DOI Specialing Update

The Division of Insurance (DOI) issued a communication on August 2nd to fully insured health plans providing guidance on coding and billing for additional services (“specialing”) that may be necessary for admissions to inpatient psychiatric units as part of the commonwealth’s Expedited Psychiatric Inpatient Admissions (EPIA) policy.
Last year, the Executive Office of Health and Human Services, the Department of Mental Health, MassHealth, the Department of Public Health, and DOI, issued a joint EPIA policy that established an escalation protocol for securing appropriate placement for patients boarding in EDs who require inpatient psychiatric hospital level of care. Part of that policy included expectations for health plans as part of the EPIA process. This month’s DOI guidance clarifies a number of definitions and health plan requirements in order to address MHA member concerns about difficulties in operationalizing specialing.