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HOUSE DOCKET, NO. 1951 FILED ON: 1/19/2023
HOUSE . . . . . . . . . . . . . . . No. 1156
The Commonwealth of Massachusetts
_________________
PRESENTED BY:
Andres X. Vargas and Kate Donaghue
_________________
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 adoption of the accompanying bill:
An Act relative to opioid use disorder treatment and rehabilitation coverage.
_______________
PETITION OF:
NAME:DISTRICT/ADDRESS :DATE ADDED:Andres X. Vargas3rd Essex1/18/2023Kate Donaghue19th Worcester1/19/2023Mindy Domb3rd Hampshire1/25/2023Jack Patrick Lewis7th Middlesex1/26/2023David Paul Linsky5th Middlesex1/26/2023Christine P. Barber34th Middlesex1/27/2023Carmine Lawrence Gentile13th Middlesex2/9/2023Priscila S. Sousa6th Middlesex2/15/2023Smitty Pignatelli3rd Berkshire2/24/2023 1 of 6
HOUSE DOCKET, NO. 1951 FILED ON: 1/19/2023
HOUSE . . . . . . . . . . . . . . . No. 1156
By Representatives Vargas of Haverhill and Donaghue of Westborough, a petition (accompanied
by bill, House, No. 1156) of Andres X. Vargas, Kate Donaghue and others relative to opioid use
disorder treatment and rehabilitation. Financial Services.
The Commonwealth of Massachusetts
_______________
In the One Hundred and Ninety-Third General Court
(2023-2024)
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An Act relative to opioid use disorder treatment and rehabilitation coverage.
Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
of the same, as follows:
1 SECTION 1. Subsection (a) of section 2RRRR of chapter 29 of the General Laws, as
2appearing in the 2018 Official Edition, is hereby amended by inserting after the word “services”,
3in line 6, the following words:- , including certain non-profit substance use disorder treatment
4facilities pursuant to section 19E of chapter 94C,.
5 SECTION 2. Chapter 32A of the General Laws is hereby amended by inserting after
6section 17R, as inserted by section 2 of chapter 260 of the acts of 2020, the following section:-
7 Section 17S. Any coverage offered by the commission to an active or retired employee of
8the commonwealth insured under the group insurance commission shall provide coverage for
9prescribed or dispensed opioid antagonists as defined in section 19B of chapter 94C, and opioid
10agonist treatment, including partial agonist treatment. The prescribed or dispensed drug in this
11section shall be deemed medically necessary and shall not require prior authorization. Said drug
12shall not be subject to deductible, coinsurance, copayments or out-of-pocket limits. The 2 of 6
13commission shall reimburse providers, including but not limited to acute care hospitals,
14freestanding psychiatric facilities, and substance use disorder facilities, that dispense opioid
15antagonist, opioid agonist treatment and partial agonist treatment directly to the patient.
16 SECTION 2. Chapter 94C of the General Laws is hereby amended by inserting after
17section 19D the following section:-
18 Section 19E. (a) For the purposes of this section, the following words shall, unless the
19context clearly requires otherwise, have the following meanings:
20 “Opioid antagonist”, as defined in section 19B.
21 “Substance use disorder treatment facility”, nonprofit or for-profit facilities that offer: (i)
22acute treatment services and detoxification services; (ii) clinical stabilization services; (iii)
23transitional support services; (iv) residential support services; or (v) outpatient counseling
24services.
25 (b) Upon discharge of a patient from a substance use disorder treatment facility, the
26facility shall prescribe and dispense no less than 2 doses of an opioid antagonist to the patient or
27a legal guardian.
28 (c) The department of public health may subject to appropriation provide, at no cost to
29the substance use disorder treatment facility, opioid antagonists to nonprofit substance use
30disorder treatment facilities to be dispensed to patients pursuant to this section.
31 SECTION 3. Section 25J½ of chapter 111 of the General Laws, as appearing in the 2020
32Official Edition, is hereby amended by inserting after the first paragraph the following
33paragraph:- 3 of 6
34 Upon discharge of a patient who has a history of or is actively using opioids, diagnosed
35with opioid use disorder or who experienced an opioid-related overdose, the acute care hospital
36or satellite emergency facility shall prescribe or dispense no less than 2 doses of an opioid
37antagonist to the patient and notify the patient’s primary care physician or preferred care
38provider in consultation with the patient, if known. For the purposes of this section, “opioid
39antagonist” shall be as defined in section 19B of chapter 94C.
40 SECTION 4. Said chapter 111 is hereby amended by adding the following section:-
41 Section 243. The department shall, subject to appropriation, purchase doses of opioid
42antagonists, as defined in section 19B of chapter 94C, for distribution to acute care hospitals,
43community behavioral health centers and nonprofit substance use disorder treatment facilities
44pursuant to section 19E of chapter 94C.
45 The department shall notify said nonprofit substance use disorder treatment facilities that
46they may participate in the Municipal Naloxone Bulk Purchase Trust Fund pursuant to section
472RRRR of chapter 29.
48 SECTION 5. Chapter 118E of the General Laws is hereby amended by inserting after
49section 10N, as inserted by section 39 of said chapter 260, the following section:-
50 Section 10O. The division and its contracted health insurers, health plans, health
51maintenance organizations, behavioral health management firms and third-party administrators
52under contract to a Medicaid managed care organization, accountable care organization, or
53primary care clinician plan shall provide coverage for prescribed or dispensed opioid antagonists,
54as defined in section 19B of chapter 94C, and opioid agonist treatment, including partial agonist
55treatment. The prescribed or dispensed drug in this section shall be deemed medically necessary 4 of 6
56and shall not require prior authorization. Said drug shall not be subject to any deductible,
57coinsurance, copayments or out-of-pocket limits. The division and its contracted health insurers,
58health plans, health maintenance organizations, behavioral health management firms and third-
59party administrators shall reimburse providers, including but not limited to acute care hospitals,
60freestanding psychiatric facilities, and substance use disorder facilities, that dispense opioid
61antagonist, opioid agonist treatment and partial agonist treatment directly to the patient.
62 SECTION 6. Chapter 175 of the General Laws is hereby amended by inserting after
63section 47NN, as inserted by section 47 of said chapter 260, the following section:-
64 Section 47OO. Any policy, contract, agreement, plan or certificate of insurance issued,
65delivered or renewed within the commonwealth, which is considered creditable coverage under
66section 1 of chapter 118M, shall provide coverage for prescribed or dispensed opioid antagonists,
67as defined in section 19B of chapter 94C, and opioid agonist treatment, including partial agonist
68treatment. The prescribed or dispensed drug in this section shall be deemed medically necessary
69and shall not require prior authorization. Said drug shall not be subject to any deductible,
70coinsurance, copayments or out-of-pocket limits. The policy, contract, agreement, plan or
71certificate of insurance shall reimburse providers, including but not limited to acute care
72hospitals, freestanding psychiatric facilities, and substance use disorder facilities, that dispense
73opioid antagonist, opioid agonist treatment and partial agonist treatment directly to the patient.
74 SECTION 7. Chapter 176A of the General Laws is hereby amended by inserting after
75section 8OO, as inserted by section 48 of said chapter 260, the following section:-
76 Section 8PP. Any contract between a subscriber and the corporation under an individual
77or group hospital service plan that is delivered, issued, or renewed within the commonwealth 5 of 6
78shall provide, coverage for prescribed or dispensed opioid antagonists, as defined in section 19B
79of chapter 94C, and opioid agonist treatment, including partial agonist treatment. The prescribed
80or dispensed drug in this section shall be deemed medically necessary and shall not require prior
81authorization. Said drug shall not be subject to any deductible, coinsurance, copayments or out-
82of-pocket limits. The contract shall reimburse providers, including but not limited to acute care
83hospitals, freestanding psychiatric facilities, and substance use disorder facilities, that dispense
84opioid antagonist, opioid agonist treatment and partial agonist treatment directly to the patient.
85 SECTION 8. Chapter 176B of the General Laws is hereby amended by inserting after
86section 4OO, as inserted by section 50 of said chapter 260, the following section:-
87 Section 4PP. Any subscription certificate under an individual or group medical service
88agreement delivered or issued or renewed in the commonwealth, shall provide coverage for
89prescribed or dispensed opioid antagonists, as defined in section 19B of chapter 94C, and opioid
90agonist treatment, including partial agonist treatment. The prescribed or dispensed drug in this
91section shall be deemed medically necessary and shall not require prior authorization. Said drug
92shall not be subject to any deductible, coinsurance, copayments or out-of-pocket limits. The
93subscription certificate shall reimburse providers, including but not limited to acute care
94hospitals, freestanding psychiatric facilities, and substance use disorder facilities, that dispense
95opioid antagonist, opioid agonist treatment and partial agonist treatment directly to the patient.
96 SECTION 9. Chapter 176G of the General Laws is hereby amended by inserting after
97section 4GG, as inserted by section 52 of said chapter 260, the following section:-
98 Section 4HH. An individual or group health maintenance contract that is issued or
99renewed within or without the commonwealth shall provide coverage for prescribed or dispensed 6 of 6
100opioid antagonists, as defined in section 19B of chapter 94C, and opioid agonist treatment,
101including partial agonist treatment. The prescribed or dispensed drug in this section shall be
102deemed medically necessary and shall not require prior authorization. Said drug shall not be
103subject to any deductible, coinsurance, copayments or out-of-pocket limits. The individual or
104group health maintenance contract shall reimburse providers, including but not limited to acute
105care hospitals, freestanding psychiatric facilities, and substance use disorder facilities, that
106dispense opioid antagonist treatment, opioid agonist treatment and partial agonist treatment
107directly to the patient.
108 SECTION 11. Notwithstanding any general or special law to the contrary, the division of
109insurance, in consultation with the division of medical assistance, shall promulgate regulations or
110issue sub-regulatory guidance to require carriers reimburse providers, including but not limited
111to acute care hospitals, freestanding psychiatric facilities, and substance use disorder facilities,
112for opioid antagonist and opioid agonist treatment, including partial agonist treatment, dispensed
113directly to the patient.