SENATE DOCKET, NO. 1433 FILED ON: 1/21/2011
SENATE . . . . . . . . . . . . . . No. 475
The Commonwealth of Massachusetts
_________________
PRESENTED BY:
Steven A. Tolman
_______________
To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
Court assembled:
The undersigned legislators and/or citizens respectfully petition for the passage of the accompanying:
An Act regarding adverse determinations for mental health and substance abuse treatment.
_______________
PETITION OF:
Name: | District/Address: |
Steven A. Tolman |
[District]
|
Gale D. Candaras |
[District]
|
SENATE DOCKET, NO. 1433 FILED ON: 1/21/2011
SENATE . . . . . . . . . . . . . . No. 475
By Mr. Tolman, a petition (accompanied by bill, Senate, No. 475) of Steven A. Tolman and Gale D. Candaras for legislation relative to adverse determinations for mental health and substance abuse treatment. Financial Services. |
The Commonwealth of Massachusetts
An Act regarding adverse determinations for mental health and substance abuse treatment.
Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:
SECTION 1. Section 12 of chapter 176O of the General Laws, as appearing in the 2008 Official Edition, is hereby amended by inserting after the word “provider”, in line 20, the following words: “provided, however, that in making an adverse determination for mental health or substance abuse treatment, the carrier or its designated utilization review organization shall defer to the judgment of the treating clinician unless there is a preponderance of evidence that the requested admission, continued stay or other health care service does not meet the requirements for coverage based on medical necessity, appropriateness of health care setting and level of care, or effectiveness.”
