MA H4898

Requires health insurers to cover up to 14 days of medically necessary acute treatment services, clinical stabilization services, and co-occurring treatment services for substance use disorders without preauthorization

Applies to the Group Insurance Commission, MassHealth/Medicaid, and all commercial health insurers including HMOs, hospital service corporations, and medical service corporations in Massachusetts

Facilities must notify carriers of admission and initial treatment plans within 48 hours; utilization review may begin on day 7 of treatment

Mandates coverage without preauthorization for substance use disorder evaluations ordered under Section 51 1/2 of Chapter 111

Medical necessity determinations rest with the treating clinician in consultation with the patient, documented in the medical record