Psychiatric Collaborative Care Model; Issued January 4, 2023

COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation DIVISION OF INSURANCE 1000 Washington Street, Suite 810 • Boston, MA 02118-6200 (617) 521-7794 • Toll-free (877) 563-4467 http://www.mass.gov/doi CHARLES D. BAKER GOVERNOR KARYN E. POLITO LIEUTENANT GOVERNOR MIKE KENNEALY SECRETARY OF HOUSING AND ECONOMIC DEVELOPMENT EDWARD A. PALLESCHI UNDER SECRETARY OF CONSUMER AFFAIRS AND BUSINESS REGULATION GARY D. ANDERSON COMMISSIONER OF INSURANCE # BULLETIN 2023-04 To: All Commercial Health Insurers, Blue Cross and Blue Shield of Massachusetts, Inc., and Health Maintenance Organizations From: Gary D. Anderson, Commissioner of Insurance Date: January 4, 2023 Re: Psychiatric Collaborative Care Model of Care The Division of Insurance (“Division”) issues this Bulletin 2023-04 to Commercial Health Insurers, Blue Cross and Blue Shield of Massachusetts, Inc., and Health Maintenance Organizations (“Carriers”) to identify the Division’s expectations regarding Carriers’ requirement to provide reimbursement for behavioral health care provided through the Psychiatric Collaborative Care Model. The Division issues this Bulletin pursuant to Section 84, as well as Sections 51, 55, 58, and 61 of Chapter 177 of the Acts of 2022, which amend Massachusetts laws to add M.G.L. c. 175, §47QQ; M.G.L. c. 176A, §8RR; M.G.L. c. 176B, §4RR; and M.G.L. c. 176G, §4JJ (“Statutes”). ## Psychiatric Collaborative Care Model Insured health plans that are delivered, issued or renewed within or without the Commonwealth are required to provide coverage for mental health or substance use disorder services that are delivered through the Psychiatric Collaborative Care Model. The Statutes defines a “psychiatric collaborative care model” as an “evidence-based, integrated behavioral health service delivery method in which a primary care team consisting of a primary care provider and a care manager provides structured care management to a patient, and that works in collaboration with a psychiatric consultant that provides regular consultations to the primary care team to review the clinical status and care of patients and to make recommendations.” Carriers will take all necessary steps to notify providers about the appropriate methods to submit claims for reimbursement for services provided through the Psychiatric Collaborative Care Model, which shall include, but not be limited to, the acceptance of the following current procedural Bulletin 2023-04 January 4, 2023 Page 2 of 2 terminology billing codes established by the American Medical Association: (i) 99492; (ii) 99493; and (iii) 99494. Carriers are also directed to take all appropriate steps to update websites and coverage materials to specify that they will reimburse for behavioral health services when provided through the Psychiatric Collaborative Care Model. ## Carriers Acting as Administrators When Carriers are acting as administrators for employment-sponsored non-insured health benefit plans, the Division expects Carriers to encourage plan sponsors to take steps that are consistent with the provisions of this Bulletin 2023-04. If you have any questions about this Bulletin, please contact Kevin Beagan, Deputy Commissioner for the Health Care Access Bureau, at (617) 521-7323.