HOUSE . . . . . . . No. 4743
The Commonwealth of Massachusetts
______________________________________
HOUSE OF REPRESENTATIVES, June 11, 2024.
The committee on Ways and Means, to whom was referred the Bill
relative to recovery coach licensure (House, No. 2005), reports
recommending that the same ought to pass with an amendment
substituting therefor the accompanying bill (House, No. 4743).
For the committee,
AARON MICHLEWITZ.
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FILED ON: 6/11/2024
HOUSE . . . . . . . . . . . . . . . No. 4743
The Commonwealth of Massachusetts
_______________
In the One Hundred and Ninety-Third General Court
(2023-2024)
_______________
An Act relative to treatments and coverage for substance use disorder and recovery coach
licensure.
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. Chapter 32A of the General Laws is hereby amended by inserting after
2section 17S the following 2 sections:-
3 Section 17T. (a) Any coverage offered by the commission to an active or retired
4employee of the commonwealth insured under the group insurance commission shall provide
5coverage for prescribed or dispensed opioid antagonists, as defined in section 19B of chapter
694C, which shall be deemed medically necessary and shall not require prior authorization;
7provided, however, that a prescription from a health care practitioner shall not be required for
8coverage of opioid antagonists. An opioid antagonist shall not be subject to any deductible,
9coinsurance, copayments or out-of-pocket limits; provided, however, that cost-sharing shall be
10required if the applicable plan is governed by the federal Internal Revenue Code and would lose
11its tax-exempt status as a result of the prohibition on cost-sharing for this service.
12 (b) The commission shall provide coverage for an opioid antagonist as a medical benefit
13when dispensed by the health care facility in which the opioid antagonist was prescribed and 2 of 30
14shall provide coverage as a pharmacy benefit for an opioid antagonist dispensed by a pharmacist,
15including an opioid antagonist dispensed pursuant to section 19B of chapter 94C.
16 Section 17U. (a) The commission shall provide to any active or retired employee of the
17commonwealth who is insured under the group insurance commission coverage for the provision
18of services by a recovery coach licensed or otherwise authorized to practice pursuant to chapter
19111J, irrespective of the setting in which the services are provided; provided, that such services
20shall be within the lawful scope of practice of a recovery coach. The contractual rate for these
21services shall be not less than the prevailing MassHealth rate for recovery coach services. The
22benefits in this section shall not be subject to any deductible, coinsurance, copayments or out-of-
23pocket limits; provided, however, that cost-sharing shall be required if the applicable plan is
24governed by the federal Internal Revenue Code and would lose its tax-exempt status as a result
25of the prohibition on cost-sharing for the service. Recovery coach services shall be deemed
26medically necessary and shall not require prior authorization.
27 SECTION 2. Chapter 18 of chapter 94C of the General Laws, as appearing in the 2022
28Official Edition, is hereby amended by striking out subsection (e) and inserting in place thereof
29the following subsection:-
30 (e) Practitioners who prescribe controlled substances, except veterinarians, shall be
31required, as a prerequisite to obtaining or renewing their professional licenses, to complete
32appropriate training relative to: (i) effective pain management including, but not limited to: (A)
33appropriate, available non-opioid alternatives for the treatment of pain; (B) the advantages and
34disadvantages of the use of non-opioid treatment alternatives, considering a patient’s risk of
35substance misuse; and (C) the options for referring or prescribing appropriate non-opioid 3 of 30
36treatment alternatives based on the practitioner’s clinical judgment and following generally
37accepted clinical guidelines, taking into consideration the preference and consent of the patient
38and the educational information described in section 21; (ii) the risks of misuse and addiction
39associated with opioid medication; (iii) the identification of patients at risk for substance misuse;
40(iv) counseling patients about the side effects, risks, addictive nature and proper storage and
41disposal of prescription medications; (v) the appropriate prescription quantities for prescription
42medications that have an increased risk of misuse and addiction, including a patient’s option to
43fill a prescription for a schedule II controlled substance in a lesser quantity than indicated on the
44prescription pursuant to subsection (d¾); and (vi) opioid antagonists, overdose prevention
45treatments and information to advise patients on both the use of and ways to access opioid
46antagonists and overdose prevention treatments. The boards of registration for each professional
47license that require this training shall, in consultation with the department, relevant stakeholders
48and experts in the treatment and management of acute and chronic pain, develop the standards
49for appropriate training programs. For the purposes of this section, non-opioid treatment
50alternatives shall include, but shall not be limited to, medications, restorative therapies,
51interventional procedures, behavioral health approaches and complementary and integrative
52treatments.
53 SECTION 3. Said chapter 94C is hereby further amended by striking out section 19C and
54inserting in place thereof the following section:-
55 Section 19C. The board of registration in pharmacy shall promulgate regulations
56requiring pharmacies located in areas with high incidents of opiate overdose, as determined by
57the board in consultation with the department, to maintain a continuous supply of opioid
58antagonists, as defined in section 19B; provided, that the continuous supply of opioid antagonists 4 of 30
59shall include opioid antagonists that are approved by the federal Food and Drug Administration
60to be sold over the counter without a prescription; provided further, that such pharmacies shall
61notify the department if the supply or stock of opioid antagonist doses is insufficient to enable
62compliance with maintaining a continuous supply of opioid antagonists.
63 SECTION 4. Said chapter 94C is hereby further amended by inserting after section 19D
64the following section:-
65 Section 19D½. (a) For the purposes of this section, the following words shall, unless the
66context clearly requires otherwise, have the following meanings:
67 “Opioid antagonist”, as defined in section 19B.
68 “Substance use disorder treatment facility”, a facility licensed or approved by the
69department to offer treatment for substance use disorder, including, but not limited to: (i)
70withdrawal management services; (ii) clinical stabilization services; (iii) transitional support
71services; (iv) residential support services; (v) community behavioral health center services; (vi)
72office-based opioid or addiction treatment services; or (vii) outpatient substance use disorder
73services.
74 (b) Upon discharge of a patient from a substance use disorder treatment facility, the
75facility shall educate the patient on the use of opioid antagonists and dispense not less than 2
76doses of an opioid antagonist to the patient or a legal guardian.
77 (c) The commissioner may promulgate rules and regulations necessary to implement this
78section. 5 of 30
79 SECTION 5. Section 21 of said chapter 94C, as appearing in the 2022 Official Edition, is
80hereby amended by striking out the third paragraph and inserting in place thereof the following
81paragraph:-
82 The department, in consultation with relevant stakeholders and experts in the treatment
83and management of acute and chronic pain, and based in part on the Pain Management Best
84Practices Inter-Agency Task Force Report issued by the United States Department of Health and
85Human Services, shall produce and distribute either in written or electronic form to pharmacies,
86not including institutional pharmacies, pamphlets for consumers relative to narcotic drugs,
87specifically opiates, that include educational information related to: (i) pain management and the
88use and availability of non-opioid alternatives for the treatment of acute and chronic pain,
89including, but not limited to: (A) information on available non-opioid alternatives for the
90treatment of pain, including non-opioid medications and non-pharmacological therapies; and (B)
91the advantages and disadvantages of the use of such non-opioid treatment alternatives; (ii) the
92consumer’s option to fill a prescription for a schedule II controlled substance in a lesser quantity
93than indicated on the prescription pursuant to subsection (d¾) of section 18; (iii) misuse and
94abuse by adults and children; (iv) the risk of dependency and addiction; (v) proper storage and
95disposal; (vi) addiction support and treatment resources; and (vii) the telephone helpline operated
96by the bureau of substance addiction services established in section 18 of chapter 17. A
97pharmacist shall distribute the pamphlet when dispensing a narcotic or controlled substance
98contained in schedule II or III; provided, however, that pharmacists shall not be required to
99distribute the pamphlet if: (i) the patient is receiving outpatient palliative care pursuant to section
100227 of chapter 111; (ii) the patient is a resident of a long-term care facility; or (iii) the narcotic or
101controlled substance is prescribed for use in the treatment of substance use disorder or opioid 6 of 30
102dependence. For the purposes of this section, non-opioid treatment alternatives shall include, but
103shall not be limited to, medications, restorative therapies, interventional procedures, behavioral
104health approaches and complementary and integrative treatments.
105 SECTION 6. Said chapter 94C is hereby further amended by inserting after section 34A
106the following section:-
107 Section 34A½. (a) As used in this section, the following words shall, unless the context
108clearly requires otherwise, have the following meanings:
109 “Drug testing services”, the use of testing equipment to identify or analyze the strength,
110effectiveness or purity of a controlled substance prior to its injection, inhalation or ingestion by
111another person to determine whether the controlled substance contains chemicals, toxic
112substances or hazardous compounds.
113 “Testing equipment”, including, but not limited to: fentanyl test strips, colorimetric
114reagents, high-performance liquid chromatography, gas chromatography and mass spectrometry.
115 (b)(1) A person acting in good faith and within the scope of their role providing or
116assisting in the provision of harm reduction services as an owner, employee, intern, volunteer or
117third-party contractor of an entity providing harm reduction services may provide or assist in
118drug testing services to an individual to ensure that a controlled substance in the possession of
119the individual and exclusively for that individual’s personal use does not contain dangerous
120chemicals, toxic substances or hazardous compounds likely to cause an accidental overdose.
121 (2) A person acting in good faith and within the scope of their role providing or assisting
122in the provision of harm reduction services as an owner, employee, intern, volunteer or third- 7 of 30
123party contractor of an entity providing harm reduction services who provides or assists in the
124provision of drug testing services pursuant to this section shall not be charged or prosecuted
125pursuant to sections 32I, 34 or 40.
126 (3) A person acting in good faith and within the scope of their role providing or assisting
127in the provision of harm reduction services as an owner, employee, intern, volunteer or third-
128party contractor of an entity providing harm reduction services who provides or assists in drug
129testing services pursuant to this section shall: (i) not be held civilly liable for drug testing
130services unless for gross negligence or willful misconduct in the execution of the drug testing
131services; and (ii) not be subject to any criminal or civil liability or any professional disciplinary
132action; provided, however, that this section shall not apply to acts of gross negligence or willful
133or wanton misconduct.
134 (c) An individual acting in good faith who seeks drug testing services of a controlled
135substance in their possession and intended exclusively for their personal use from a person acting
136in good faith and within the scope of their role providing, or assisting in the provision of, harm
137reduction services as an owner, employee, intern, volunteer or third-party contractor of an entity
138providing harm reduction services shall not be charged or prosecuted pursuant to sections 32I, 34
139or 40 while on the premises where the drug testing services are conducted.
140 SECTION 7. Section 25J½ of chapter 111 of the General Laws, as appearing in the 2022
141Official Edition, is hereby amended by inserting after the first paragraph the following
142paragraph:-
143 Upon discharge of a patient from an acute care hospital or satellite emergency facility
144who has: (i) a history of or is actively using opioids; (ii) been diagnosed with opioid use 8 of 30
145disorder; or (iii) experienced an opioid-related overdose, the acute care hospital or satellite
146emergency facility shall educate the patient on the use of opioid antagonists, as defined in section
14719B of chapter 94C, and prescribe or dispense not less than 2 doses of an opioid antagonist to the
148patient or a legal guardian and notify the patient’s primary care physician or preferred care
149provider, if known and in consultation with the patient, of the prescribed or dispensed opioid
150antagonist.
151 SECTION 8. Said chapter 111, as so appearing, is hereby amended by inserting after
152section 110C the following section:-
153 Section 110D. (a) The department shall collect and provide data to the department of
154children and families and the office of the child advocate on all births of infants affected by
155prenatal substance exposure in a form and manner consistent with any requirements of the
156federal Child Abuse Prevention and Treatment Act; provided, that said data shall not include
157personally identifiable information.
158 (b) Annually, not later than April 1, the department, in consultation with the department
159of children and families and the office of the child advocate, shall file with the clerks of the
160house of representatives and the senate, the house and senate committees on ways and means, the
161joint committee on children, families and person with disabilities and the joint committee on
162mental health, substance use and recovery a report, along with any recommendations, examining
163the prevalence of births of infants identified as affected by prenatal substance exposure or fetal
164alcohol spectrum disorder, including, but not limited to: (i) any gaps in services for perinatal
165patients or such infants; (ii) an examination of child abuse and neglect reports related to an
166infant’s prenatal exposure to substances, including those that were ultimately screened out by the 9 of 30
167department of children and families; (iii) an examination of child abuse and neglect reports made
168pursuant to section 51A of chapter 119 related to an infant’s prenatal exposure to substances; and
169(iv) any recommended changes, including legislative or regulatory changes, that may be
170necessary to ensure the ongoing health, safety and wellbeing of perinatal patients and infants. If
171applicable, the department, in consultation with the department of children and families and the
172office of the child advocate, shall provide recommendations to address disparate impacts of the
173safety and wellbeing of infants identified as affected by prenatal substance exposure or fetal
174alcohol spectrum disorder.
175 SECTION 9. Section 7 of chapter 111E of the General Laws, as so appearing, is hereby
176amended by inserting after the word “basis”, in line 28, the following words:- , as determined by
177the department to be consistent with section 4 of chapter 151B and sufficient to ensure the needs
178of such residents are met and such residents have adequate access to such a facility,.
179 SECTION 10. The General Laws are hereby amended by striking out chapter 111J and
180inserting in place thereof the following chapter:-
181 CHAPTER 111J
182 ALCOHOL AND DRUG COUNSELORS; RECOVERY COACHES.
183 Section 1. As used in this chapter, the following words shall, unless the context clearly
184requires otherwise, have the following meanings:
185 “Applicant”, an individual seeking licensure under this chapter. 10 of 30
186 “Approved continuing education”, continuing education approved by the department,
187including research and training programs, college and university courses, in-service training
188programs, seminars and conferences designed to maintain and enhance the skills of licensees.
189 “Approved program”, a program approved by the department for the education and
190training of licensees.
191 “Approved work experience”, supervised work experience, approved by the department,
192in the practice area for which an applicant seeks licensure.
193 “Department”, the department of public health.
194 “Licensee”, an individual who is licensed under this chapter.
195 “Licensed alcohol and drug counselor I”, a person licensed by the department to conduct
196an independent practice of alcohol and drug counseling and to provide supervision to other
197alcohol and drug counselors. A licensed alcohol and drug counselor I shall have: (i) received a
198master’s or doctoral degree in behavioral sciences, which included a supervised counseling
199practicum that meets the requirements established by the department or such equivalent
200educational credits as may be established by the department; (ii) at least 3 years of approved
201work experience; and (iii) passed a licensing examination approved by the department.
202 “Licensed alcohol and drug counselor II”, a person licensed by the department to practice
203alcohol and drug counseling under clinical supervision. A licensed alcohol and drug counselor II
204shall have: (i) completed an approved program of education, which included a supervised
205counseling practicum that meets the requirements established by the department or such 11 of 30
206equivalent educational credits as may be established by the department; (ii) at least 3 years of
207approved work experience; and (iii) passed a licensing examination approved by the department.
208 “Licensed recovery coach”, a person with lived experience who is licensed by the
209department to practice recovery coaching using shared understanding, respect and mutual
210empowerment to help others become and stay engaged in the process of recovery from a
211substance use disorder. A licensed recovery coach shall: (i) have completed an approved
212program of education, including approved work experience that meets the requirements
213established by the department; (ii) demonstrate at least 2 years of sustained recovery; and (iii)
214have met all education, training and experience requirements and qualifications as established by
215the department.
216 “Lived experience”, the experience of addiction and recovery from a substance use
217disorder.
218 Section 2. (a) The department shall establish and administer a program for the licensure
219of alcohol and drug counselors and recovery coaches. The department shall: (i) establish the
220licensure requirements for licensed alcohol and drug counselors practicing in the commonwealth;
221(ii) establish the licensure requirements for licensed recovery coaches practicing in the
222commonwealth; (iii) evaluate the qualifications of applicants for licensure; (iv) supervise
223licensing examinations, where applicable; (v) establish and collect fees for licensing and
224examination, where applicable; (vi) grant and issue licenses to applicants who satisfy the
225department’s requirements for licensure; (vii) establish continuing education requirements; (viii)
226investigate complaints; (ix) take appropriate disciplinary action to protect the public health, 12 of 30
227safety and welfare; and (x) perform other functions and duties as may be necessary to carry out
228this chapter.
229 (b) The department shall establish requirements for licensed alcohol and drug counselors
230I and licensed alcohol and drug counselors II and may establish other reasonable classifications
231for alcohol and drug counselors as it finds necessary and appropriate, taking into consideration
232different levels of education, training and work experience.
233 (c) The department shall establish requirements for licensed recovery coaches, including,
234but not limited to, establishing an ethical code of conduct for recovery coaches, and may
235establish other reasonable classifications for recovery coaches as it finds necessary and
236appropriate, taking into consideration different levels of education, training and work experience.
237 (d) The department shall approve and issue certificates of approval of programs for the
238training of alcohol and drug counselors. The department shall maintain a list of approved
239programs and a current roster of persons serving as licensed alcohol and drug counselors in the
240commonwealth.
241 (e) The department shall approve and issue certificates of approval of programs for the
242training of recovery coaches. The department shall maintain a list of approved programs and a
243current roster of persons serving as licensed recovery coaches in the commonwealth.
244 (f) The department shall promulgate rules and regulations as it deems necessary to
245implement the provisions of this chapter, including, but not limited to, rules and regulations
246establishing the educational and professional requirements for licensing individuals under this
247chapter, establishing fees for licensing and examination, where applicable, and governing the
248practice and employment of licensees to promote the public health, safety and welfare. 13 of 30
249 Section 3. (a) Each applicant shall furnish the department with proof of satisfactory
250completion of the educational, training and experience requirements for licensure, including
251completion of an approved program and approved work experience and proof of having passed
252any licensing examinations required by the department; provided, that the department may
253establish additional requirements for licensure and exemptions by regulation.
254 (b) A licensee shall apply biennially to the department for license renewal. A licensee
255seeking license renewal shall submit proof of having successfully completed the requirements for
256approved continuing education as may be established by the department.
257 (c) Applications for licenses and renewals thereof shall be submitted in accordance with
258procedures established by the department. The department may establish fees for license
259applications or renewals.
260 Section 4. (a) Except as otherwise provided for in this chapter or by regulation of the
261department, persons not licensed or otherwise exempt from licensing shall not hold themselves
262out as a licensed recovery coach and shall not use the title, initials, abbreviations, insignia or
263description of a licensed recovery coach or practice or attempt to practice recovery coaching
264unless otherwise authorized by law or rule or regulation of the department. Whoever engages in
265any such unauthorized action shall be subject to a fine of not less than $500. The department may
266bring a petition in superior court to enjoin such action or any other violation of this chapter or a
267regulation of the department.
268 (b) The following individuals pursuing a recovery coach license who meet the
269requirements for licensed recovery coach applicants as set forth in this chapter or in rules or 14 of 30
270regulations of the department may practice without a license in order to obtain the requisite hours
271of supervised work experience needed to obtain such license:
272 (i) an educational psychologist, marriage and family therapist, alcohol and drug
273counselor, mental health counselor, nurse practitioner, occupational therapist, physician,
274physician assistant, practical nurse, psychologist, registered nurse, rehabilitation counselor or
275social worker;
276 (ii) an employee or other agent of a recognized academic institution or employee
277assistance program or a federal, state, county or local government institution, program, agency or
278facility or school committee, school district, school board or board of regents while performing
279recovery coach duties solely for the respective entity or under the jurisdiction and supervision of
280such entity; and
281 (iii) an employee of a program or facility approved or licensed by the department
282pursuant to chapters 111B and 111E; provided, however, that such individual shall perform
283recovery coaching solely within or under the jurisdiction and supervision of such program or
284facility.
285 (c) Nothing in this section shall be construed to prevent members of peer groups or self-
286help groups from performing peer counseling or self-help activities that may be included within
287the practice recovery coaching; provided, however, that no members of peer groups or self-help
288groups who are not so credentialed shall use a title stating or implying that such person is a
289licensed recovery coach.
290 Section 5. (a) Except as otherwise provided for in this chapter or by regulation, a person
291who is not licensed or is otherwise exempt from licensing shall not hold themself out as a 15 of 30
292licensed alcohol and drug counselor and shall not use the title, initials or description of a licensed
293alcohol and drug counselor or practice or attempt to practice alcohol and drug counseling.
294Whoever engages in any such unauthorized action shall be subject to a fine of not less than $500.
295The department may bring a petition in superior court to enjoin such action or any other violation
296of this chapter or a regulation of the department.
297 (b) The following individuals shall be exempt from the licensing requirements for alcohol
298and drug counseling under this chapter:
299 (i) an educational psychologist, marriage and family therapist, mental health counselor,
300nurse practitioner, occupational therapist, physician, physician assistant, practical nurse,
301psychologist, registered nurse, rehabilitation counselor and social worker;
302 (ii) an employee or other agent of a recognized academic institution or employee
303assistance program or a federal, state, county or local government institution, program, agency or
304facility or school committee, school district, school board or board of regents while performing
305alcohol and drug counseling duties solely for the respective entity or under the jurisdiction of
306such entity; provided, however, that a license pursuant to this chapter need not be a requirement
307for employment in any state, county or municipal agency; and
308 (iii) an employee of a treatment program or facility licensed or approved by the
309department pursuant to chapters 111B and 111E; provided, however, that such individual shall
310perform alcohol and drug counseling solely within or under the jurisdiction of such program or
311facility.
312 (c) Nothing in this section shall be construed to prevent qualified members of other
313professions, including attorneys, Christian Science practitioners or members of the clergy, from 16 of 30
314providing alcohol or drug counseling consistent with accepted standards of their respective
315professions; provided, however, that no such person shall use a title stating or implying that such
316person is a licensed alcohol and drug counselor.
317 (d) Nothing in this section shall be construed to prevent members of peer groups or self-
318help groups from performing peer group or self-help activities; provided, however, that no such
319person shall use a title stating or implying that such person is a licensed alcohol and drug
320counselor.
321 Section 6. (a) The department shall establish procedures for consumers to file written
322complaints regarding an individual licensed under this chapter. The department shall investigate
323all complaints relating to the proper practice of a person holding a license under this chapter and
324all complaints relating to any violation of this chapter or regulation of the department.
325 (b) The department may conduct an adjudicatory proceeding pursuant to chapter 30A, but
326shall not have the power to issue, vacate, modify or enforce subpoenas pursuant to section 12 of
327chapter 30A. The department may, after a hearing pursuant to chapter 30A, deny, refuse renewal,
328revoke, limit or suspend a license or otherwise discipline a licensee; provided, however, the
329department may suspend the license of a licensee who poses an imminent danger to the public;
330provided further, that the licensee shall be afforded a hearing within 7 business days to determine
331whether the action is warranted; and provided further, that the department shall conduct its
332proceedings in accordance with the provisions of this chapter and said chapter 30A. Grounds for
333denial, refusal to renew, revocation, limitation, suspension or other discipline shall include the
334following:
335 (i) fraud or misrepresentation in obtaining a license; 17 of 30
336 (ii) criminal conduct which the department determines to be of such a nature as to render
337such person unfit to practice as licensed as evidenced by criminal proceedings resulting in a
338conviction, guilty plea or plea of nolo contendere or an admission of sufficient facts;
339 (iii) violation of any law or rule or regulation of the department governing the practice of
340the licensee;
341 (iv) violation of ethical standards which the department determines to be of such a nature
342as to render such person unfit to practice as a licensee; or
343 (v) other just and sufficient cause that the department determines would render a person
344unfit to practice as a licensee.
345 (c) Where denial, refusal to renew, revocation or suspension is based solely on the failure
346of the licensee to timely file an application or pay prescribed fees or to maintain insurance
347coverage as required by law or regulation, the department may act without first granting the
348applicant or licensee a hearing.
349 Section 7. (a) Examinations for licensure, where applicable, shall be conducted at least
350twice per year at times and places designated by the department. Examinations for licensure,
351where applicable, shall be written; provided, however, that portions thereof may be conducted
352orally. A person who has failed an examination may be admitted to the next subsequent
353examination.
354 (b) The department may accept, in lieu of its own examination, a current certificate of
355any recognized certifying body issued on the basis of an examination satisfactory to the 18 of 30
356department; provided, however, that the standards of such body shall be at least as stringent as
357those established by the department.
358 Section 8. (a) The department may issue a license without examination to an applicant
359who meets the requirements for licensure established by the department if such applicant is
360licensed or certified in alcohol and drug counseling or in recovery coaching or a comparable
361field in another state wherein the requirements for licensure shall be deemed by the department
362to be equivalent to or in excess of the requirements of this chapter.
363 (b) The department may authorize an alcohol and drug counselor or a recovery coach to
364practice by reciprocity.
365 (c) The department shall promulgate rules and regulations as may be necessary to
366implement this section.
367 Section 9. (a) There shall be a recovery coach advisory council within the department to
368assist and support the department in carrying out this chapter by planning, guiding and
369coordinating the components of the practice of recovery coaching; provided, that the council may
370advise the department on other such matters related to the practice of recovery coaching, the
371practice of alcohol and drug counseling and the inclusion of people with lived experience in
372guiding such practices.
373 (b) The advisory council shall consist of the following members: the director of the
374bureau of substance addiction services, or a designee, who shall serve as chair; and 7 members
375appointed by the secretary of health and human services, 4 of whom shall be employed as
376recovery coaches, recovery coach supervisors or recovery coach educators and shall be, to the
377extent possible, representative of the demographic diversity of the commonwealth, including, but 19 of 30
378not limited to, diversity in race, ethnicity, gender, gender identity, sexual orientation, age,
379disability, geographical region, workplace and history of involvement with the criminal legal
380system, 1 of whom shall be a representative of the Massachusetts Board of Substance Abuse
381Counselor Certification, 1 of whom shall represent a health plan and 1 of whom shall be a person
382with lived experience who has received or is receiving recovery coaching services. Members of
383the advisory council shall be residents of the commonwealth.
384 Section 10. The bureau of substance addiction services shall establish a comprehensive
385peer support program to provide mentorship, technical assistance and support resources for the
386wellbeing of recovery coaches, including, but not limited to, peer support specialists, peer
387recovery coaches and recovery support navigators. The program shall include, but shall not be
388limited to: (i) a network for peer-to-peer trainings, education, mentorship, counseling and
389support; (ii) educational and other clinical support materials; (iii) technical assistance for
390licensure, certification, credentialing and other employment and practice requirements; and (iv)
391billing technical assistance for organizations that employ recovery coaches.
392 SECTION 11. Chapter 118E of the General Laws is hereby amended by inserting after
393section 10Q the following 2 sections:-
394 Section 10R. The division and its contracted health insurers, health plans, health
395maintenance organizations, behavioral health management firms and third-party administrators
396under contract to a Medicaid managed care organization, accountable care organization or
397primary care clinician plan shall provide coverage for prescribed or dispensed opioid antagonists,
398as defined in section 19B of chapter 94C, which shall be deemed medically necessary and shall
399not require prior authorization; provided, however, that a prescription from a health care 20 of 30
400practitioner shall not be required for coverage of opioid antagonists. An opioid antagonist shall
401not be subject to any deductible, coinsurance, copayments or out-of-pocket limits; provided,
402however, that cost-sharing shall be required if the applicable plan is governed by the federal
403Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on cost-
404sharing for this service.
405 (b) The division and its contracted health insurers, health plans, health maintenance
406organizations, behavioral health management firms and third-party administrators shall provide
407coverage for an opioid antagonist as a medical benefit when dispensed by the health care facility
408in which the opioid antagonist was prescribed and shall provide coverage as a pharmacy benefit
409for an opioid antagonist dispensed by a pharmacist, including an opioid antagonist dispensed
410pursuant to section 19B of chapter 94C.
411 Section 10S. The division and its contracted health insurers, health plans, health
412maintenance organizations, behavioral health management firms and third-party administrators
413under contract to a Medicaid managed care organization, accountable care organization or
414primary care clinician plan shall provide coverage for the provision of services by a recovery
415coach licensed or otherwise authorized to practice pursuant to chapter 111J, irrespective of the
416setting in which these services are provided; provided, that such services shall be within the
417lawful scope of practice of a recovery coach. The benefits in this section shall not be subject to
418any deductible, coinsurance, copayments or out-of-pocket limits; provided, however, that cost-
419sharing shall be required if the applicable plan is governed by the federal Internal Revenue Code
420and would lose its tax-exempt status as a result of the prohibition on cost-sharing for this service.
421Recovery coach services shall be deemed medically necessary and shall not require prior
422authorization. 21 of 30
423 SECTION 12. Subsection (a) of section 51A of chapter 119 of the General Laws, as
424appearing in the 2022 Official Edition, is hereby amended by striking out the first paragraph and
425inserting in place thereof the following paragraph:-
426 A mandated reporter shall immediately communicate with the department orally and
427shall, within 48 hours, file a written report with the department detailing suspected abuse or
428neglect if, in their professional capacity, they have reasonable cause to believe that a child is: (i)
429suffering physical or emotional injury resulting from abuse inflicted upon them which causes
430harm or substantial risk of harm to the child’s health or welfare including, but not limited to,
431sexual abuse; (ii) suffering physical or emotional injury resulting from neglect including, but not
432limited to, malnutrition; (iii) a sexually exploited child; or (iv) a human trafficking victim, as
433defined by section 20M of chapter 233.
434 SECTION 13. Section 1 of chapter 151B of the General Laws, as so appearing, is hereby
435amended by striking out subsection 17 and inserting in place thereof the following subsection:-
436 17. The term “handicap” means: (a) a physical or mental impairment which substantially
437limits 1 or more major life activities of a person; (b) a record of having such impairment; (c)
438being regarded as having such impairment; or (d) the lawful possession and clinically
439appropriate taking of any medication that is: (i) approved by the federal Food and Drug
440Administration for the treatment of an opioid-related substance use disorder, including, but not
441limited to, an opioid agonist or a partial opioid agonist and used for the treatment of an opioid-
442related substance use disorder; (ii) obtained directly or pursuant to a valid prescription or order
443from a practitioner, as defined in section 1 of chapter 94C; (iii) determined to be medically
444necessary by a practitioner while acting in the course of professional practice; and (iv) offered in 22 of 30
445accordance with a treatment plan that is reviewed by a practitioner at a frequency consistent with
446appropriate clinical standards. The term handicap shall not include current, illegal use of a
447controlled substance, as defined in said section 1 of said chapter 94C. For the purposes of this
448subsection, the words “clinically appropriate” shall mean the taking of a prescribed medication
449for the treatment of an opioid-related substance use disorder when such drug is medically
450indicated and intake is proportioned to the medical need.
451 SECTION 14. Chapter 175 of the General Laws is hereby amended by inserting after
452section 47UU the following 2 sections:-
453 Section 47VV. Any policy, contract, agreement, plan or certificate of insurance issued,
454delivered or renewed within the commonwealth, which is considered creditable coverage under
455section 1 of chapter 111M, shall provide coverage for prescribed or dispensed opioid antagonists,
456as defined in section 19B of chapter 94C, which shall be deemed medically necessary and shall
457not require prior authorization; provided, however, that a prescription from a health care
458practitioner shall not be required for coverage of opioid antagonists. An opioid antagonist shall
459not be subject to any deductible, coinsurance, copayments or out-of-pocket limits; provided,
460however, that cost-sharing shall be required if the applicable plan is governed by the federal
461Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on cost-
462sharing for this service.
463 (b) The policy, contract, agreement, plan or certificate of insurance shall provide
464coverage for an opioid antagonist as a medical benefit when dispensed by the health care facility
465in which the opioid antagonist was prescribed and shall provide coverage as a pharmacy benefit 23 of 30
466for an opioid antagonist dispensed by a pharmacist, including an opioid antagonist dispensed
467pursuant to section 19B of chapter 94C.
468 Section 47WW. Any policy, contract, agreement, plan or certificate of insurance issued,
469delivered or renewed within the commonwealth, which is considered creditable coverage under
470section 1 of chapter 111M, shall provide coverage for the provision of services by a recovery
471coach licensed or otherwise authorized to practice under chapter 111J, irrespective of the setting
472in which these services are provided; provided, that such services shall be within the lawful
473scope of practice of a recovery coach. The contractual rate for these services shall be no less than
474the prevailing MassHealth rate for recovery coach services. The benefits in this section shall not
475be subject to any deductible, coinsurance, copayments or out-of-pocket limits; provided,
476however, that cost-sharing shall be required if the applicable plan is governed by the federal
477Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on cost-
478sharing for this service. Recovery coach services shall be deemed medically necessary and shall
479not require prior authorization.
480 SECTION 15. Said chapter 175 is hereby further amended by inserting after section
481122A the following section:-
482 Section 122B. (a) No insurer authorized to issue policies on the lives of persons in the
483commonwealth shall make a distinction or otherwise discriminate between persons, reject an
484applicant, cancel a policy or demand or require a higher rate of premium for reasons based solely
485upon an applicant or insured having or had a prescription for, purchased or otherwise possessed
486an opioid antagonist, as defined in section 19B of chapter 94C. 24 of 30
487 (b) A violation of this section shall constitute an unfair method of competition or unfair
488and deceptive act or practice pursuant to chapters 93A and 176D.
489 SECTION 16. Chapter 176A of the General Laws is hereby amended by inserting after
490section 8VV the following 2 sections:-
491 Section 8WW. Any contract between a subscriber and the corporation under an
492individual or group hospital service plan that is delivered, issued or renewed within the
493commonwealth shall provide coverage for prescribed or dispensed opioid antagonists, as defined
494in section 19B of chapter 94C, which shall be deemed medically necessary and shall not require
495prior authorization; provided, however, that a prescription from a health care practitioner shall
496not be required for coverage of opioid antagonists. An opioid antagonist shall not be subject to
497any deductible, coinsurance, copayments or out-of-pocket limits; provided, however, that cost-
498sharing shall be required if the applicable plan is governed by the federal Internal Revenue Code
499and would lose its tax-exempt status as a result of the prohibition on cost-sharing for this service.
500 (b) Such contract shall provide coverage for an opioid antagonist as a medical benefit
501when dispensed by the health care facility in which the opioid antagonist was prescribed and
502shall provide coverage as a pharmacy benefit for an opioid antagonist dispensed by a pharmacist,
503including an opioid antagonist dispensed pursuant to section 19B of chapter 94C.
504 Section 8XX. Any contract between a subscriber and the corporation under an individual
505or group hospital service plan that is delivered, issued or renewed within the commonwealth
506shall provide coverage for the provision of services by a recovery coach licensed or otherwise
507authorized to practice under chapter 111J, irrespective of the setting in which these services are
508provided; provided, that such services shall be within the lawful scope of practice of a recovery 25 of 30
509coach. The contractual rate for these services shall be no less than the prevailing MassHealth rate
510for recovery coach services. The benefits in this section shall not be subject to any deductible,
511coinsurance, copayments or out-of-pocket limits; provided, however, that cost-sharing shall be
512required if the applicable plan is governed by the federal Internal Revenue Code and would lose
513its tax-exempt status as a result of the prohibition on cost-sharing for this service. Recovery
514coach services shall be deemed medically necessary and shall not require prior authorization.
515 SECTION 17. Chapter 176B of the General Laws is hereby amended by inserting after
516section 4VV the following 2 sections:-
517 Section 4WW. Any subscription certificate under an individual or group medical service
518agreement delivered, issued or renewed within the commonwealth, shall provide coverage for
519prescribed or dispensed opioid antagonists, as defined in section 19B of chapter 94C, which shall
520be deemed medically necessary and shall not require prior authorization; provided, however, that
521a prescription from a health care practitioner shall not be required for coverage of opioid
522antagonists. An opioid antagonist shall not be subject to any deductible, coinsurance,
523copayments or out-of-pocket limits; provided, however, that cost-sharing shall be required if the
524applicable plan is governed by the federal Internal Revenue Code and would lose its tax-exempt
525status as a result of the prohibition on cost-sharing for this service.
526 (b) The policy, contract, agreement, plan or certificate of insurance shall provide
527coverage for an opioid antagonist as a medical benefit when dispensed by the health care facility
528in which the opioid antagonist was prescribed and shall provide coverage as a pharmacy benefit
529for an opioid antagonist dispensed by a pharmacist, including an opioid antagonist dispensed
530pursuant to section 19B of chapter 94C. 26 of 30
531 Section 4XX. Any subscription certificate under an individual or group medical service
532agreement delivered, issued or renewed within the commonwealth shall provide coverage for the
533provision of services by a recovery coach licensed or otherwise authorized to practice under
534chapter 111J, irrespective of the setting in which these services are provided; provided, that such
535services shall be within the lawful scope of practice of a recovery coach. The contractual rate for
536these services shall be no less than the prevailing MassHealth rate for recovery coach services.
537The benefits in this section shall not be subject to any deductible, coinsurance, copayments or
538out-of-pocket limits; provided, however, that cost-sharing shall be required if the applicable plan
539is governed by the federal Internal Revenue Code and would lose its tax-exempt status as a result
540of the prohibition on cost-sharing for this service. Recovery coach services shall be deemed
541medically necessary and shall not require prior authorization.
542 SECTION 18. Chapter 176G of the General Laws is hereby amended by inserting after
543section 4NN the following 2 sections:-
544 Section 4OO. An individual or group health maintenance contract that is issued or
545renewed within or without the commonwealth shall provide coverage for prescribed or dispensed
546opioid antagonists, as defined in section 19B of chapter 94C, which shall be deemed medically
547necessary and shall not require prior authorization; provided, however, that a prescription from a
548health care practitioner shall not be required for coverage of opioid antagonists. An opioid
549antagonist shall not be subject to any deductible, coinsurance, copayments or out-of-pocket
550limits; provided, however, that cost-sharing shall be required if the applicable plan is governed
551by the federal Internal Revenue Code and would lose its tax-exempt status as a result of the
552prohibition on cost-sharing for this service. 27 of 30
553 (b) The individual or group health maintenance contract shall provide coverage for an
554opioid antagonist as a medical benefit when dispensed by the health care facility in which the
555opioid antagonist was prescribed and shall provide coverage as a pharmacy benefit for an opioid
556antagonist dispensed by a pharmacist, including an opioid antagonist dispensed pursuant to
557section 19B of chapter 94C.
558 Section 4PP. An individual or group health maintenance contract that is issued or
559renewed within or without the commonwealth shall provide coverage for the provision of
560services by a recovery coach licensed or otherwise authorized to practice under chapter 111J,
561irrespective of the setting in which these services are provided; provided, that such services shall
562be within the lawful scope of practice of a recovery coach. The contractual rate for these services
563shall be no less than the prevailing MassHealth rate for recovery coach services. The benefits in
564this section shall not be subject to any deductible, coinsurance, copayments or out-of-pocket
565limits; provided, however, that cost-sharing shall be required if the applicable plan is governed
566by the federal Internal Revenue Code and would lose its tax-exempt status as a result of the
567prohibition on cost-sharing for this service. Recovery coach services shall be deemed medically
568necessary and shall not require prior authorization.
569 SECTION 19. (a) The department of children and families, in consultation with the
570department of public health and the office of the child advocate, shall promulgate regulations or
571issue further guidance for the requirements of health care providers involved in the delivery or
572care of infants identified as being affected by prenatal substance exposure or fetal alcohol
573spectrum disorder. The regulations or guidance shall include, but shall not be limited to: (i)
574factors for determining instances in which prenatal substance exposure from a medication
575prescribed by a licensed health care provider require filing a report pursuant to section 51A of 28 of 30
576chapter 119 of the General Laws; provided, that an indication of prenatal substance exposure
577shall not solely meet the requirements of said section 51A of said chapter 119; and (ii) the roles
578and responsibilities of health care providers and staff who care for perinatal patients or newborns
579pursuant to 42 U.S.C. § 5106a(b)(2)(B)(ii) and in accordance with the federal Child Abuse
580Prevention and Treatment Act, 42 U.S.C. § 5101 et seq. and 42 U.S.C. § 5116 et seq., as
581amended from time to time.
582 (b) Such regulations or guidance shall: (i) reflect current accepted standards of health
583care and substance use treatment practices; (ii) conform to the reporting requirements under the
584federal Child Abuse Prevention and Treatment Act, 42 U.S.C. § 5101 et seq. and 42 U.S.C. §
5855116 et seq., as amended from time to time; and (iii) to the extent possible, reduce racial
586disparities in maternal and child health care, reports of suspected child abuse or neglect under
587said section 51A of said chapter 119 or the number of patients identified for plans of safe care
588pursuant to the federal Child Abuse Prevention and Treatment Act, 42 U.S.C. § 5101 et seq. and
58942 U.S.C. § 5116 et seq., as amended from time to time.
590 (c) Such regulations or guidance shall be developed with input from relevant
591stakeholders, including, but not limited to: (i) medical professional associations and health care
592providers with expertise in the provision of care to pregnant people; (ii) individuals who have
593lived experience of seeking or receiving behavioral health services or treatment prior to, during
594and after pregnancy; (iii) professional associations and organizations with expertise in prenatal
595substance exposure, perinatal and child health, treatment of substance use disorder and racial
596equity in access to health care; and (iv) behavioral health professionals with expertise in
597providing culturally-competent care. 29 of 30
598 SECTION 20. The bureau of substance addiction services within the department of
599public health shall conduct a comprehensive review of barriers to certification, credentialing and
600other employment and practice requirements of recovery coaches, including, but not limited to,
601peer support specialists, peer recovery coaches and recovery support navigators, and issue a
602report on its findings. The report shall include, but shall not be limited to: (i) cost barriers for
603individuals with lived experience, including, but not limited to, application and examination fees
604for initial certification and credentialing; (ii) cost barriers to certification and credentialing
605renewals; (iii) cost and reimbursement barriers for hospitals and clinics licensed under chapter
606111 of the General Laws and other employers to hire, train and retain recovery coaches,
607including, but not limited to, peer support specialists, peer recovery coaches and recovery
608support navigators; (iv) eligibility requirements for certification and credentialing; (v) access to
609training programs and resources; and (vi) any additional barriers to obtaining and maintaining
610authorization to practice recovery coaching. The report shall also include recommendations to
611address said barriers. The bureau shall submit a copy of the report to the secretary of health and
612human services, the clerks of the house of representatives and the senate and the joint committee
613on mental health, substance use and recovery within 90 days of the effective date of this act.
614 SECTION 21. (a) The department of public health may issue a recovery coach license to
615an applicant who: (i) is practicing in the commonwealth as a recovery coach as of the effective
616date of this act; and (ii) applies for licensure within 1 year of the effective date of this act. The
617lived experience requirement pursuant to section 1 of chapter 111J of the General Laws, as
618inserted by section 10, shall be waived for applicants who were credentialed by the
619Massachusetts Board of Substance Abuse Counselor Certification prior to the effective date of
620this act. 30 of 30
621 (b) The department of public health shall issue a temporary recovery coach license to an
622applicant who has received a Certified Addictions Recovery Coach certification, issued by the
623Massachusetts Board of Substance Abuse Counselor Certification and provides satisfactory proof
624for any test or examination that may be required for licensure; provided, that no temporary
625license shall be valid for more than 2 years. The applicants eligible for a temporary license shall
626meet all other qualifications and requirements for licensure as determined by the department of
627public health.
628 (c) The department of public health shall promulgate rules or regulations for the
629implementation of this section.
630 SECTION 22. No person shall be found to have violated section 4 of chapter 111J of the
631General Laws, as inserted by section 10, until 6 months after the department of public health first
632issues a recovery coach license pursuant to said section 4 of said chapter 111J.
633 SECTION 23. Not later than 18 months after the effective date of this act, the initial
634report consistent with the report required pursuant to section 110D of chapter 111 of the General
635Laws, as inserted by section 8, shall be filed by the department of public health, in consultation
636with the department of children and families and the office of the child advocate, with the clerks
637of the house of representatives and the senate, the house and senate committees on ways and
638means, the joint committee on children, families and person with disabilities and the joint
639committee on mental health, substance use and recovery examining the prevalence of births of
640infants identified as being affected by prenatal substance exposure or fetal alcohol spectrum
641disorder.