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Bill

S 677

Christopher Koon

2025-2026 Regular Session Introduced by Overture Walker

Massachusetts insurers must cover at least 90% of treatments a clinician says are needed to prevent a psychiatric emergency, with 7-day claim approvals.

Introduced and adopted
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Bill Summary · S 677

Summary — S.677: "An Act relative to preventing psychiatric emergencies"

Status: Introduced in the Massachusetts Senate (filed 1/16/2025; read twice and referred 02/20/2025). Referred to committees listed as Education and Financial Services/Finance. Hearings were scheduled for 09/09/2025. (See legislative actions for full procedural history.)

Purpose

To require certain health insurers doing business in Massachusetts to cover the bulk of treatments that a licensed clinician determines are necessary to prevent a “psychiatric emergency,” and to accelerate insurer approval for such treatments so patients receive timely care.

Key provisions

  • Amendment location: Inserts a new Section 19 into Chapter 176Q of the General Laws.
  • Coverage mandate: Insurers operating in Massachusetts must cover at least 90% of the cost of any treatment a physician determines is required to prevent a psychiatric emergency.
  • Timely approval requirement: Insurers must develop protocols to ensure approval of claims for treatments covered under this section within 7 days.
  • Effective date: The section takes effect within 90 days after enactment, to allow insurers time to adjust policies.

Defined terms (selected)

  • Patient: individual seeking mental health treatment.
  • Physician: a licensed medical doctor or a psychologist authorized to diagnose mental health conditions.
  • Psychiatric emergency: defined to include manic, psychotic, catatonic episodes; homicidal episodes with high risk of attempted homicide; substance-use episodes with high risk of extreme harm or fatal overdose; self-harm episodes with high risk of extreme self-injury; suicidal episodes with high risk of attempted suicide.
  • High risk: defined as greater than 50% likelihood.
  • Psychiatric emergency treatment: any medical intervention recommended by a physician to prevent a psychiatric emergency when the physician attests the patient has a high risk of such an event without intervention.
  • Extreme self-injury / extreme harm: defined as self-injury or substance-caused injury posing a high risk of permanent disability or death.

Who is affected

  • Patients seeking mental health care in Massachusetts (reduced out-of-pocket share for covered preventive emergency treatments: insurers cover ≥90%).
  • Licensed physicians and psychologists (their clinical determinations and attestations trigger coverage).
  • Insurance companies operating in Massachusetts (obligation to cover ≥90% and implement 7‑day approval protocols).

Potential impacts & considerations

  • Access: Could improve timely access to interventions intended to avert severe psychiatric crises.
  • Financial: Shifts more immediate cost burden to insurers (patients would remain responsible for up to 10% of covered costs unless other rules apply).
  • Clinical discretion: Relies on clinician attestation and the >50% “high risk” threshold; potential for disputes over assessments and scope of covered treatments.
  • Implementation detail: Bill requires insurers to create approval protocols but does not specify penalties or oversight/enforcement mechanisms for noncompliance.
  • Coverage scope: The text does not enumerate specific services (medication, inpatient care, outpatient therapies), leaving scope subject to insurer interpretation or later regulation.

Sponsors & related measures

Sponsors listed in the provided metadata include William N. Brownsberger (presented by request) and several others noted as primary or cosponsors. Related or companion measures are cited (e.g., HR 2962, SD 1274, A 809). (Readers should consult the Legislature’s official docket for sponsor confirmation and companion bill status.)

Compiled from official sources — confirm details with the bill’s official record.

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