Mass. Gen. Laws ch. 176O, sec. 20 — MA Code / Part I / Title XXII / Chapter 176O / Section 20
Information provided to insured adults by behavioral health manager; submission of material changes; workers' compensation; preferred provider arrangements
Status: in_force

Section 20. (a) A behavioral health manager shall provide the following information to at least 1 adult insured in each household covered by their services: (1) a notice to the insured regarding emergency mental health services that states: (i) that the insured may obtain emergency mental health services, including the option of calling the local pre-hospital emergency medical service system by dialing the 911 emergency telephone number or its local equivalent, if the insured has an emergency mental health condition that would be judged by a prudent layperson to require pre-hospital emergency services; (ii) that no insured shall be discouraged from using the local pre-hospital emergency medical service system, the 911 emergency telephone number or its local equivalent; (iii) that no insured shall be denied coverage for medical and transportation expenses incurred as a result of such emergency mental health condition; and (iv) if the behavioral health manager requires an insured to contact either the behavioral health manager, carrier or the primary care provider of the insured within 48 hours of receiving emergency services, notification already given to the behavioral health manager, carrier or primary care provider by the attending emergency physician shall satisfy that requirement; (2) a summary of the process by which clinical guidelines and utilization review criteria are developed for behavioral health services; and (3) a statement that the office of patient protection, established by section 16 of chapter 6D or, if applicable, the designated state consumer assistance program is available to assist consumers, a description of the grievance and review processes available to consumers under chapter 176O, and relevant contact information to access the office and these processes. (b) The information required by subsection (a) may be contained in the carrier's evidence of coverage and need not be provided in a separate document. Every disclosure described in this section shall contain the effective date, date of issue and, if applicable, expiration date. (c) A behavioral health manager shall submit material changes to the information required by subsection (a) to the bureau of managed care, established by section 2 of chapter 176O, at least 30 days before their effective dates and to at least 1 adult insured in every household residing in the commonwealth at least biennially. (d) A behavioral health manager that provides specified services through a workers' compensation preferred provider arrangement that meets the requirements of 211 CMR 112.00 and 452 CMR 6.00 shall be considered to comply with this section.

Section 20. (a) A behavioral health manager shall provide the following information to at least 1 adult insured in each household covered by their services:

(1) a notice to the insured regarding emergency mental health services that states:

(i) that the insured may obtain emergency mental health services, including the option of calling the local pre-hospital emergency medical service system by dialing the 911 emergency telephone number or its local equivalent, if the insured has an emergency mental health condition that would be judged by a prudent layperson to require pre-hospital emergency services;

(ii) that no insured shall be discouraged from using the local pre-hospital emergency medical service system, the 911 emergency telephone number or its local equivalent;

(iii) that no insured shall be denied coverage for medical and transportation expenses incurred as a result of such emergency mental health condition; and

(iv) if the behavioral health manager requires an insured to contact either the behavioral health manager, carrier or the primary care provider of the insured within 48 hours of receiving emergency services, notification already given to the behavioral health manager, carrier or primary care provider by the attending emergency physician shall satisfy that requirement;

(2) a summary of the process by which clinical guidelines and utilization review criteria are developed for behavioral health services; and

(3) a statement that the office of patient protection, established by section 16 of chapter 6D or, if applicable, the designated state consumer assistance program is available to assist consumers, a description of the grievance and review processes available to consumers under chapter 176O, and relevant contact information to access the office and these processes.

(b) The information required by subsection (a) may be contained in the carrier's evidence of coverage and need not be provided in a separate document. Every disclosure described in this section shall contain the effective date, date of issue and, if applicable, expiration date.

(c) A behavioral health manager shall submit material changes to the information required by subsection (a) to the bureau of managed care, established by section 2 of chapter 176O, at least 30 days before their effective dates and to at least 1 adult insured in every household residing in the commonwealth at least biennially.

(d) A behavioral health manager that provides specified services through a workers' compensation preferred provider arrangement that meets the requirements of 211 CMR 112.00 and 452 CMR 6.00 shall be considered to comply with this section.