Mental wellness annual exams are covered for commercial Massachusetts plans

An act addressing barriers to care for mental health

In accordance with Massachusetts law, commercial Massachusetts plans will:

  • Provide coverage for:
    • an annual mental health wellness examination performed by a licensed mental health professional or a primary care provider (as part of an annual preventive visit). The exam will be covered with no patient cost sharing. If you are covered under a PPO or POS plan and you use Out-of-Network benefits, standard Out-of-Network cost sharing will apply.
    • mental health or substance use disorder services that are delivered through the psychiatric collaborative care model.
    • medically necessary emergency services programs (ESP) including behavioral health crisis assessment, intervention, and stabilization services through (i) mobile crisis intervention services; (ii) emergency service provider community-based locations; and (iii) adult community crisis stabilization services.
    • medically necessary mental health acute treatment, community-based acute treatment (CBAT) and intensive community-based acute treatment (ICBAT) and will not require a preauthorization before obtaining treatment of medically necessary mental health acute treatment, community-based acute treatment (CBAT) and intensive community-based acute treatment (ICBAT) and will not require a preauthorization before obtaining treatment.