Pediatric Behavioral Health Mandate

Help for Children and Adolescents with Serious Emotional Disturbances

April 29, 2019  

Under a new Massachusetts state law, children and adolescents who meet criteria for, and are diagnosed with, a serious emotional disturbance that substantially interferes with and substantially limits their functioning and social interactions may be able to receive additional behavioral health services.

This mandate applies to members of Massachusetts fully insured groups only, effective with renewals on or after July 1, 2019.1 Self-insured groups may also elect to offer these additional services to eligible members.

Learn more about Behavioral Health services, information, tools, and support for our members

  1. Coverage for these services will become part of the standard intermediate level of care benefit for behavioral health effective 7/1/19 and will default to plan design (e.g. deductible on deductible plans, covered in full on copay plans). Massachusetts self-insured groups may elect to opt out of covering these services. Not applicable to groups who have carved out behavioral health services. Not applicable to Medicare Advantage Plans or any RI, NH or CT plan.



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