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Legislation expanding access to behavioral health in MassHealth

In its final days of formal session, the legislature passed two important laws that will expand access to behavioral health services for people with substance use disorders and autism spectrum disorders including provisions specifically covering MassHealth. Great work by legislative champions & dedicated advocates!

Both Acts now go to the Governor for his approval.

H. 4047 (final text H. 4373) An Act Relative to Assisting Individuals with Autism and Other Disabilities, implements many of the recommendations of the Autism Commission including the following provision specific to MassHealth (it will require federal approval before it can be implemented):

SECTION 25. Chapter 118E of General Laws is hereby amended by inserting after section 10G the following section:-

Section 10H. Subject to the availability of federal financial participation, the division shall cover medically necessary treatments for persons younger than 21 years old who are receiving medical coverage under this chapter and who are diagnosed with an autism spectrum disorder by a licensed physician or a licensed psychologist. If federal funds are available to the commonwealth, said coverage shall include, but shall not be limited to, services for applied behavior analysis supervised by a board certified behavior analyst and dedicated and non-dedicated augmentative and alternative communication devices, including, but not limited to medically necessary tablets.

S. 2142 An Act Improving Long Term Substance Abuse Recovery takes aim at the opioid epidemic and includes provisions specific to MassHealth in Section 19 of the law & summarized below, effective Oct 1, 2015 & subject to federal approval:

  • Requires all MassHealth Managed Care Entities (MCEs) to cover the cost of detox (Acute Treatment Services (ATS)) without prior authorization.
  • Requires all MassHealth MCEs to cover up to 14 days of step-down detox (Clinical Stabilization Services (CSS)) without prior authorization.  Utilization review procedures may be initiated on day 7.
  • Requires MassHealth MCEs, commercial insurers and the GIC to defer to the treating clinician for medical necessity criteria.
  • Requires MassHealth MCEs, the GIC, and commercial insurers to reimburse for addiction treatment services delivered by a Licensed Alcohol and Drug Counselor (LADC 1).