Bill
S 726
Requires public and private payers in MA to cover MIH services at parity with facility-based care, including no higher cost-sharing and waiving certain behavioral health fees.
Status & origin
- Filed in the Massachusetts Senate (Senate Docket No. 1863) on 1/16/2025. Presented by Senator William J. Driscoll, Jr. (Norfolk, Plymouth and Bristol).
- Referred to Financial Services and other committees; printed as 726A after amendments. A public hearing was scheduled for 04/29/2025; the bill was reported favorably by committee and sent to Health Care Financing (8/28/2025). (Legislative actions show multiple committee referrals and amendment steps.)
Purpose and intent
- To require public and private health payers in Massachusetts to cover medical, behavioral and health-care services provided through state-approved Mobile Integrated Health (MIH) programs on parity with the same services when delivered inside a health care facility. The bill also reduces administrative barriers for behavioral-health–focused MIH programs by waiving certain fees.
Key provisions
1. Coverage parity for MIH services
- The Group Insurance Commission (GIC), insurers, HMOs, Medicaid contractors, Medicaid managed care plans, accountable care organizations, behavioral health management firms and third‑party administrators may not deny coverage solely because services were delivered by a health care provider participating in a Department of Public Health (DPH)–approved MIH program.
- MIH-delivered services must be covered to the same extent as if provided in a health care facility (as defined in chapter 111O).
- Payment rates for otherwise-covered services may not be reduced merely because they were delivered through an approved MIH program.
Cost-sharing parity
Fee waiver for behavioral-health MIH programs
Scope / who is affected
- Providers: clinicians and other health professionals who participate in DPH‑approved MIH programs.
- Payers: Group Insurance Commission contracts, commercial insurers, HMOs, hospital service plans, Medicaid programs and their contractors/administrators operating in Massachusetts.
- Patients: insured individuals (public and private) receiving medical or behavioral health services via approved MIH programs.
- State agencies: Department of Public Health (approval/oversight role); Division of Insurance and Medicaid program administrators for enforcement.
Potential impacts
- Increases access to community- and home-based care by removing payer-based coverage barriers for MIH services.
- Encourages adoption and scaling of MIH programs (including behavioral health outreach) by assuring reimbursement parity and lowering administrative fees.
- Could change insurer payment practices and affect utilization patterns; payers must reimburse MIH services at parity with facility-based care and cannot apply lower rates solely because of the care setting.
- Supports integration of emergency, primary and behavioral health services delivered in nontraditional settings, potentially reducing emergency department visits and institutional care.
Notes and context
- The bill references definitions and approval processes in chapter 111O (MA law governing mobile integrated health) and makes parallel amendments across state insurance statutes (chapters 32A, 118E, 175, 176A and others) to ensure broad coverage parity.
- Related prior filings: similar matter filed in the 2023–2024 session (Senate No. 718).
Compiled from official sources — confirm details with the bill’s official record.
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