- Home
- Committees
- Events
- DEI&J
- Member Resources
- State Issues
- Newsroom
Behavioral Health for Children and AdolescentsClick here to access the Division of Insurance (DOI) webpage on Behavioral Health Services for Children and Adolescents (BHCA). Updated BHCA Carrier Provider Lists Please find below linked carrier provider lists for behavioral health services for children and adolescents. These are up-to-date as of March 13, 2023:
The Insurance Resource Center for Autism and Behavioral Health (formerly the Autism Insurance Resource Center) Presentation and Fact Sheets The Insurance Resource Center for Autism and Behavioral Health (formerly the Autism Insurance Resource Center) presented a webinar on September 15, 2021 providing an overview of new resources related to Behavioral Health Insurance Coverage for Children and Adolescents (BHCA). The presentation provides an overview of:
A copy of the presentation can be found here. Additionally, the Insurance Resource Center for Autism and Behavioral Health has published the following Fact Sheets on BHCA and BHCA Related Services:
Updates for Family Support & Training and Therapeutic Mentoring Services Important Update: MassHealth Guidance to Providers and Carriers Regarding Transition to Commercial Coverage of Intermediate Services for Youth In order to facilitate a smooth transition to commercial coverage for Therapeutic Mentor and Family Partner services for youth MassHealth members with third party insurance (TPL) and to promote continuity of care, EOHHS is extending the transition period end date from 12/31/20 to 6/30/2021. Effective July 1, 2021, all MBHP contracted Family Support and Training (FS&T) and Therapeutic Mentor (TM) providers will be required to provide a primary insurance Explanation of Benefits (EOB) for TPL members when submitting claims to MBHP. The guidance can be viewed here. Family Partner and Therapeutic Mentoring Services Go Live January 1, 2021 As of January 1, 2021, family support and training and therapeutic mentoring will be covered by fully-insured Massachusetts plans. Prior to this, families with commercial insurance either went without these services or used “secondary MassHealth” to obtain the services. Community Health Worker Certification As you may know, the original start date for these two services was set later than other Behavioral Health for Children and Adolescents (BHCA) benefits in order for certification standards to be established. The Department of Mental Health was charged with identifying the certification standards and process that best fits the knowledge and skills needed by Family Partners and Therapeutic Mentors. DMH determined that to be the Community Health Worker (CHW) certification. DMH partnered with DPH’s Bureau of Health Professions Licensure to record a webinar that explains the CHW certification requirements and process. DMH also created “cross-walk” documents (attached) to help family partners, therapeutic mentors, their supervisors and program managers understand how their work is reflected in those standards. Links to those materials can be found below As a reminder, the “work hours only” certification pathway is the only one currently available and is due to expire on June 30, 2021. Family partners and therapeutic mentors who have at least 4,000 hours of relevant work experience can pursue this pathway. Plan Webinars and Documentation of Family Support & Training and Therapeutic Mentoring Aetna Beacon Health Options Blue Cross Blue Shield of Massachusetts Cigna Tufts Related Resources TM Crosswalk and Application Instructions FP Crosswalk and Application Instructions COVID-19 Updates for Providers Behavioral Health Section of Public Provider Website Therapeutic Mentoring & Family Support and Training FAQ Effective September 1, 2020, all MBHP contracted CBHI providers are required to provide a primary insurance Explanation of Benefits (EOB) for TPL members when submitting claims to MBHP. EOHHS has amended Sections 2, 3, and 4 of the linked guidance document to reflect this extension: AMENDED: MassHealth Guidance to Providers and Carriers Regarding Transition to Commercial Coverage of Intermediate Services for Youth On August 13, 2020, MBHP held an additional webinar for ICC, IHT, and IHBS providers targetd to CBHI program directos, and billing staff on how to receive reimbursement after 9/1/20 for youth with Third-Party Liability. On December 14, 2018, the Massachusetts Division of Insurance and Department of Mental Health issued a joint bulletin to clarify certain mandated benefits for child-adolescent services. As of July 1, 2019, the following intermediate care and outpatient services are covered by fully-insured Massachusetts plans: In-home behavioral services, behavior management monitoring, behavior management therapy, family support and training, in-home therapy, therapeutic clinical intervention, ongoing therapeutic training and support, therapeutic mentoring, mobile crisis intervention, intensive care coordination, community-based acute treatment for children and adolescents (CBAT), and intensive community-based acute treatment for children and adolescents (ICBAT). Prior to this bulleting, families with commercial insurance either went without these services or used “secondary MassHealth” to obtain the services. Important Update: Anticipating a large number of renewals on 1/1/2020, and in order to facilitate a smooth transition to commercial coverage for youth MassHealth members with third party insurance (TPL) and to promote continuity of care for those youth and their families, EOHHS is extending the transition period end date from 3/31/2020 to 6/30/2020. Effective July 1, 2020, all MBHP contracted CBHI providers will be required to provide a primary insurance explanation of benefits (EOB) for MassHealth members with TPL. Please refer to the following guidance for further detail and expectations of activities to ensure continuity of care during the transition period and beyond: MH Guidance Regarding Coverage of Intermediate Services (3.10.2020). Coordination of Benefits for Children and Adolescents with MassHealth Secondary MassHealth regulations and administrative guidance require providers to make "diligent efforts" to identify and obtain payment from all other liable parties. Diligent efforts include, but are not limited to:
Please see MassHealth Administrative and Billing Regulations (130 CMR 450.316 through 450.318) for more information. For children and youth for whom MassHealth is the secondary insurers (often called members with Third-Party Liability), the Massachusetts Behavioral Health Partnership serves as the entity responsible for covering eligible charges not covered by the primary insurer. These charges include child/family liability such as co-pays, coinsurance, and deductibles, and under certain circumstances, claims denied by the primary insurer. Masachusetts Behavioral Health Partnership Resources on Reimbursement for Behavioral Health for Children and Adolescents (BHCA) Services for Members with Third-Party Liability
Plan Specific Resources Aetna
Beacon Health Options
BCBSMA Plans BHCA Crosswalk (2.18.2021)
Cigna Plans BHCA Crosswalk (2.4.2020) Optum
Tufts Health Plan and Tufts Health Direct
Additional Information FAQs 1. When does this bulletin go into effect? 1a. Services Covered by Plans Issued or Renewed On or After July 1, 2019
The Bulletin’s language states that health coverage “becoming effective on or after July 1, 2019” must include these benefits. This means that coverage does not become effective for all plans on July 1, 2019. For example, if a company’s insurance plan does not renew until January 1, 2020, the insurance company is not required to cover these services until the policy renews on January 1st. 1b. Services Covered by Plans Issued or Renewed On or After July 1, 2020
Children and families who need to access these services can continue to access them through MassHealth as Secondary (where eligible) until their commercial plan renewal date or a new plan is issued on or after July 1, 2020. 2. When do Health Plans Renew? Employers renew their employees’ insured health plans at different times throughout the year, usually at the beginning of calendar quarters. January and April tend to be the biggest renewal months. If coverage does not renew until April 1, 2020, BHCA does apply for that coverage until April 1, 2020. 3. Which Commercial Health Plans Must Follow This Bulletin? Self-insured plans that are offered through ERISA are federally regulated and therefore not subject to this Bulletin. Families on self-insured plans can continue to access these services through MassHealth as Secondary, where eligible. 4. What about these services will be different from MassHealth Children’s Behavioral Health Initiative? 5. What happens to children who are accessing CBHI services through MassHealth Secondary? 6. Will Primary Insurance Cost Sharing Apply? 7. Where do Health Plans post the most up-to-date information?
|