MA S709

Requires all Massachusetts health insurance plans (including student health plans, Group Insurance Commission, HMOs, and preferred provider organizations) 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 an individual's first psychotic episode; coverage cannot impose limits on the number of provider visits

Payment must use bundled treatment models rather than fee-for-service for each team member's services; credentialing the psychiatrist or clinical leader qualifies all treatment team members with the insurer

Medical necessity is presumed upon recommendation by a licensed physician, psychologist, clinical counselor, or clinical social worker; disability or functional impairment cannot be required as a precondition for treatment

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; a cost-impact analysis is required 5 years after implementation