This article is for the acute care facilities, mental health facilities, and community mental health centers caring for our members.
Consistent with the Massachusetts Chapter 177 of the Acts of 2022, an act aimed at addressing barriers to care for mental health, we have removed prior authorization requirements for children and adolescents up to the age of 18* for the following services:
Moving forward, we will not require prior authorization from any provider (both in- and out-of-network) to determine medical necessity for these mental health services. Facilities will need to provide notification only.
However, this does not change the level of out-of-network benefits or associated cost-sharing detailed in the member’s plan benefits. This act also applies to out-of-state services, for all levels of care described above.
Although this state act does not apply to self-insured accounts (ASCs), we apply the same utilization review and prior authorization requirements to all members. This change aligns with our ongoing commitment to expanding access to mental health care.
*Youth ages 19-20 may be eligible for admission based on a program’s licensing requirements and the member’s clinical needs.
Behavioral Health for Children and Adolescents Billing Guide
Call Provider Service at 1-800-882-2060. As always, thank you for the care you provide to your patients—our members.