HOUSE . . . . . . . . No. 4392
The Commonwealth of Massachusetts
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HOUSE OF REPRESENTATIVES, February 15, 2024.
The committee on Children, Families and Persons with Disabilities, to
whom were referred the petition (accompanied by bill, Senate, No. 64) of
Joanne M. Comerford and Jason M. Lewis for legislation to support
families, the petition (accompanied by bill, Senate, No. 129) of John C.
Velis for legislation relative to medication-assisted treatment, the petition
(accompanied by bill, House, No. 166) of Carole A. Fiola and others
relative to substance exposed newborns and the petition (accompanied by
bill, House, No. 173) of Sean Garballey and others for legislation to
protect infants affected by in-utero substance exposure or fetal alcohol
spectrum disorder, reports recommending that the accompanying bill
(House, No. 4392) ought to pass [Representatives Berthiaume of Spencer
and Sullivan-Almeida of Abington dissent].
For the committee,
JAY D. LIVINGSTONE. 1 of 6
FILED ON: 2/7/2024
HOUSE . . . . . . . . . . . . . . . No. 4392
The Commonwealth of Massachusetts
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In the One Hundred and Ninety-Third General Court
(2023-2024)
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An Act relative to substance exposed newborns.
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. Section 51A of chapter 119 of the general laws is hereby amended in
2subsection (a) in the first paragraph by striking out the words:-
3 (iii) physical dependence upon an addictive drug at birth,
4 SECTION 2. Said section 51A is hereby further amended by inserting after subsection (a)
5the following new subsection:-
6 (a ½) An indication of prenatal substance exposure does not, in of itself, meet the
7requirements of subsection (a). The Department of Public Health shall promulgate regulations
8and guidance in consultation with the Department of Children and Families under Section 51L of
9Chapter 111 of the general laws as to how substance exposure shall be weighed in determining
10whether to file a report, including any instances in which prenatal substance exposure from a
11medication prescribed by a licensed healthcare provider may be considered in filing a report. 2 of 6
12 SECTION 3. Chapter 111 of the general laws is hereby amended by inserting in Section 1
13the following:
14 “Plan of Safe Care”, a family care plan designed to ensure the safety and well-being of an
15infant with prenatal substance exposure following his or her release from the care of a healthcare
16provider by addressing the health and substance use treatment needs of the infant and affected
17family or caregiver.
18 SECTION 4: Chapter 111 of the general laws is hereby amended by inserting after
19section 51K the following section:-
20 Section 51L. (a) The Department of Public Health in consultation with the Department of
21Children and Families shall promulgate regulations and corresponding guidance for all
22healthcare providers who care for perinatal patients and/or newborns detailing the roles and
23responsibilities of staff related to the requirement that healthcare providers must:
24 (1) Screen for prenatal substance exposure using a validated questionnaire and provide
25brief intervention, treatment initiation, and referral as clinically indicated;
26 (2) Notify the Department of Public Health of all births of infants who were prenatally
27exposed to substances pursuant to the requirements of the federal Child Abuse Prevention and
28Treatment Act and the protocols described in this section;
29 (3) Prior to postnatal discharge, determine whether to file a report of suspected child
30abuse or neglect as required by section 51A of chapter 119 and identify if a plan of safe care, as
31defined in section 1 of chapter 111, has been developed; 3 of 6
32 (4) Assess family needs, develop a plan of safe care if indicated, and refer families to
33appropriate services, as directed by the Department of Public Health and pursuant to the federal
34Child Abuse Prevention and Treatment Act.
35 (b) The Department of Public Health shall develop a plan to receive notifications of
36substance exposed births, as defined in regulation under subsection (a) of this section, directly
37from healthcare providers and shall collect data for reporting in a manner that is in compliance
38with the federal Child Abuse Prevention and Treatment Act.
39 (c) The Department of Public Health shall establish a program to ensure perinatal
40individuals, families, and providers have access to services designed to support the development
41and implementation of an effective plan of safe care, including services addressing the health and
42substance use disorder treatment needs of the infants and affected family or caregivers, as
43required by the federal Child Abuse Prevention and Treatment Act. Said program shall include a
44central system perinatal individuals, families and providers can contact to receive information
45and referrals, as well as a system of community-based services to meet the behavioral health,
46parenting, and child development needs of families affected by substance use and substance use
47disorders, subject to appropriation.
48 (d) The Department of Children and Families shall provide, and the Department of Public
49Health shall receive, submissions of data from the Department of Children and Families to the
50Public Health Data Warehouse in order to facilitate ongoing quality assurance and evaluation
51projects related to this statute and other family-service initiatives.
52 (e) The Department of Public Health shall provide date to the Department of Children
53and Families on all births of infants who were prenatally exposed to substances in a form and 4 of 6
54manner that is complaint with the requirements of the federal Child Abuse Prevention and
55Treatment Act, provided that said data shall not include personally identifiable information.
56 (f) There may be a multidisciplinary standing committee established for the purpose of
57advising the Department of Public Health in matters related to prenatal substance exposure,
58maternal and child health, treatment of substance use disorder, and racial equity in access to
59healthcare, and includes at least one child focused professional. This advisory committee shall
60consist of seven persons appointed by the governor with one representative from each of the
61following organizations: the Massachusetts Medical Society, the Massachusetts Health and
62Hospital Association, Massachusetts Organization for Addiction Recovery, the Massachusetts
63branches of the National Association for the Advancement of Colored People New England Area
64Conference, the Massachusetts chapter of the National Association of Social Workers, the
65Committee for Public Counsel Services, and the Massachusetts chapter of the American
66Congress of Obstetricians and Gynecologists. The committee shall make recommendations to the
67Department of Public Health, based on research and analysis, to ensure that all regulations: (i)
68reflect current accepted standards of healthcare and substance use treatment practices; (ii)
69conform to the reporting requirements under the federal Child Abuse Prevention and Treatment
70Act; and (iii) do not create racial disparities in maternal and child healthcare, reports of suspected
71child abuse or neglect under section 51A of chapter 119, or number of patients identified for
72plans of safe care as defined in section 1 of chapter 111.
73 SECTION 5. (a) The department of the children and families, in consultation with the
74department of public health and the office of the child advocate, shall develop a report to study
75the impact of this legislation on child and family safety and well-being. The departments shall
76consider: 5 of 6
77 (1) Any impact, positive or negative, the changes may have had on racial and ethnic
78disparities;
79 (2) Any impact the statutory changes may have had on child safety;
80 (3) Any impact the statutory changes may have had on child well-being;
81 (4) Gaps in infant and parent services; and
82 (5) Any additional statutory or regulatory changes that may be needed.
83 (b) The report shall include, but not be limited to:
84 (1) An examination of child abuse and neglect reports related to an infant’s exposure at
85birth to substances, including those that were ultimately screened out by the department of
86children and families;
87 (2) An examination of longitudinal custodial, developmental, and service provision
88outcomes of infants who were reported to be exposed to substances at birth that did not result in
89a child abuse and neglect report;
90 (3) An examination of child abuse and neglect reports made under Section 51A of chapter
91119 related to an infant’s exposure at birth to substances;
92 (4) The demographics, including race and ethnicity, of both the child and the parents that
93are the subject of reports described in clauses (1) through (3).
94 (c) If feasible, said report shall include relevant aggregate quantitative data on all cases
95that meet the criteria specified in subsection (b)(1) and (b)(2) above, as well as a qualitative 6 of 6
96analysis that includes a review of case notes in the database maintained by the department of
97children and families for a sample of cases.
98 (d) No later than 18 months after the effective date of this legislation the department of
99children and families, shall file an interim report of its findings with the clerks of the senate and
100house of representatives, the senate committee on ways and means, the house committee on ways
101and means, the joint committee on children, families, and person with disabilities, and the joint
102committee on mental health, substance use and recovery.
103 (e) No later than three years after the effective date of this legislation, the department of
104children and families shall file a final report of its findings with the clerks of the senate and
105house of representatives, the senate committee on ways and means, the house committee on ways
106and means, the joint committee on children, families, and person with disabilities, and the joint
107committee on mental health, substance use and recovery.
108 SECTION 6. Sections 1 and 2 shall be effective eighteen months after the passage of this
109legislation.
110 SECTION 7. Sections 3 and 4 shall be implemented and effective twelve months after the
111passage of this legislation.
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