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Bill

SD 3935

MassHealth 2025 Mental Health Parity Report

194th Legislature (2025-2026)

MassHealth must annually report on parity compliance across all managed care plans, ensuring BH/SUD benefits are no more restrictive than medical/surgical benefits.

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Bill Summary · SD 3935

Purpose and intent

  • This Massachusetts bill summarizes and reports on MassHealth’s compliance with mental health parity requirements. It fulfills statutory obligations to review parity adherence for Medicaid managed care plans and to annually report findings to the Legislature.
  • The overarching goal is to ensure that mental health and substance use disorder (BH/SUD) benefits are provided no more restrictively than medical/surgical benefits, in accordance with federal and state parity laws.

Key provisions and changes

  • Parity compliance examination and annual reporting
    • MassHealth must conduct a parity compliance review of each managed care entity under contract (including MCOs, Accountable Care Partnership Plans, SCOs, and One Care/ICO plans) at least every four years, and collect annual parity reports from these plans.
    • An annual report summarizing these parity reports must be submitted to the Legislature by December 1 each year.
  • Regulatory framework and cross-references
    • References to relevant state regulations (130 CMR 450.117(J) and 130 CMR 450.123) and federal parity standards under the Wellstone-Domenici Act (federal Mental Health Parity and Addiction Equity Act) are maintained.
    • The appendix reproduces 130 CMR 450.123, detailing requirements for annual compliance certifications and corrective actions if non-compliance is found.
  • Contractual parity language
    • MCOs and ACPPs must include contract language requiring annual review for parity compliance and submission of a certification to EOHHS.
    • SCOs and ICOs have similar requirements to review practices and certify compliance or outline corrective actions.
  • Member communications and grievance rights
    • Plans must include parity information in member handbooks, explaining that mental health/substance use benefits must be provided with parity to medical/surgical benefits, including prior authorization and medical necessity criteria, and the right to file grievances.
    • MassHealth provides a pathway for members to file grievances regarding parity with MassHealth customer service.
  • 2025 compliance findings and 2024-2025 data
    • The report notes that all contracted plans certified compliance with federal and state parity laws for calendar year 2025; no plan identified disparities between BH/SUD and medical/surgical benefits.
    • Data summaries include authorization requests, approval rates, internal and external appeals, and percentages of plans meeting parity standards (with specific figures for M/S and BH/SUD services).
  • Innovations and program enhancements (2025–2026)
    • Implementation of the Behavioral Health Treatment and Referral Platform (TRP) to streamline inpatient psychiatric admissions from the ED, reduce administrative burden, and improve patient throughput.
    • 2025 expansion of Program for Assertive Community Treatment (PACT) to MassHealth Fee-for-Service members.
    • New payment model for Behavioral Health Urgent Care services to bolster provider stability.
    • 2026 planned modernization of the Child/Adolescent Needs and Strengths (CANS) assessment tool.
    • Continued support for Primary Care Sub-Capitation Program to integrate behavioral health into primary care, with progress in expanding integrated services.

Who is affected

  • MassHealth members enrolled in MCOs, ACPPs, SCOs, and ICOs (including those under Fee-for-Service arrangements).
  • Managed care plans and their behavioral health subcontractors/TPAs, which must comply with parity requirements and submit annual certifications.
  • MassHealth, as the oversight and reporting entity, and the public through annual parity reports.

Procedural and timeline aspects

  • Compliance review cadence: at least once every four years for each plan; annual parity reports due December 1.
  • Certifications: plans must submit CEO/CMO-signed certifications confirming compliance or detailing non-compliance and corrective actions.
  • Appendix regulations provide the enforcement framework for certifications and grievance processes.
  • Ongoing enhancements and pilot programs are noted with anticipated 2025–2026 implementation timelines.

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

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