MA H4896

Requires all Massachusetts health insurers (including Group Insurance Commission, HMOs, and commercial plans) to cover Coordinated Specialty Care for first-episode psychosis 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 initial psychosis episode; coverage applies to adults 19+ with serious mental illness and children under 19 with serious emotional disturbance

Prohibits visit limits on covered services and requires bundled payment models rather than fee-for-service; medical necessity is presumed upon recommendation by a licensed physician, psychologist, counselor, or clinical social worker

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

Division of Insurance must convene a working group within 6 months to develop billing codes for bundled treatment; Health Policy Commission must analyze cost impacts 5 years after implementation; act takes effect 1 year after passage