On July 31, 2015, the Massachusetts Division of Insurance published Bulletin 2015-05. The bulletin is directed toward insurers and relates to access to services to treat substance use disorders. Massachusetts law requires fully insured plans issued, delivered or renewed within Massachusetts to provide coverage for medically necessary acute treatment and clinical stabilization services for at least 14 consecutive days. According to the bulletin, insured plans must cover such services without preauthorization requirements, so long as the services are delivered by a provider that is properly licensed or certified.
For purposes of the coverage requirements, ‘acute treatment services’ means 24-hour medically supervised addiction treatment for adults or adolescents provided in a medically managed or medically monitored inpatient facility. ‘Clinical stabilization services’ means 24-hour clinically managed post detoxification treatment for adults or adolescents, which may include intensive education and counseling regarding the nature of addiction and its consequences, relapse prevention, outreach to families and significant others and after-care planning for individuals beginning to engage in recovery from addiction.
The bulletin also includes a list of services for which carriers may not require preauthorization. Those services include: early intervention services, outpatient services (including medically assisted therapies), early intervention for substance use disorder treatment, intensive outpatient and partial hospitalization services and residential and medically managed intensive inpatient services. The bulletin contains additional explanations for each of those covered services.
The bulletin contains no new compliance obligations for employers, but employers will want to be aware of the bulletin should they (or employees) have questions relating to substance use disorder coverage.
Bulletin 2015-05 »