MA H1135

Requires all Massachusetts health insurers (including Group Insurance Commission, HMOs, and preferred provider organizations) to cover Coordinated Specialty Care for first-episode psychosis treatment and Assertive Community Treatment for individuals with serious mental illness or serious emotional disturbance

First-episode psychosis treatment must be initiated within 74 weeks of an individual's first psychotic episode; no limits may be placed on the number of provider visits

Payment must use bundled treatment models rather than fee-for-service, and medical necessity is presumed upon recommendation by a licensed physician, psychologist, clinical counselor, or social worker without requiring proof of disability or functional impairment

Carriers that fail to demonstrate adequate provider networks by the effective date must cover out-of-network services at in-network rates, report monthly to the Division of Insurance, and pay $50,000 monthly fines

Division of Insurance must convene a working group within 6 months to develop billing codes for bundled services; Health Policy Commission must analyze cost impacts 5 years after implementation