behavioral health clinician, or a non-licensed clinician or trainee under supervision, without requiring prior authorization. Coverage shall include individual, family and group sessions when delivered by a behavioral health clinician practicing in an integrated pediatric primary care setting and group sessions when delivered in community-based outpatient and school settings. Preventive behavioral health services shall be covered with no patient cost-sharing; provided, however, that cost-sharing shall be required if the applicable plan is governed by the Federal Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on cost-sharing for this service. (2) The commission and its contracted carriers shall accept an alternative diagnosis code, including a Social Determinants of Health Z-code, as the primary diagnosis from eligible providers submitting claims for preventive behavioral health services. SECTION 2. Chapter 175 of the General Laws, is hereby amended by inserting before section 47CCC the following section:- Section 47AAA. (a) For the purpose of this section, the following term shall have the following meaning: “Preventive behavioral health services”, short-term interventions in supportive group, individual, or family settings that cultivate coping skills and strategies for symptoms of depression, anxiety, and other social and emotional concerns, which may prevent the development of behavioral health conditions for members who are under 21 years old who have a positive behavioral health screening, or, in the case of an infant, a caregiver with a positive post-partum depression screening, even if the individual does not meet criteria for behavioral health diagnosis. (b)(1) Any blanket or general policy of insurance described in subdivision (A), (C), or (D) of section one hundred and ten which is issued or subsequently renewed by agreement between the insurer and the policyholder, within or without the commonwealth, during the period within which this premium is effective, or any policy of accident or sickness insurance as described in section one hundred and eight which provides hospital expense and surgical expense insurance and which is delivered or issued for delivery or subsequently renewed by agreement between the insurer and the policyholder in the commonwealth, during the period within which this provision is effective, or any employers' health and welfare fund which provides hospital expense and surgical expense benefits and which is issued or renewed to any person or group of persons in the commonwealth, during the period within which this provision is effective, shall provide coverage for no fewer than six sessions of preventive behavioral health services provided by a qualified licensed behavioral health clinician, or a non-licensed clinician or trainee under supervision, without requiring prior authorization. Coverage shall include individual, family and group sessions when delivered by a behavioral health clinician practicing in an integrated pediatric primary care setting and group sessions when delivered in community-based outpatient and school settings. Preventive behavioral health services shall be covered with no patient cost-sharing; provided, however, that cost-sharing shall be required if the applicable plan is governed by the Federal Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on cost-sharing for this service. (2) Payers covered under this section shall accept an alternative diagnosis code, including a Social Determinants of Health Z-code, as the primary diagnosis from eligible providers submitting claims for preventive behavioral health services. SECTION 3. Chapter 176A of the General Laws, is hereby amended by inserting after section 8DDD the following section:- Section 8EEE. (a) For the purpose of this section, the following term shall have the following meaning: “Preventive behavioral health services”, short-term interventions in supportive group, individual, or family settings that cultivate coping skills and strategies for symptoms of depression, anxiety, and other social and emotional concerns, which may prevent the development of behavioral health conditions for members who are under 21 years old who have a positive behavioral health screening, or, in the case of an infant, a caregiver with a positive post-partum depression screening, even if the individual does not meet criteria for behavioral health diagnosis. (b)(1) Any contract between a subscriber and a corporation subject to this chapter, pursuant to an individual or group hospital service plan that is delivered, issued or renewed within or without the commonwealth shall provide coverage for no fewer than six sessions of preventive behavioral health services provided by a qualified licensed behavioral health clinician, or a non-licensed clinician or trainee under supervision, without requiring prior authorization. Coverage shall include individual, family and group sessions when delivered by a behavioral health clinician practicing in an integrated pediatric primary care setting and group sessions when delivered in community-based outpatient and school settings. Preventive behavioral health services shall be covered with no patient cost-sharing; provided, however, that cost-sharing shall be required if the applicable plan is governed by the Federal Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on cost-sharing for this service. (2) Payers covered under this section shall accept an alternative diagnosis code, including a Social Determinants of Health Z-code, as the primary diagnosis from eligible providers submitting claims for preventive behavioral health services. SECTION 4. Chapter 176B of the General Laws, is hereby amended by inserting after section 4DDD the following section:- Section 4EEE. (a) For the purpose of this section, the following term shall have the following meaning: “Preventive behavioral health services”, short-term interventions in supportive group, individual, or family settings that cultivate coping skills and strategies for symptoms of depression, anxiety, and other social and emotional concerns, which may prevent the development of behavioral health conditions for members who are under 21 years old who have a positive behavioral health screening, or, in the case of an infant, a caregiver with a positive post-partum depression screening, even if the individual does not meet criteria for behavioral health diagnosis. (b)(1) Any subscription certificate under an individual or group medical service agreement that is delivered, issued or renewed within or without the commonwealth shall provide coverage for no fewer than six sessions of preventive behavioral health services provided by a qualified licensed behavioral health clinician, or a non-licensed clinician or trainee under supervision, without requiring prior authorization. Coverage shall include individual, family and group sessions when delivered by a behavioral health clinician practicing in an integrated pediatric primary care setting and group sessions when delivered in community-based outpatient and school settings. Preventive behavioral health services shall be covered with no patient cost-sharing; provided, however, that cost-sharing shall be required if the applicable plan is governed by the Federal Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on cost-sharing for this service. (2) Payers covered under this section shall accept an alternative diagnosis code, including a Social Determinants of Health Z-code, as the primary diagnosis from eligible providers submitting claims for preventive behavioral health services. SECTION 5. Chapter 176G of the General Laws, is hereby amended by inserting after section 4VV the following section:- Section 4WW. (a) For the purpose of this section, the following term shall have the following meaning: “Preventive behavioral health services”, short-term interventions in supportive group, individual, or family settings that cultivate coping skills and strategies for symptoms of depression, anxiety, and other social and emotional concerns, which may prevent the development of behavioral health conditions for members who are under 21 years old who have a positive behavioral health screening, or, in the case of an infant, a caregiver with a positive post-partum depression screening, even if the individual does not meet criteria for behavioral health diagnosis. (b)(1) Any individual or group health maintenance contract that is issued or renewed within or without the commonwealth shall provide coverage for no fewer than six sessions of preventive behavioral health services provided by a qualified licensed behavioral health clinician, or a non-licensed clinician or trainee under supervision, without requiring prior authorization. Coverage shall include individual, family and group sessions when delivered by a behavioral health clinician practicing in an integrated pediatric primary care setting and group sessions when delivered in community-based outpatient and school settings. Preventive behavioral health services shall be covered with no patient cost-sharing; provided, however, that cost-sharing shall be required if the applicable plan is governed by the Federal Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on cost-sharing for this service. (2) Payers covered under this section shall accept an alternative diagnosis code, including a Social Determinants of Health Z-code, as the primary diagnosis from eligible providers submitting claims for preventive behavioral health services. SECTION 6. The division of insurance, in consultation with the office of Medicaid, shall develop guidance to implement coverage of preventive behavioral health services.