SENATE DOCKET, NO. 1522        FILED ON: 1/16/2025

SENATE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No.         

The Commonwealth of Massachusetts

_________________

PRESENTED BY:

Patrick M. O'Connor

_________________

To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
Court assembled:

The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:

An Act to support behavioral health prevention for children.

_______________

PETITION OF:

SENATE DOCKET, NO. 1522        FILED ON: 1/16/2025

SENATE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No.         

The Commonwealth of Massachusetts

_______________

In the One Hundred and Ninety-Fourth General Court
(2025-2026)

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An Act to support behavioral health prevention for children.

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 inserting after section 33 the following section:-

Section 34. (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 after section 47UU the following section:-

Section 47VV. (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) A policy, contract, agreement, plan or certificate of insurance issued, delivered or renewed within 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 3.  Chapter 176A of the General Laws, is hereby amended by inserting after section 8VV the following section:-

Section 8WW. (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 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 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 4NN the following section:-

Section 4OO. (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.