Starting on July 1, 2019 fully-insured commercial insurance plans in Massachusetts must cover certain outpatient and intermediate care behavioral health services for children when medically necessary.
What are outpatient and intermediate care behavioral health services?
Outpatient behavioral health services are services delivered in a community-based setting, like a clinic, school, or home, that help diagnose or treat mental health conditions, emotional/behavioral issues, or substance misuse. Intermediate care behavioral health services are more intensive services that can help prevent the need for higher levels of care, like inpatient hospitalization.
Why this requirement?
Commercial health insurance plans have long been required to offer behavioral health coverage that is equal to physical health coverage. Despite this requirement, many commercial plans in Massachusetts were not offering access to a full continuum of behavioral health supports. In December 2018, the Massachusetts Division of Insurance and the Department of Mental Health jointly issued a bulletin that addressed this discrepancy. The bulletin clarified that fully-insured commercial health insurers must cover medically-necessary outpatient and intermediate care behavioral health services for children and adolescents. It provided a list of services that plans must cover (although plans may cover additional behavioral health services), and gave plans two deadlines for ensuring coverage.
Services that plans must cover beginning July 1, 2019:
- In-Home Therapy: therapeutic clinical intervention, training, and support
- In-Home Behavioral Services: interventions and monitoring that addresses challenging behaviors
- Intensive Care Coordination: targeted case management services for the child and family
- Mobile Crisis Intervention: short-term, mobile, face-to-face therapeutic response service that is available 24 hours a day, 7 days a week to a child experiencing a behavioral health crisis
- Community-Based Acute Treatment (CBAT): intensive therapeutic services provided in a secure setting on a 24-hour basis
- Intensive Community-Based Acute Treatment (ICABT): similar to a Community-Based Acute Treatment, but with more intensive staffing and services
Services that plans must cover beginning July 1, 2020:
- Family Support And Training: services provided to parents and other caregivers to improve their ability address their child’s emotional or behavioral needs
- Therapeutic Mentoring Services: services designed to support a child’s age-appropriate social functioning
To access these services:
- If you think your child may need one of the listed services or another behavioral health service, speak to their pediatrician or current behavioral health provider. Note that these services will require a referral in most cases.
- If you are trying to find a provider for one of the listed services, consult your insurance plan’s provider database or call your insurance company. Note that many insurance plans partner with another company to manage behavioral health benefits and services. Contact information for the behavioral health partner is often listed on the front or back of your insurance card. You can also consult plan materials or call your insurance company to find out if you plan has a behavioral health partner.
- If your child has MassHealth Standard or CommonHealth, know that these services are already available for your child through the Children’s Behavioral Health Initiative (CBHI). In-Home Therapy and Mobile Crisis Intervention services are already available for children with MassHealth Family Assistance coverage. Find out more about CBHI here (opens in a new window).
For more information: