Massachusetts 2023-2024 Regular Session

Massachusetts House Bill H4758 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	1 of 47
2	2	FILED ON: 6/13/2024
3	3	HOUSE . . . . . . . . . . . . . . . No. 4758
4	4	House bill No. 4743, as change by the House committee on Bills in the Third Reading, and as
5	5	amended and passed to be engrossed by the House. June 13, 2024.
6	6	The Commonwealth of Massachusetts
7	7	_______________
8	8	In the One Hundred and Ninety-Third General Court
9	9	(2023-2024)
10	10	_______________
11	11	An Act relative to treatments and coverage for substance use disorder and recovery coach
12	12	licensure.
13	13	Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
14	14	of the same, as follows:
15	15	1 SECTION A1. Chapter 32A of the General Laws is hereby amended by striking out
16	16	2section 17Q and inserting in place thereof the following section:-
17	17	3 Section 17Q. (a) The commission shall develop a plan to provide active or retired
18	18	4employees insured under the group insurance commission adequate coverage and access to a
19	19	5broad spectrum of pain management services, including, but not limited to, non-medication, non-
20	20	6surgical treatment modalities and non-opioid medication treatment options that serve as
21	21	7alternatives to opioid prescribing, in accordance with guidelines developed by the division of
22	22	8insurance.
23	23	9 (b) No such coverage offered by the commission shall, relative to pain management
24	24	10services identified by the commission pursuant to subsection (a), require a member to obtain a
25	25	11preauthorization for non-medication, non-surgical treatment modalities that include restorative 2 of 47
26	26	12therapies, behavioral health approaches or integrative health therapies, including acupuncture,
27	27	13chiropractic treatments, massage and movement therapies.
28	28	14 (c)(1) The plan pursuant to subsection (a) shall be subject to review by the division of
29	29	15insurance. In its review, the division shall consider the adequacy of access to a broad spectrum of
30	30	16pain management services and any policies that may create unduly preferential coverage to
31	31	17prescribing opioids without other pain management modalities.
32	32	18 (2) Any coverage offered by the commission to an active or retired employee of the
33	33	19commonwealth insured under the group insurance commission shall not establish utilization
34	34	20controls, including preauthorization or step therapy requirements, for clinically appropriate non-
35	35	21opioid drugs approved by the federal Food and Drug Administration for the treatment or
36	36	22management of pain that are more restrictive or extensive than the least restrictive or extensive
37	37	23utilization controls applicable to any clinically appropriate opioid drug.
38	38	24 (d) The commission shall annually distribute educational materials to providers within
39	39	25their network and to members about the pain management access plan and shall make
40	40	26information about its plan publicly available on its website.
41	41	27 SECTION 1. Said chapter 32A is hereby further amended by inserting after section 17S
42	42	28the following 2 sections:-
43	43	29 Section 17T. (a) Any coverage offered by the commission to an active or retired
44	44	30employee of the commonwealth insured under the group insurance commission shall provide
45	45	31coverage for prescribed or dispensed opioid antagonists, as defined in section 19B of chapter
46	46	3294C and used in the reversal of overdoses caused by opioids, which shall be deemed medically 3 of 47
47	47	33necessary and shall not require prior authorization; provided, however, that a prescription from a
48	48	34health care practitioner shall not be required for coverage of opioid antagonists. An opioid
49	49	35antagonist used in the reversal of overdoses caused by opioids shall not be subject to any
50	50	36deductible, coinsurance, copayments or out-of-pocket limits; provided, however, that cost-
51	51	37sharing shall be required if the applicable plan is governed by the federal Internal Revenue Code
52	52	38and would lose its tax-exempt status as a result of the prohibition on cost-sharing for this service.
53	53	39 (b) The commission shall provide coverage for an opioid antagonist used in the reversal
54	54	40of overdoses caused by opioids as a medical benefit when dispensed by the health care facility in
55	55	41which the opioid antagonist was prescribed and shall provide coverage as a pharmacy benefit for
56	56	42an opioid antagonist used in the reversal of overdoses caused by opioids dispensed by a
57	57	43pharmacist, including an opioid antagonist dispensed pursuant to section 19B of chapter 94C;
58	58	44provided, however, that the rate to be reimbursed under the medical benefit shall not exceed the
59	59	45commission’s average in-network pharmacy benefit rate and the health care facility shall not
60	60	46balance bill the patient.
61	61	47 Section 17U. (a) The commission shall provide to any active or retired employee of the
62	62	48commonwealth who is insured under the group insurance commission coverage for the provision
63	63	49of services by a recovery coach licensed or otherwise authorized to practice pursuant to chapter
64	64	50111J, irrespective of the setting in which the services are provided; provided, that such services
65	65	51shall be within the lawful scope of practice of a recovery coach. The contractual rate for these
66	66	52services shall be not less than the prevailing MassHealth rate for recovery coach services. The
67	67	53benefits in this section shall not be subject to any deductible, coinsurance, copayments or out-of-
68	68	54pocket limits; provided, however, that cost-sharing shall be required if the applicable plan is
69	69	55governed by the federal Internal Revenue Code and would lose its tax-exempt status as a result 4 of 47
70	70	56of the prohibition on cost-sharing for the service. Recovery coach services shall be deemed
71	71	57medically necessary and shall not require prior authorization.
72	72	58 SECTION 2. Chapter 18 of chapter 94C of the General Laws, as appearing in the 2022
73	73	59Official Edition, is hereby amended by striking out subsection (e) and inserting in place thereof
74	74	60the following subsection:-
75	75	61 (e) Practitioners who prescribe controlled substances, except veterinarians, shall be
76	76	62required, as a prerequisite to obtaining or renewing their professional licenses, to complete
77	77	63appropriate training relative to: (i) effective pain management including, but not limited to: (A)
78	78	64appropriate, available non-opioid alternatives for the treatment of pain; (B) the advantages and
79	79	65disadvantages of the use of non-opioid treatment alternatives, considering a patient’s risk of
80	80	66substance misuse; and (C) the options for referring or prescribing appropriate non-opioid
81	81	67treatment alternatives based on the practitioner’s clinical judgment and following generally
82	82	68accepted clinical guidelines, taking into consideration the preference and consent of the patient
83	83	69and the educational information described in section 21; (ii) the risks of misuse and addiction
84	84	70associated with opioid medication; (iii) the identification of patients at risk for substance misuse;
85	85	71(iv) counseling patients about the side effects, risks, addictive nature and proper storage and
86	86	72disposal of prescription medications; (v) the appropriate prescription quantities for prescription
87	87	73medications that have an increased risk of misuse and addiction, including a patient’s option to
88	88	74fill a prescription for a schedule II controlled substance in a lesser quantity than indicated on the
89	89	75prescription pursuant to subsection (d¾); and (vi) opioid antagonists, overdose prevention
90	90	76treatments and information to advise patients on both the use of and ways to access opioid
91	91	77antagonists and overdose prevention treatments. The boards of registration for each professional
92	92	78license that require this training shall, in consultation with the department, relevant stakeholders 5 of 47
93	93	79and experts in the treatment and management of acute and chronic pain, develop the standards
94	94	80for appropriate training programs. For the purposes of this section, non-opioid treatment
95	95	81alternatives shall include, but shall not be limited to, medications, restorative therapies,
96	96	82interventional procedures, behavioral health approaches and complementary and integrative
97	97	83treatments.
98	98	84 SECTION 3. Said chapter 94C is hereby further amended by striking out section 19C and
99	99	85inserting in place thereof the following section:-
100	100	86 Section 19C. The board of registration in pharmacy shall promulgate regulations
101	101	87requiring pharmacies located in areas with high incidents of opiate overdose, as determined by
102	102	88the board in consultation with the department, to maintain a continuous supply of opioid
103	103	89antagonists, as defined in section 19B; provided, that the continuous supply of opioid antagonists
104	104	90shall include opioid antagonists that are approved by the federal Food and Drug Administration
105	105	91to be sold over the counter without a prescription; provided further, that such pharmacies shall
106	106	92notify the department if the supply or stock of opioid antagonist doses is insufficient to enable
107	107	93compliance with maintaining a continuous supply of opioid antagonists.
108	108	94 SECTION 4. Said chapter 94C is hereby further amended by inserting after section 19D
109	109	95the following section:-
110	110	96 Section 19D½. (a) For the purposes of this section, the following words shall, unless the
111	111	97context clearly requires otherwise, have the following meanings:
112	112	98 “Opioid antagonist”, as defined in section 19B. 6 of 47
113	113	99 “Substance use disorder treatment facility”, a facility licensed or approved by the
114	114	100department to offer treatment for substance use disorder, including, but not limited to: (i)
115	115	101withdrawal management services; (ii) clinical stabilization services; (iii) transitional support
116	116	102services; (iv) residential support services; (v) community behavioral health center services; (vi)
117	117	103office-based opioid or addiction treatment services; or (vii) outpatient substance use disorder
118	118	104services.
119	119	105 (b) Upon discharge of a patient from a substance use disorder treatment facility, the
120	120	106facility shall educate the patient on the use of opioid antagonists and dispense not less than 2
121	121	107doses of an opioid antagonist to the patient or a legal guardian.
122	122	108 (c) The commissioner may promulgate rules and regulations necessary to implement this
123	123	109section.
124	124	110 SECTION 5. Section 21 of said chapter 94C, as appearing in the 2022 Official Edition, is
125	125	111hereby amended by striking out the third paragraph and inserting in place thereof the following
126	126	112paragraph:-
127	127	113 The department, in consultation with relevant stakeholders and experts in the treatment
128	128	114and management of acute and chronic pain, and based in part on the Pain Management Best
129	129	115Practices Inter-Agency Task Force Report issued by the United States Department of Health and
130	130	116Human Services, shall produce and distribute either in written or electronic form to pharmacies,
131	131	117not including institutional pharmacies, pamphlets for consumers relative to narcotic drugs,
132	132	118specifically opiates, that include educational information related to: (i) pain management and the
133	133	119use and availability of non-opioid alternatives for the treatment of acute and chronic pain,
134	134	120including, but not limited to: (A) information on available non-opioid alternatives for the 7 of 47
135	135	121treatment of pain, including non-opioid medications and non-pharmacological therapies; and (B)
136	136	122the advantages and disadvantages of the use of such non-opioid treatment alternatives; (ii) the
137	137	123consumer’s option to fill a prescription for a schedule II controlled substance in a lesser quantity
138	138	124than indicated on the prescription pursuant to subsection (d¾) of section 18; (iii) misuse and
139	139	125abuse by adults and children; (iv) the risk of dependency and addiction; (v) proper storage and
140	140	126disposal; (vi) addiction support and treatment resources; (vii) the telephone helpline operated by
141	141	127the bureau of substance addiction services established in section 18 of chapter 17; (viii) risks of
142	142	128unintended overdoses associated with prescription opioid use, including, but not limited to: (A)
143	143	129mixing any opioid with respiratory depressants, including, but not limited to, alcohol,
144	144	130benzodiazepines and stimulants; and (B) changes in personal tolerance levels for persons with a
145	145	131history of overdose; and (ix) risk reduction measures to prevent, respond to and reverse an opioid
146	146	132overdose. A pharmacist shall distribute the pamphlet when dispensing a narcotic or controlled
147	147	133substance contained in schedule II or III; provided, however, that pharmacists shall not be
148	148	134required to distribute the pamphlet if: (i) the patient is receiving outpatient palliative care
149	149	135pursuant to section 227 of chapter 111; (ii) the patient is a resident of a long-term care facility; or
150	150	136(iii) the narcotic or controlled substance is prescribed for use in the treatment of substance use
151	151	137disorder or opioid dependence. For the purposes of this section, non-opioid treatment alternatives
152	152	138shall include, but shall not be limited to, medications, restorative therapies, interventional
153	153	139procedures, behavioral health approaches and complementary and integrative treatments.
154	154	140SECTION 6. Said chapter 94C is hereby further amended by inserting after section 34A the
155	155	141following section:-
156	156	142 Section 34A½. (a) As used in this section, the following words shall, unless the context
157	157	143clearly requires otherwise, have the following meanings: 8 of 47
158	158	144 “Drug testing services”, the use of testing equipment to identify or analyze the strength,
159	159	145effectiveness or purity of a controlled substance prior to its injection, inhalation or ingestion by
160	160	146another person to determine whether the controlled substance contains chemicals, toxic
161	161	147substances or hazardous compounds.
162	162	148 “Testing equipment”, including, but not limited to: fentanyl test strips, colorimetric
163	163	149reagents, high-performance liquid chromatography, gas chromatography and mass spectrometry.
164	164	150 (b)(1) A person acting in good faith and within the scope of their role providing or
165	165	151assisting in the provision of harm reduction services as an owner, employee, intern, volunteer or
166	166	152third-party contractor of an entity providing harm reduction services may provide or assist in
167	167	153drug testing services to an individual to ensure that a controlled substance in the possession of
168	168	154the individual and exclusively for that individual’s personal use does not contain dangerous
169	169	155chemicals, toxic substances or hazardous compounds likely to cause an accidental overdose.
170	170	156 (2) A person acting in good faith and within the scope of their role providing or assisting
171	171	157in the provision of harm reduction services as an owner, employee, intern, volunteer or third-
172	172	158party contractor of an entity providing harm reduction services who provides or assists in the
173	173	159provision of drug testing services pursuant to this section shall not be charged or prosecuted
174	174	160pursuant to sections 32I, 34 or 40.
175	175	161 (3) A person acting in good faith and within the scope of their role providing or assisting
176	176	162in the provision of harm reduction services as an owner, employee, intern, volunteer or third-
177	177	163party contractor of an entity providing harm reduction services who provides or assists in drug
178	178	164testing services pursuant to this section shall: (i) not be held civilly liable for drug testing
179	179	165services unless for gross negligence or willful misconduct in the execution of the drug testing 9 of 47
180	180	166services; and (ii) not be subject to any criminal or civil liability or any professional disciplinary
181	181	167action; provided, however, that this section shall not apply to acts of gross negligence or willful
182	182	168or wanton misconduct.
183	183	169 (c) An individual acting in good faith who seeks drug testing services of a controlled
184	184	170substance in their possession and intended exclusively for their personal use from a person acting
185	185	171in good faith and within the scope of their role providing, or assisting in the provision of, harm
186	186	172reduction services as an owner, employee, intern, volunteer or third-party contractor of an entity
187	187	173providing harm reduction services shall not be charged or prosecuted pursuant to sections 32I, 34
188	188	174or 40 while on the premises where the drug testing services are conducted.
189	189	175 SECTION 7. Section 25J½ of chapter 111 of the General Laws, as appearing in the 2022
190	190	176Official Edition, is hereby amended by inserting after the first paragraph the following
191	191	177paragraph:-
192	192	178 Upon discharge of a patient from an acute care hospital or satellite emergency facility
193	193	179who has: (i) a history of or is actively using opioids; (ii) been diagnosed with opioid use
194	194	180disorder; or (iii) experienced an opioid-related overdose, the acute care hospital or satellite
195	195	181emergency facility shall educate the patient on the use of opioid antagonists, as defined in section
196	196	18219B of chapter 94C, and prescribe or dispense not less than 2 doses of an opioid antagonist to the
197	197	183patient or a legal guardian and notify the patient’s primary care physician or preferred care
198	198	184provider, if known and in consultation with the patient, of the prescribed or dispensed opioid
199	199	185antagonist.
200	200	186 SECTION 8. Said chapter 111, as so appearing, is hereby amended by inserting after
201	201	187section 110C the following section:- 10 of 47
202	202	188 Section 110D. (a) The department shall collect and provide data to the department of
203	203	189children and families and the office of the child advocate on all births of infants affected by
204	204	190prenatal substance exposure in a form and manner consistent with any requirements of the
205	205	191federal Child Abuse Prevention and Treatment Act; provided, that said data shall not include
206	206	192personally identifiable information.
207	207	193 (b) Annually, not later than April 1, the department, in consultation with the department
208	208	194of children and families and the office of the child advocate, shall file with the clerks of the
209	209	195house of representatives and the senate, the house and senate committees on ways and means, the
210	210	196joint committee on children, families and person with disabilities and the joint committee on
211	211	197mental health, substance use and recovery a report, along with any recommendations, examining
212	212	198the prevalence of births of infants identified as affected by prenatal substance exposure or fetal
213	213	199alcohol spectrum disorder, including, but not limited to: (i) any gaps in services for perinatal
214	214	200patients or such infants; (ii) an examination of child abuse and neglect reports related to an
215	215	201infant’s prenatal exposure to substances, including those that were ultimately screened out by the
216	216	202department of children and families; (iii) an examination of child abuse and neglect reports made
217	217	203pursuant to section 51A of chapter 119 related to an infant’s prenatal exposure to substances; and
218	218	204(iv) any recommended changes, including legislative or regulatory changes, that may be
219	219	205necessary to ensure the ongoing health, safety and wellbeing of perinatal patients and infants. If
220	220	206applicable, the department, in consultation with the department of children and families and the
221	221	207office of the child advocate, shall provide recommendations to address disparate impacts of the
222	222	208safety and wellbeing of infants identified as affected by prenatal substance exposure or fetal
223	223	209alcohol spectrum disorder. 11 of 47
224	224	210 SECTION 9. Section 7 of chapter 111E of the General Laws, as so appearing, is hereby
225	225	211amended by inserting after the word “basis”, in line 28, the following words:- , as determined by
226	226	212the department to be consistent with section 4 of chapter 151B and sufficient to ensure the needs
227	227	213of such residents are met and such residents have adequate access to such a facility,.
228	228	214 SECTION 10. The General Laws are hereby amended by striking out chapter 111J and
229	229	215inserting in place thereof the following chapter:-
230	230	216 CHAPTER 111J
231	231	217 ALCOHOL AND DRUG COUNSELORS; RECOVERY COACHES.
232	232	218 Section 1. As used in this chapter, the following words shall, unless the context clearly
233	233	219requires otherwise, have the following meanings:
234	234	220 “Applicant”, an individual seeking licensure under this chapter.
235	235	221 “Approved continuing education”, continuing education approved by the department,
236	236	222including research and training programs, college and university courses, in-service training
237	237	223programs, seminars and conferences designed to maintain and enhance the skills of licensees.
238	238	224 “Approved program”, a program approved by the department for the education and
239	239	225training of licensees.
240	240	226 “Approved work experience”, supervised work experience, approved by the department,
241	241	227in the practice area for which an applicant seeks licensure.
242	242	228 “Department”, the department of public health.
243	243	229 “Licensee”, an individual who is licensed under this chapter. 12 of 47
244	244	230 “Licensed alcohol and drug counselor I”, a person licensed by the department to conduct
245	245	231an independent practice of alcohol and drug counseling and to provide supervision to other
246	246	232alcohol and drug counselors. A licensed alcohol and drug counselor I shall have: (i) received a
247	247	233master’s or doctoral degree in behavioral sciences, which included a supervised counseling
248	248	234practicum that meets the requirements established by the department or such equivalent
249	249	235educational credits as may be established by the department; (ii) at least 3 years of approved
250	250	236work experience; and (iii) passed a licensing examination approved by the department.
251	251	237 “Licensed alcohol and drug counselor II”, a person licensed by the department to practice
252	252	238alcohol and drug counseling under clinical supervision. A licensed alcohol and drug counselor II
253	253	239shall have: (i) completed an approved program of education, which included a supervised
254	254	240counseling practicum that meets the requirements established by the department or such
255	255	241equivalent educational credits as may be established by the department; (ii) at least 3 years of
256	256	242approved work experience; and (iii) passed a licensing examination approved by the department.
257	257	243 “Licensed recovery coach”, a person with lived experience who is licensed by the
258	258	244department to practice recovery coaching using shared understanding, respect and mutual
259	259	245empowerment to help others become and stay engaged in the process of recovery from a
260	260	246substance use disorder. A licensed recovery coach shall: (i) have completed an approved
261	261	247program of education, including approved work experience that meets the requirements
262	262	248established by the department; (ii) demonstrate at least 2 years of sustained recovery; and (iii)
263	263	249have met all education, training and experience requirements and qualifications as established by
264	264	250the department. 13 of 47
265	265	251 “Lived experience”, the experience of addiction and recovery from a substance use
266	266	252disorder.
267	267	253 Section 2. (a) The department shall establish and administer a program for the licensure
268	268	254of alcohol and drug counselors and recovery coaches. The department shall: (i) establish the
269	269	255licensure requirements for licensed alcohol and drug counselors practicing in the commonwealth;
270	270	256(ii) establish the licensure requirements for licensed recovery coaches practicing in the
271	271	257commonwealth; (iii) evaluate the qualifications of applicants for licensure; (iv) supervise
272	272	258licensing examinations, where applicable; (v) establish and collect fees for licensing and
273	273	259examination, where applicable; (vi) grant and issue licenses to applicants who satisfy the
274	274	260department’s requirements for licensure; (vii) establish continuing education requirements; (viii)
275	275	261investigate complaints; (ix) take appropriate disciplinary action to protect the public health,
276	276	262safety and welfare; and (x) perform other functions and duties as may be necessary to carry out
277	277	263this chapter.
278	278	264 (b) The department shall establish requirements for licensed alcohol and drug counselors
279	279	265I and licensed alcohol and drug counselors II and may establish other reasonable classifications
280	280	266for alcohol and drug counselors as it finds necessary and appropriate, taking into consideration
281	281	267different levels of education, training and work experience.
282	282	268 (c) The department shall establish requirements for licensed recovery coaches, including,
283	283	269but not limited to, establishing an ethical code of conduct for recovery coaches, and may
284	284	270establish other reasonable classifications for recovery coaches as it finds necessary and
285	285	271appropriate, taking into consideration different levels of education, training and work experience. 14 of 47
286	286	272 (d) The department shall approve and issue certificates of approval of programs for the
287	287	273training of alcohol and drug counselors. The department shall maintain a list of approved
288	288	274programs and a current roster of persons serving as licensed alcohol and drug counselors in the
289	289	275commonwealth.
290	290	276 (e) The department shall approve and issue certificates of approval of programs for the
291	291	277training of recovery coaches. The department shall maintain a list of approved programs and a
292	292	278current roster of persons serving as licensed recovery coaches in the commonwealth.
293	293	279 (f) The department shall promulgate rules and regulations as it deems necessary to
294	294	280implement the provisions of this chapter, including, but not limited to, rules and regulations
295	295	281establishing the educational and professional requirements for licensing individuals under this
296	296	282chapter, establishing fees for licensing and examination, where applicable, and governing the
297	297	283practice and employment of licensees to promote the public health, safety and welfare.
298	298	284 Section 3. (a) Each applicant shall furnish the department with proof of satisfactory
299	299	285completion of the educational, training and experience requirements for licensure, including
300	300	286completion of an approved program and approved work experience and proof of having passed
301	301	287any licensing examinations required by the department; provided, that the department may
302	302	288establish additional requirements for licensure and exemptions by regulation.
303	303	289 (b) A licensee shall apply biennially to the department for license renewal. A licensee
304	304	290seeking license renewal shall submit proof of having successfully completed the requirements for
305	305	291approved continuing education as may be established by the department. 15 of 47
306	306	292 (c) Applications for licenses and renewals thereof shall be submitted in accordance with
307	307	293procedures established by the department. The department may establish fees for license
308	308	294applications or renewals.
309	309	295 Section 4. (a) Except as otherwise provided for in this chapter or by regulation of the
310	310	296department, persons not licensed or otherwise exempt from licensing shall not hold themselves
311	311	297out as a licensed recovery coach and shall not use the title, initials, abbreviations, insignia or
312	312	298description of a licensed recovery coach or practice or attempt to practice recovery coaching
313	313	299unless otherwise authorized by law or rule or regulation of the department. Whoever engages in
314	314	300any such unauthorized action shall be subject to a fine of not less than $500. The department may
315	315	301bring a petition in superior court to enjoin such action or any other violation of this chapter or a
316	316	302regulation of the department.
317	317	303 (b) The following individuals pursuing a recovery coach license who meet the
318	318	304requirements for licensed recovery coach applicants as set forth in this chapter or in rules or
319	319	305regulations of the department may practice without a license in order to obtain the requisite hours
320	320	306of supervised work experience needed to obtain such license:
321	321	307 (i) an educational psychologist, marriage and family therapist, alcohol and drug
322	322	308counselor, mental health counselor, nurse practitioner, occupational therapist, physician,
323	323	309physician assistant, practical nurse, psychologist, registered nurse, rehabilitation counselor or
324	324	310social worker;
325	325	311 (ii) an employee or other agent of a recognized academic institution or employee
326	326	312assistance program or a federal, state, county or local government institution, program, agency or
327	327	313facility or school committee, school district, school board or board of regents while performing 16 of 47
328	328	314recovery coach duties solely for the respective entity or under the jurisdiction and supervision of
329	329	315such entity; and
330	330	316 (iii) an employee of a program or facility approved or licensed by the department
331	331	317pursuant to chapters 111B and 111E; provided, however, that such individual shall perform
332	332	318recovery coaching solely within or under the jurisdiction and supervision of such program or
333	333	319facility.
334	334	320 (c) Nothing in this section shall be construed to prevent members of peer groups or self-
335	335	321help groups from performing peer counseling or self-help activities that may be included within
336	336	322the practice recovery coaching; provided, however, that no members of peer groups or self-help
337	337	323groups who are not so credentialed shall use a title stating or implying that such person is a
338	338	324licensed recovery coach.
339	339	325 Section 5. (a) Except as otherwise provided for in this chapter or by regulation, a person
340	340	326who is not licensed or is otherwise exempt from licensing shall not hold themself out as a
341	341	327licensed alcohol and drug counselor and shall not use the title, initials or description of a licensed
342	342	328alcohol and drug counselor or practice or attempt to practice alcohol and drug counseling.
343	343	329Whoever engages in any such unauthorized action shall be subject to a fine of not less than $500.
344	344	330The department may bring a petition in superior court to enjoin such action or any other violation
345	345	331of this chapter or a regulation of the department.
346	346	332 (b) The following individuals shall be exempt from the licensing requirements for alcohol
347	347	333and drug counseling under this chapter: 17 of 47
348	348	334 (i) an educational psychologist, marriage and family therapist, mental health counselor,
349	349	335nurse practitioner, occupational therapist, physician, physician assistant, practical nurse,
350	350	336psychologist, registered nurse, rehabilitation counselor and social worker;
351	351	337 (ii) an employee or other agent of a recognized academic institution or employee
352	352	338assistance program or a federal, state, county or local government institution, program, agency or
353	353	339facility or school committee, school district, school board or board of regents while performing
354	354	340alcohol and drug counseling duties solely for the respective entity or under the jurisdiction of
355	355	341such entity; provided, however, that a license pursuant to this chapter need not be a requirement
356	356	342for employment in any state, county or municipal agency; and
357	357	343 (iii) an employee of a treatment program or facility licensed or approved by the
358	358	344department pursuant to chapters 111B and 111E; provided, however, that such individual shall
359	359	345perform alcohol and drug counseling solely within or under the jurisdiction of such program or
360	360	346facility.
361	361	347 (c) Nothing in this section shall be construed to prevent qualified members of other
362	362	348professions, including attorneys, Christian Science practitioners or members of the clergy, from
363	363	349providing alcohol or drug counseling consistent with accepted standards of their respective
364	364	350professions; provided, however, that no such person shall use a title stating or implying that such
365	365	351person is a licensed alcohol and drug counselor.
366	366	352 (d) Nothing in this section shall be construed to prevent members of peer groups or self-
367	367	353help groups from performing peer group or self-help activities; provided, however, that no such
368	368	354person shall use a title stating or implying that such person is a licensed alcohol and drug
369	369	355counselor. 18 of 47
370	370	356 Section 6. (a) The department shall establish procedures for consumers to file written
371	371	357complaints regarding an individual licensed under this chapter. The department shall investigate
372	372	358all complaints relating to the proper practice of a person holding a license under this chapter and
373	373	359all complaints relating to any violation of this chapter or regulation of the department.
374	374	360 (b) The department may conduct an adjudicatory proceeding pursuant to chapter 30A, but
375	375	361shall not have the power to issue, vacate, modify or enforce subpoenas pursuant to section 12 of
376	376	362said chapter 30A. The department may, after a hearing pursuant to said chapter 30A, deny, refuse
377	377	363renewal, revoke, limit or suspend a license or otherwise discipline a licensee; provided, however,
378	378	364the department may suspend the license of a licensee who poses an imminent danger to the
379	379	365public; provided further, that the licensee shall be afforded a hearing within 7 business days to
380	380	366determine whether the action is warranted; and provided further, that the department shall
381	381	367conduct its proceedings in accordance with the provisions of this chapter and said chapter 30A.
382	382	368Grounds for denial, refusal to renew, revocation, limitation, suspension or other discipline shall
383	383	369include the following:
384	384	370 (i) fraud or misrepresentation in obtaining a license;
385	385	371 (ii) criminal conduct which the department determines to be of such a nature as to render
386	386	372such person unfit to practice as licensed as evidenced by criminal proceedings resulting in a
387	387	373conviction, guilty plea or plea of nolo contendere or an admission of sufficient facts;
388	388	374 (iii) violation of any law or rule or regulation of the department governing the practice of
389	389	375the licensee;
390	390	376 (iv) violation of ethical standards which the department determines to be of such a nature
391	391	377as to render such person unfit to practice as a licensee; or 19 of 47
392	392	378 (v) other just and sufficient cause that the department determines would render a person
393	393	379unfit to practice as a licensee.
394	394	380 (c) Where denial, refusal to renew, revocation or suspension is based solely on the failure
395	395	381of the licensee to timely file an application or pay prescribed fees or to maintain insurance
396	396	382coverage as required by law or regulation, the department may act without first granting the
397	397	383applicant or licensee a hearing.
398	398	384 Section 7. (a) Examinations for licensure, where applicable, shall be conducted at least
399	399	385twice per year at times and places designated by the department. Examinations for licensure,
400	400	386where applicable, shall be written; provided, however, that portions thereof may be conducted
401	401	387orally. A person who has failed an examination may be admitted to the next subsequent
402	402	388examination.
403	403	389 (b) The department may accept, in lieu of its own examination, a current certificate of
404	404	390any recognized certifying body issued on the basis of an examination satisfactory to the
405	405	391department; provided, however, that the standards of such body shall be at least as stringent as
406	406	392those established by the department.
407	407	393 Section 8. (a) The department may issue a license without examination to an applicant
408	408	394who meets the requirements for licensure established by the department if such applicant is
409	409	395licensed or certified in alcohol and drug counseling or in recovery coaching or a comparable
410	410	396field in another state wherein the requirements for licensure shall be determined by the
411	411	397department to be equivalent to or in excess of the requirements of this chapter.
412	412	398 (b) The department may authorize an alcohol and drug counselor or a recovery coach to
413	413	399practice by reciprocity. 20 of 47
414	414	400 (c) The department shall promulgate rules and regulations as may be necessary to
415	415	401implement this section.
416	416	402 Section 9. (a) There shall be a recovery coach advisory council within the department to
417	417	403assist and support the department in carrying out this chapter by planning, guiding and
418	418	404coordinating the components of the practice of recovery coaching; provided, that the council may
419	419	405advise the department on other such matters related to the practice of repractice of alcohol and
420	420	406drug counseling and the inclusion of people with lived experience in guiding such practices.
421	421	407 (b) The advisory council shall consist of the following members: the director of the
422	422	408bureau of substance addiction services, or a designee, who shall serve as chair; and 7 members
423	423	409appointed by the secretary of health and human services, 4 of whom shall be employed as
424	424	410recovery coaches, recovery coach supervisors or recovery coach educators and shall be, to the
425	425	411extent possible, representative of the demographic diversity of the commonwealth, including, but
426	426	412not limited to, diversity in race, ethnicity, gender, gender identity, sexual orientation, age,
427	427	413disability, geographical region, workplace and history of involvement with the criminal legal
428	428	414system, 1 of whom shall be a representative of the Massachusetts Board of Substance Abuse
429	429	415Counselor Certification, 1 of whom shall represent a health plan and 1 of whom shall be a person
430	430	416with lived experience who has received or is receiving recovery coaching services. Members of
431	431	417the advisory council shall be residents of the commonwealth.
432	432	418 Section 10. The bureau of substance addiction services shall establish a comprehensive
433	433	419peer support program to provide mentorship, technical assistance and support resources for the
434	434	420wellbeing of recovery coaches, including, but not limited to, peer support specialists, peer
435	435	421recovery coaches and recovery support navigators. The program shall include, but shall not be 21 of 47
436	436	422limited to: (i) a network for peer-to-peer trainings, education, mentorship, counseling and
437	437	423support; (ii) educational and other clinical support materials; (iii) technical assistance for
438	438	424licensure, certification, credentialing and other employment and practice requirements; and (iv)
439	439	425billing technical assistance for organizations that employ recovery coaches.
440	440	426 SECTION 10A. Chapter 112 of the General Laws is hereby amended by inserting after
441	441	427section 52G the following section:-
442	442	428 Section 52H. (a) For the purpose of this section, the following words shall, unless the
443	443	429context clearly requires otherwise, have the following meanings:
444	444	430 “Board”, the board of registration in dentistry established in section 19 of chapter 13.
445	445	431 “Continuing care”, guidance, support, toxicology collection and accountability through a
446	446	432formal monitoring contract concurrent with or following an evaluation and treatment process.
447	447	433 “Peer review committee”, a committee of healthcare providers which evaluates or
448	448	434improves the quality of health care rendered by providers of health care services and evaluates
449	449	435and assists health care providers impaired or allegedly impaired by reason of alcohol, drugs,
450	450	436physical disability, mental instability or otherwise.
451	451	437 “Substantive non-compliance”, a pattern of non-compliance or dishonesty in continuing
452	452	438care monitoring or an episode of non-compliance which could place patients at risk.
453	453	439 (b)(1) The board is hereby authorized and directed to offer a remediation program for
454	454	440dentists and dental hygienists. 22 of 47
455	455	441 (2) The board shall select 1 or more providers to serve as designated remediation
456	456	442programs.
457	457	443 (3) The board shall establish: (i) criteria for the acceptance, denial or termination of
458	458	444registered dentists and dental hygienists in the program; and (ii) an outreach program to identify
459	459	445registered dentists and dental hygienists who may have a substance use disorder and to provide
460	460	446education about the remediation program.
461	461	447 (4) No member of the board shall be employed by or volunteer for the program.
462	462	448 (c)(1) A remediation program shall serve as a voluntary alternative to traditional
463	463	449disciplinary actions. Any registered dentist or dental hygienist in the commonwealth may request
464	464	450to participate in the program.
465	465	451 (2) To be eligible for designation, a remediation program shall have demonstrable
466	466	452experience in the field of substance use disorder and shall employ a licensed mental health
467	467	453professional with experience in the treatment of substance use disorders.
468	468	454 (3) The remediation program shall have the following duties and responsibilities: (i) to
469	469	455evaluate registered dentists and dental hygienists who request to participate in the program for
470	470	456admission into the program; (ii) to agree to accept referrals from the board; (iii) to review and
471	471	457designate treatment facilities and assessment services to which participants may be referred; (iv)
472	472	458to receive and review information concerning a participant in the program; (v) to disclose to the
473	473	459board aggregate data on compliance-based on ongoing recovery documentation; (vi) to provide
474	474	460each participant, through contracted agreements, with an individualized remediation plan
475	475	461according to guidelines developed through collaboration between the board and the remediation 23 of 47
476	476	462program with regards to requirements for supervision; (vii) to provide information to dentists or
477	477	463dental hygienists who request to participate in the program; and (viii) to establish an outreach
478	478	464program to identify registered dentists and dental hygienists who may have a substance use or
479	479	465other mental health disorder, and to provide education about the remediation program.
480	480	466 (4) A registered dentist or dental hygienist who requests to participate in the remediation
481	481	467program shall agree to cooperate with the individualized remediation plan recommended by the
482	482	468remediation program. The remediation program may report to the board the name and license
483	483	469number of a registered dentist or dental hygienist who fails to comply with an individualized
484	484	470remediation plan.
485	485	471 (5) After the remediation program, in its discretion, has determined that a registered
486	486	472dentist or dental hygienist has successfully completed an individualized remediation plan
487	487	473through the program, the board shall seal all records pertaining to the participation of the
488	488	474registered dentist or dental hygienist in the program. No record shall be sealed sooner than 5
489	489	475years from the participant’s date of entry into the program. All board and remediation program
490	490	476records of a participant’s involvement in the program shall be kept confidential and shall not be
491	491	477subject to discovery or subpoena in any civil, criminal, legislative or administrative proceeding
492	492	478without the prior written consent of the participant.
493	493	479 (6) The designated remediation programs shall be confidential and shall offer a means of
494	494	480recovery and rehabilitation without the loss of a license by providing access to early
495	495	481identification, intervention, evaluation, monitoring, referral to appropriate intervention programs
496	496	482and treatment services, and earned advocacy, when appropriate, of licensees with potentially
497	497	483impairing illness, ideally prior to functional impairment. 24 of 47
498	498	484 (7) In accordance with peer review law, proceedings, reports and records of the
499	499	485remediation program shall be confidential pursuant to section 240. Such records shall not to be
500	500	486disclosed, and shall not subject to subpoena or discovery, and shall not be introduced into
501	501	487evidence in any judicial or administrative proceeding, subject to paragraph (4) and (5).
502	502	488 (8) No employee or volunteer member of the remediation program who is licensed to
503	503	489practice by the department of public health division of professional licensure or by the board
504	504	490shall have had any type of disciplinary or enforcement action taken against them by their
505	505	491respective licensing board, during the 5 years preceding their appointment to the program.
506	506	492 SECTION 11. Chapter 118E of the General Laws is hereby amended by inserting after
507	507	493section 10Q the following 2 sections:-
508	508	494 Section 10R. The division and its contracted health insurers, health plans, health
509	509	495maintenance organizations, behavioral health management firms and third-party administrators
510	510	496under contract to a Medicaid managed care organization, accountable care organization or
511	511	497primary care clinician plan shall provide coverage for prescribed or dispensed opioid antagonists,
512	512	498as defined in section 19B of chapter 94C, which shall be deemed medically necessary and shall
513	513	499not require prior authorization; provided, however, that a prescription from a health care
514	514	500practitioner shall not be required for coverage of opioid antagonists. An opioid antagonist shall
515	515	501not be subject to any deductible, coinsurance, copayments or out-of-pocket limits; provided,
516	516	502however, that cost-sharing shall be required if the applicable plan is governed by the federal
517	517	503Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on cost-
518	518	504sharing for this service. 25 of 47
519	519	505 (b) The division and its contracted health insurers, health plans, health maintenance
520	520	506organizations, behavioral health management firms and third-party administrators shall provide
521	521	507coverage for an opioid antagonist as a medical benefit when dispensed by the health care facility
522	522	508in which the opioid antagonist was prescribed and shall provide coverage as a pharmacy benefit
523	523	509for an opioid antagonist dispensed by a pharmacist, including an opioid antagonist dispensed
524	524	510pursuant to section 19B of chapter 94C.
525	525	511 Section 10S. The division and its contracted health insurers, health plans, health
526	526	512maintenance organizations, behavioral health management firms and third-party administrators
527	527	513under contract to a Medicaid managed care organization, accountable care organization or
528	528	514primary care clinician plan shall provide coverage for the provision of services by a recovery
529	529	515coach licensed or otherwise authorized to practice pursuant to chapter 111J, irrespective of the
530	530	516setting in which these services are provided; provided, that such services shall be within the
531	531	517lawful scope of practice of a recovery coach. The benefits in this section shall not be subject to
532	532	518any deductible, coinsurance, copayments or out-of-pocket limits. Recovery coach services shall
533	533	519be deemed medically necessary and shall not require prior authorization.
534	534	520 SECTION 11A. Section 35 of chapter 123 of the General Laws, as appearing in the 2022
535	535	521Official Edition, is hereby amended by inserting after the definition of “Facility” the following
536	536	522definition:-
537	537	523 “Secured facility”, any public or private facility that provides care and treatment for a
538	538	524person with alcohol or substance use disorder located within a correctional facility funded,
539	539	525controlled, or administered by a county sheriff, or a private facility that provides a comparable
540	540	526level of security. 26 of 47
541	541	527 SECTION 11B. Said section 35 of chapter 123, as so appearing, is hereby amended by
542	542	528striking out the fourth, fifth and six paragraphs and inserting in place thereof the following
543	543	529paragraphs:-
544	544	530 The secretary of health and human services shall ensure an adequate supply of suitable
545	545	531beds for the treatment of alcohol or substance use disorders at facilities licensed or approved by
546	546	532the department of public health or the department of mental health for persons ordered to be
547	547	533committed under this section.
548	548	534 If the department of public health informs the court that there are no such suitable
549	549	535facilities or if the court makes a specific finding that the only appropriate setting for treatment for
550	550	536the person is a secure facility, then the person may be committed to a secure facility licensed or
551	551	537approved by the department of public health or the department of mental health; provided
552	552	538further, that such secure facilities shall be geographically distributed so as to provide access to
553	553	539treatment in all regions of the commonwealth.
554	554	540 A person committed under this section shall, upon release, be encouraged to consent to
555	555	541further treatment and shall be allowed voluntarily to remain in the facility for such purpose. The
556	556	542department of public health shall maintain a roster of public and private facilities available,
557	557	543together with the number of beds currently available and the level of security at each facility, for
558	558	544the care and treatment of alcohol use disorder and substance use disorder and shall make the
559	559	545roster available to the trial court.
560	560	546 SECTION 12. Subsection (a) of section 51A of chapter 119 of the General Laws, as
561	561	547appearing in the 2022 Official Edition, is hereby amended by striking out the first paragraph and
562	562	548inserting in place thereof the following paragraph:- 27 of 47
563	563	549 A mandated reporter shall immediately communicate with the department orally and
564	564	550shall, within 48 hours, file a written report with the department detailing suspected abuse or
565	565	551neglect if, in their professional capacity, they have reasonable cause to believe that a child is: (i)
566	566	552suffering physical or emotional injury resulting from abuse inflicted upon them which causes
567	567	553harm or substantial risk of harm to the child’s health or welfare including, but not limited to,
568	568	554sexual abuse; (ii) suffering physical or emotional injury resulting from neglect including, but not
569	569	555limited to, malnutrition; (iii) a sexually exploited child; or (iv) a human trafficking victim, as
570	570	556defined by section 20M of chapter 233.
571	571	557 SECTION 13. Section 1 of chapter 151B of the General Laws, as so appearing, is hereby
572	572	558amended by striking out subsection 17 and inserting in place thereof the following subsection:-
573	573	559 17. The term “handicap” means: (a) a physical or mental impairment which substantially
574	574	560limits 1 or more major life activities of a person; (b) a record of having such impairment; (c)
575	575	561being regarded as having such impairment; or (d) the lawful possession and clinically
576	576	562appropriate taking of any medication that is: (i) approved by the federal Food and Drug
577	577	563Administration for the treatment of an opioid-related substance use disorder, including, but not
578	578	564limited to, an opioid agonist or a partial opioid agonist and used for the treatment of an opioid-
579	579	565related substance use disorder; (ii) obtained directly or pursuant to a valid prescription or order
580	580	566from a practitioner, as defined in section 1 of chapter 94C; (iii) determined to be medically
581	581	567necessary by a practitioner while acting in the course of professional practice; and (iv) offered in
582	582	568accordance with a treatment plan that is reviewed by a practitioner at a frequency consistent with
583	583	569appropriate clinical standards. The term handicap shall not include current, illegal use of a
584	584	570controlled substance, as defined in said section 1 of said chapter 94C. For the purposes of this
585	585	571subsection, the words “clinically appropriate” shall mean the taking of a prescribed medication 28 of 47
586	586	572for the treatment of an opioid-related substance use disorder when such drug is medically
587	587	573indicated and intake is proportioned to the medical need.
588	588	574 SECTION 13A. Chapter 175 of the General Laws is hereby amended by striking out
589	589	575section 47KK and inserting in place thereof the following section:-
590	590	576Section 47KK. (a) Any policy, contract, agreement, plan or certificate of insurance issued,
591	591	577delivered or renewed within the commonwealth, which is considered creditable coverage under
592	592	578section 1 of chapter 111M, shall develop a plan to provide adequate coverage and access to a
593	593	579broad spectrum of pain management services, including, but not limited to, non-medication, non-
594	594	580surgical treatment modalities and non-opioid medication treatment options that serve as
595	595	581alternatives to opioid prescribing, in accordance with guidelines developed by the division of
596	596	582insurance.
597	597	583 (b) No such policy, contract, agreement, plan or certificate of insurance shall, relative to
598	598	584pain management services identified by the carrier pursuant to subsection (a), require a member
599	599	585to obtain a preauthorization for non-medication, non-surgical treatment modalities that include
600	600	586restorative therapies, behavioral health approaches or integrative health therapies, including
601	601	587acupuncture, chiropractic treatments, massage and movement therapies.
602	602	588 (c)(1) The plan pursuant to subsection (a) shall be subject to approval and shall be a
603	603	589component of carrier accreditation by the division of insurance pursuant to section 2 of chapter
604	604	590176O. In its review, the division shall consider the adequacy of access to a broad spectrum of
605	605	591pain management services and any carrier policies that may create unduly preferential coverage
606	606	592to prescribing opioids without other pain management modalities. 29 of 47
607	607	593 (2) No policy, contract, agreement, plan or certificate of insurance issued, delivered or
608	608	594renewed within the commonwealth, which is considered creditable coverage under said section 1
609	609	595of said chapter 111M, shall establish utilization controls, including preauthorization or step
610	610	596therapy requirements, for clinically appropriate non-opioid drugs approved by the federal Food
611	611	597and Drug Administration for the treatment or management of pain, that are more restrictive or
612	612	598extensive than the least restrictive or extensive utilization controls applicable to any clinically
613	613	599appropriate opioid drug.
614	614	600 (d) Carriers shall annually distribute educational materials to providers within their
615	615	601networks and to members about the pain management access plan and shall make information
616	616	602about their plans publicly available on their websites.
617	617	603 SECTION 14. Said chapter 175 is hereby further amended by inserting after section
618	618	60447UU the following 2 sections:-
619	619	605 Section 47VV. Any policy, contract, agreement, plan or certificate of insurance issued,
620	620	606delivered or renewed within the commonwealth, which is considered creditable coverage under
621	621	607section 1 of chapter 111M, shall provide coverage for prescribed or dispensed opioid antagonists,
622	622	608as defined in section 19B of chapter 94C and used in the reversal of overdoses caused by opioids,
623	623	609which shall be deemed medically necessary and shall not require prior authorization; provided,
624	624	610however, that a prescription from a health care practitioner shall not be required for coverage of
625	625	611opioid antagonists. An opioid antagonist used in the reversal of overdoses caused by opioids
626	626	612shall not be subject to any deductible, coinsurance, copayments or out-of-pocket limits;
627	627	613provided, however, that cost-sharing shall be required if the applicable plan is governed by the 30 of 47
628	628	614federal Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition
629	629	615on cost-sharing for this service.
630	630	616 (b) The policy, contract, agreement, plan or certificate of insurance shall provide
631	631	617coverage for an opioid antagonist used in the reversal of overdoses caused by opioids as a
632	632	618medical benefit when dispensed by the health care facility in which the opioid antagonist was
633	633	619prescribed and shall provide coverage as a pharmacy benefit for an opioid antagonist used in the
634	634	620reversal of overdoses caused by opioids dispensed by a pharmacist, including an opioid
635	635	621antagonist dispensed pursuant to section 19B of chapter 94C; provided, however, that the rate to
636	636	622be reimbursed under the medical benefit shall not exceed the carrier’s average in-network
637	637	623pharmacy benefit rate and the health care facility shall not balance bill the patient.
638	638	624 Section 47WW. Any policy, contract, agreement, plan or certificate of insurance issued,
639	639	625delivered or renewed within the commonwealth, which is considered creditable coverage under
640	640	626section 1 of chapter 111M, shall provide coverage for the provision of services by a recovery
641	641	627coach licensed or otherwise authorized to practice under chapter 111J, irrespective of the setting
642	642	628in which these services are provided; provided, that such services shall be within the lawful
643	643	629scope of practice of a recovery coach. The contractual rate for these services shall be no less than
644	644	630the prevailing MassHealth rate for recovery coach services. The benefits in this section shall not
645	645	631be subject to any deductible, coinsurance, copayments or out-of-pocket limits; provided,
646	646	632however, that cost-sharing shall be required if the applicable plan is governed by the federal
647	647	633Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on cost-
648	648	634sharing for this service. Recovery coach services shall be deemed medically necessary and shall
649	649	635not require prior authorization. 31 of 47
650	650	636 SECTION 15. Said chapter 175 is hereby further amended by inserting after section
651	651	637122A the following section:-
652	652	638 Section 122B. (a) No insurer authorized to issue policies on the lives of persons in the
653	653	639commonwealth shall make a distinction or otherwise discriminate between persons, reject an
654	654	640applicant, cancel a policy or demand or require a higher rate of premium for reasons based solely
655	655	641upon an applicant or insured having or had a prescription for, purchased or otherwise possessed
656	656	642an opioid antagonist, as defined in section 19B of chapter 94C.
657	657	643 (b) A violation of this section shall constitute an unfair method of competition or unfair
658	658	644and deceptive act or practice pursuant to chapters 93A and 176D.
659	659	645 SECTION 15A. Chapter 176A of the General Laws is hereby amended by striking out
660	660	646section 8MM and inserting in place thereof the following section:-
661	661	647 Section 8MM. (a) Any contract between a subscriber and the corporation under an
662	662	648individual or group hospital service plan that is delivered, issued or renewed within the
663	663	649commonwealth shall develop a plan to provide adequate coverage and access to a broad
664	664	650spectrum of pain management services, including, but not limited to, non-medication, non-
665	665	651surgical treatment modalities and non-opioid medication treatment options that serve as
666	666	652alternatives to opioid prescribing, in accordance with guidelines developed by the division of
667	667	653insurance.
668	668	654 (b) No such contract shall, relative to pain management services identified by the carrier
669	669	655pursuant to subsection (a), require a member to obtain a preauthorization for non-medication,
670	670	656non-surgical treatment modalities that include restorative therapies, behavioral health approaches 32 of 47
671	671	657or integrative health therapies, including acupuncture, chiropractic treatments, massage, and
672	672	658movement therapies.
673	673	659 (c)(1) The plan pursuant to subsection (a) shall be subject to approval and shall be a
674	674	660component of carrier accreditation by the division of insurance pursuant to section 2 of chapter
675	675	661176O. In its review, the division shall consider the adequacy of access to a broad spectrum of
676	676	662pain management services and any carrier policies that may create unduly preferential coverage
677	677	663to prescribing opioids without other pain management modalities.
678	678	664 (2) No contract between a subscriber and the corporation under an individual or group
679	679	665hospital service plan that is delivered, issued or renewed within the commonwealth shall
680	680	666establish utilization controls, including preauthorization or step therapy requirements, for
681	681	667clinically appropriate non-opioid drugs approved by the federal Food and Drug Administration
682	682	668for the treatment or management of pain, that are more restrictive or extensive than the least
683	683	669restrictive or extensive utilization controls applicable to any clinically appropriate opioid drug.
684	684	670 (d) Carriers shall annually distribute educational materials to providers within their
685	685	671networks and to members about the pain management access plan and shall make information
686	686	672about their plans publicly available on their websites.
687	687	673 SECTION 16. Said chapter 176A is hereby further amended by inserting after section
688	688	6748VV the following 2 sections:-
689	689	675 Section 8WW. Any contract between a subscriber and the corporation under an
690	690	676individual or group hospital service plan that is delivered, issued or renewed within the
691	691	677commonwealth shall provide coverage for prescribed or dispensed opioid antagonists, as defined 33 of 47
692	692	678in section 19B of chapter 94C and used in the reversal of overdoses caused by opioids, which
693	693	679shall be deemed medically necessary and shall not require prior authorization; provided,
694	694	680however, that a prescription from a health care practitioner shall not be required for coverage of
695	695	681opioid antagonists. An opioid antagonist used in the reversal of overdoses caused by opioids
696	696	682shall not be subject to any deductible, coinsurance, copayments or out-of-pocket limits;
697	697	683provided, however, that cost-sharing shall be required if the applicable plan is governed by the
698	698	684federal Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition
699	699	685on cost-sharing for this service.
700	700	686 (b) Such contract shall provide coverage for an opioid antagonist used in the reversal of
701	701	687overdoses caused by opioids as a medical benefit when dispensed by the health care facility in
702	702	688which the opioid antagonist was prescribed and shall provide coverage as a pharmacy benefit for
703	703	689an opioid antagonist used in the reversal of overdoses caused by opioids dispensed by a
704	704	690pharmacist, including an opioid antagonist dispensed pursuant to section 19B of chapter 94C;
705	705	691provided, however, that the rate to be reimbursed under the medical benefit shall not exceed the
706	706	692carrier’s average in-network pharmacy benefit rate and the health care facility shall not balance
707	707	693bill the patient.
708	708	694 Section 8XX. Any contract between a subscriber and the corporation under an individual
709	709	695or group hospital service plan that is delivered, issued or renewed within the commonwealth
710	710	696shall provide coverage for the provision of services by a recovery coach licensed or otherwise
711	711	697authorized to practice under chapter 111J, irrespective of the setting in which these services are
712	712	698provided; provided, that such services shall be within the lawful scope of practice of a recovery
713	713	699coach. The contractual rate for these services shall be no less than the prevailing MassHealth rate
714	714	700for recovery coach services. The benefits in this section shall not be subject to any deductible, 34 of 47
715	715	701coinsurance, copayments or out-of-pocket limits; provided, however, that cost-sharing shall be
716	716	702required if the applicable plan is governed by the federal Internal Revenue Code and would lose
717	717	703its tax-exempt status as a result of the prohibition on cost-sharing for this service. Recovery
718	718	704coach services shall be deemed medically necessary and shall not require prior authorization.
719	719	705 SECTION 16A. Chapter 176B of the General Laws is hereby amended by striking out
720	720	706section 4MM and inserting in place thereof the following section:-
721	721	707 Section 4MM. (a) Any subscription certificate under an individual or group medical
722	722	708service agreement delivered, issued or renewed within the commonwealth shall develop a plan to
723	723	709provide adequate coverage and access to a broad spectrum of pain management services,
724	724	710including, but not limited to, non-medication, non-surgical treatment modalities and non-opioid
725	725	711medication treatment options that serve as alternatives to opioid prescribing, in accordance with
726	726	712guidelines developed by the division of insurance.
727	727	713 (b) No such subscription certificate shall, relative to pain management services identified
728	728	714by the carrier pursuant to subsection (a), require a member to obtain a preauthorization for non-
729	729	715medication, non-surgical treatment modalities that include restorative therapies, behavioral
730	730	716health approaches or integrative health therapies, including acupuncture, chiropractic treatments,
731	731	717massage, and movement therapies.
732	732	718 (c)(1) The plan pursuant to subsection (a) shall be subject to approval and shall be a
733	733	719component of carrier accreditation by the division of insurance pursuant to section 2 of chapter
734	734	720176O. In its review, the division shall consider the adequacy of access to a broad spectrum of
735	735	721pain management services and any carrier policies that may create unduly preferential coverage
736	736	722to prescribing opioids without other pain management modalities. 35 of 47
737	737	723 (2) No subscription certificate under an individual or group medical service agreement
738	738	724delivered, issued or renewed within the commonwealth shall establish utilization controls,
739	739	725including preauthorization or step therapy requirements, for clinically appropriate non-opioid
740	740	726drugs approved by the federal Food and Drug Administration for the treatment or management of
741	741	727pain, that are more restrictive or extensive than the least restrictive or extensive utilization
742	742	728controls applicable to any clinically appropriate opioid drug.
743	743	729 (d) Carriers shall annually distribute educational materials to providers within their
744	744	730networks and to members about the pain management access plan and shall make information
745	745	731about their plans publicly available on their websites.
746	746	732 SECTION 17. Said chapter 176B is hereby further amended by inserting after section
747	747	7334VV the following 2 sections:-
748	748	734 Section 4WW. Any subscription certificate under an individual or group medical service
749	749	735agreement delivered, issued or renewed within the commonwealth, shall provide coverage for
750	750	736prescribed or dispensed opioid antagonists, as defined in section 19B of chapter 94C and used in
751	751	737the reversal of overdoses caused by opioids, which shall be deemed medically necessary and
752	752	738shall not require prior authorization; provided, however, that a prescription from a health care
753	753	739practitioner shall not be required for coverage of opioid antagonists. An opioid antagonist used in
754	754	740the reversal of overdoses caused by opioids shall not be subject to any deductible, coinsurance,
755	755	741copayments or out-of-pocket limits; provided, however, that cost-sharing shall be required if the
756	756	742applicable plan is governed by the federal Internal Revenue Code and would lose its tax-exempt
757	757	743status as a result of the prohibition on cost-sharing for this service. 36 of 47
758	758	744 (b) The policy, contract, agreement, plan or certificate of insurance shall provide
759	759	745coverage for an opioid antagonist used in the reversal of overdoses caused by opioids as a
760	760	746medical benefit when dispensed by the health care facility in which the opioid antagonist was
761	761	747prescribed and shall provide coverage as a pharmacy benefit for an opioid antagonist used in the
762	762	748reversal of overdoses caused by opioids dispensed by a pharmacist, including an opioid
763	763	749antagonist dispensed pursuant to section 19B of chapter 94C; provided, however, that the rate to
764	764	750be reimbursed under the medical benefit shall not exceed the carrier’s average in-network
765	765	751pharmacy benefit rate and the health care facility shall not balance bill the patient.
766	766	752 Section 4XX. Any subscription certificate under an individual or group medical service
767	767	753agreement delivered, issued or renewed within the commonwealth shall provide coverage for the
768	768	754provision of services by a recovery coach licensed or otherwise authorized to practice under
769	769	755chapter 111J, irrespective of the setting in which these services are provided; provided, that such
770	770	756services shall be within the lawful scope of practice of a recovery coach. The contractual rate for
771	771	757these services shall be no less than the prevailing MassHealth rate for recovery coach services.
772	772	758The benefits in this section shall not be subject to any deductible, coinsurance, copayments or
773	773	759out-of-pocket limits; provided, however, that cost-sharing shall be required if the applicable plan
774	774	760is governed by the federal Internal Revenue Code and would lose its tax-exempt status as a result
775	775	761of the prohibition on cost-sharing for this service. Recovery coach services shall be deemed
776	776	762medically necessary and shall not require prior authorization.
777	777	763 SECTION 17A. Chapter 176G of the General Laws is hereby amended by striking out
778	778	764section 4EE and inserting in place thereof the following section:- 37 of 47
779	779	765 Section 4EE. (a) Any individual or group health maintenance contract that is issued or
780	780	766renewed within or without the commonwealth shall develop a plan to provide adequate coverage
781	781	767and access to a broad spectrum of pain management services, including, but not limited to, non-
782	782	768medication, non-surgical treatment modalities and non-opioid medication treatment options that
783	783	769serve as alternatives to opioid prescribing, in accordance with guidelines developed by the
784	784	770division of insurance.
785	785	771 (b) No such contract shall, relative to pain management services identified by the carrier
786	786	772pursuant to subsection (a), require a member to obtain a preauthorization for non-medication,
787	787	773non-surgical treatment modalities that include restorative therapies, behavioral health approaches
788	788	774or integrative health therapies, including acupuncture, chiropractic treatments, massage, and
789	789	775movement therapies.
790	790	776 (c)(1) The plan pursuant to subsection (a) shall be subject to approval and shall be a
791	791	777component of carrier accreditation by the division of insurance pursuant to section 2 of chapter
792	792	778176O. In its review, the division shall consider the adequacy of access to a broad spectrum of
793	793	779pain management services and any carrier policies that may create unduly preferential coverage
794	794	780to prescribing opioids without other pain management modalities.
795	795	781 (2) No individual or group health maintenance contract that is issued or renewed within
796	796	782or without the commonwealth shall establish utilization controls, including preauthorization or
797	797	783step therapy requirements, for clinically appropriate non-opioid drugs approved by the federal
798	798	784Food and Drug Administration for the treatment or management of pain, that are more restrictive
799	799	785or extensive than the least restrictive or extensive utilization controls applicable to any clinically
800	800	786appropriate opioid drug. 38 of 47
801	801	787 (d) Carriers shall annually distribute educational materials to providers within their
802	802	788networks and to members about the pain management access plan and shall make information
803	803	789about their plans publicly available on their websites.
804	804	790 SECTION 18. Said chapter 176G is hereby further amended by inserting after section
805	805	7914NN the following 2 sections:-
806	806	792 Section 4OO. An individual or group health maintenance contract that is issued or
807	807	793renewed within or without the commonwealth shall provide coverage for prescribed or dispensed
808	808	794opioid antagonists, as defined in section 19B of chapter 94C and used in the reversal of
809	809	795overdoses caused by opioids, which shall be deemed medically necessary and shall not require
810	810	796prior authorization; provided, however, that a prescription from a health care practitioner shall
811	811	797not be required for coverage of opioid antagonists. An opioid antagonist used in the reversal of
812	812	798overdoses caused by opioids shall not be subject to any deductible, coinsurance, copayments or
813	813	799out-of-pocket limits; provided, however, that cost-sharing shall be required if the applicable plan
814	814	800is governed by the federal Internal Revenue Code and would lose its tax-exempt status as a result
815	815	801of the prohibition on cost-sharing for this service.
816	816	802 (b) The individual or group health maintenance contract shall provide coverage for an
817	817	803opioid antagonist used in the reversal of overdoses caused by opioids as a medical benefit when
818	818	804dispensed by the health care facility in which the opioid antagonist was prescribed and shall
819	819	805provide coverage as a pharmacy benefit for an opioid antagonist used in the reversal of
820	820	806overdoses caused by opioids dispensed by a pharmacist, including an opioid antagonist
821	821	807dispensed pursuant to section 19B of chapter 94C; provided, however, that the rate to be 39 of 47
822	822	808reimbursed under the medical benefit shall not exceed the carrier’s average in-network pharmacy
823	823	809benefit rate and the health care facility shall not balance bill the patient.
824	824	810 Section 4PP. An individual or group health maintenance contract that is issued or
825	825	811renewed within or without the commonwealth shall provide coverage for the provision of
826	826	812services by a recovery coach licensed or otherwise authorized to practice under chapter 111J,
827	827	813irrespective of the setting in which these services are provided; provided, that such services shall
828	828	814be within the lawful scope of practice of a recovery coach. The contractual rate for these services
829	829	815shall be no less than the prevailing MassHealth rate for recovery coach services. The benefits in
830	830	816this section shall not be subject to any deductible, coinsurance, copayments or out-of-pocket
831	831	817limits; provided, however, that cost-sharing shall be required if the applicable plan is governed
832	832	818by the federal Internal Revenue Code and would lose its tax-exempt status as a result of the
833	833	819prohibition on cost-sharing for this service. Recovery coach services shall be deemed medically
834	834	820necessary and shall not require prior authorization.
835	835	821 SECTION 18A. (a) Notwithstanding any general or special law to the contrary, the
836	836	822Massachusetts alcohol and substance abuse center, hereinafter referred to as the center, shall be
837	837	823considered a security facility under section 35 of chapter 123 of the General Laws for the
838	838	824purposes of commitments under said section 35 until the conditions under subsection (b) are
839	839	825satisfied.
840	840	826 (b) The secretary of health and human services shall develop a plan to end operations at
841	841	827the center as a facility accepting persons committed for treatment for alcohol or substance use
842	842	828disorder by not later than December 31, 2026; provided, however, that persons may continue to
843	843	829be committed to the center under said section 35 of said chapter 123 until the department of 40 of 47
844	844	830public health and department of mental health have licensed and approved suitable facilities with
845	845	831a total bed capacity equal to the center. Such facilities shall be geographically distributed so as to
846	846	832provide access to treatment in all regions of the commonwealth.
847	847	833 (c) The secretary shall submit the plan required under subsection (b) to the clerks of the
848	848	834senate and house of representatives and to the joint committee on mental health, substance abuse
849	849	835and recovery not later than 180 days after the effective date of this act. The secretary shall submit
850	850	836interim reports quarterly detailing the progress towards ending operations at the center to the
851	851	837clerks of the senate and house of representatives and to the joint committee on mental health,
852	852	838substance abuse and recovery. The quarterly reports shall include, but shall not be limited to
853	853	839following: (i) a census of persons being treated at the center; (ii) the number of persons
854	854	840transferred from the center to other facilities licensed by the department of public health or
855	855	841department of mental health; (iii) the location and bed capacity of each newly licensed facility;
856	856	842(iv) the type of facility and location of newly committed persons under section 35 of chapter 123
857	857	843of the General Laws; and (v) the anticipated fiscal impact, if any, of complying with this section.
858	858	844 SECTION 19. (a) The department of children and families, in consultation with the
859	859	845department of public health and the office of the child advocate, shall promulgate regulations or
860	860	846issue further guidance for the requirements of health care providers involved in the delivery or
861	861	847care of infants identified as being affected by prenatal substance exposure or fetal alcohol
862	862	848spectrum disorder. The regulations or guidance shall include, but shall not be limited to: (i)
863	863	849factors for determining instances in which prenatal substance exposure from a medication
864	864	850prescribed by a licensed health care provider require filing a report pursuant to section 51A of
865	865	851chapter 119 of the General Laws; provided, that an indication of prenatal substance exposure
866	866	852shall not solely meet the requirements of said section 51A of said chapter 119; and (ii) the roles 41 of 47
867	867	853and responsibilities of health care providers and staff who care for perinatal patients or newborns
868	868	854pursuant to 42 U.S.C. § 5106a(b)(2)(B)(ii) and in accordance with the federal Child Abuse
869	869	855Prevention and Treatment Act, 42 U.S.C. § 5101 et seq. and 42 U.S.C. § 5116 et seq., as
870	870	856amended from time to time.
871	871	857 (b) Such regulations or guidance shall: (i) reflect current accepted standards of health
872	872	858care and substance use treatment practices; (ii) conform to the reporting requirements under the
873	873	859federal Child Abuse Prevention and Treatment Act, 42 U.S.C. § 5101 et seq. and 42 U.S.C. §
874	874	8605116 et seq., as amended from time to time; and (iii) to the extent possible, reduce racial
875	875	861disparities in maternal and child health care, reports of suspected child abuse or neglect under
876	876	862said section 51A of said chapter 119 or the number of patients identified for plans of safe care
877	877	863pursuant to the federal Child Abuse Prevention and Treatment Act, 42 U.S.C. § 5101 et seq. and
878	878	86442 U.S.C. § 5116 et seq., as amended from time to time.
879	879	865 (c) Such regulations or guidance shall be developed with input from relevant
880	880	866stakeholders, including, but not limited to: (i) medical professional associations and health care
881	881	867providers with expertise in the provision of care to pregnant people; (ii) individuals who have
882	882	868lived experience of seeking or receiving behavioral health services or treatment prior to, during
883	883	869and after pregnancy; (iii) professional associations and organizations with expertise in prenatal
884	884	870substance exposure, perinatal and child health, treatment of substance use disorder and racial
885	885	871equity in access to health care; and (iv) behavioral health professionals with expertise in
886	886	872providing culturally-competent care.
887	887	873 SECTION 20. The bureau of substance addiction services within the department of
888	888	874public health shall conduct a comprehensive review of barriers to certification, credentialing and 42 of 47
889	889	875other employment and practice requirements of recovery coaches, including, but not limited to,
890	890	876peer support specialists, peer recovery coaches and recovery support navigators, and issue a
891	891	877report on its findings. The report shall include, but shall not be limited to: (i) cost barriers for
892	892	878individuals with lived experience, including, but not limited to, application and examination fees
893	893	879for initial certification and credentialing; (ii) cost barriers to certification and credentialing
894	894	880renewals; (iii) cost and reimbursement barriers for hospitals and clinics licensed under chapter
895	895	881111 of the General Laws and other employers to hire, train and retain recovery coaches,
896	896	882including, but not limited to, peer support specialists, peer recovery coaches and recovery
897	897	883support navigators; (iv) eligibility requirements for certification and credentialing; (v) access to
898	898	884training programs and resources; and (vi) any additional barriers to obtaining and maintaining
899	899	885authorization to practice recovery coaching. The report shall also include recommendations to
900	900	886address said barriers. The bureau shall submit a copy of the report to the secretary of health and
901	901	887human services, the clerks of the house of representatives and the senate and the joint committee
902	902	888on mental health, substance use and recovery within 90 days of the effective date of this act.
903	903	889 SECTION 20A. (a) The bureau of substance addiction services within the department of
904	904	890public health shall review and study the disparate impacts and disparities of substance use
905	905	891disorder, overdoses, overdose deaths and clinical outcomes for members of historically
906	906	892marginalized communities, including, but not limited to, impacts based on race, ethnicity,
907	907	893language, gender, gender identity, sexual orientation, age, disability and other social
908	908	894determinants of health identified by the bureau.
909	909	895 (b) The bureau shall: (i) review current data and trends regarding substance use and
910	910	896overdose rates, disparities in treatment access and corresponding causes within historically
911	911	897marginalized communities; (ii) evaluate the effectiveness of current treatment interventions 43 of 47
912	912	898within historically marginalized communities; (iii) identify barriers to accessing treatment,
913	913	899including, but not limited to, access to necessary resources, education and access to appropriate
914	914	900care and interventions; and (iv) identify evidence-based strategies to reduce overdose deaths and
915	915	901improve access, treatment and education within historically marginalized communities.
916	916	902 (c) Not later than June 30, 2025, the bureau shall submit a report of its findings and any
917	917	903recommendations, including any legislative or regulatory changes that may be necessary to carry
918	918	904out any recommendations, to the clerks of the house of representatives and the senate, the joint
919	919	905committee on mental health, substance use and recovery and the joint committee on racial equity,
920	920	906civil rights, and inclusion.
921	921	907 SECTION 20B. (a) For the purposes of this section, the words “administrative discharge”
922	922	908shall mean the termination of treatment of a patient determined by a health care provider to have
923	923	909a substance use disorder and related treatment needs despite a lack of clinical improvement in the
924	924	910patient due to a violation of an administrative rule of a licensed substance use disorder treatment
925	925	911program.
926	926	912 (b) The bureau of substance addiction services within the department of public health
927	927	913shall study the circumstances and effects of administrative discharges of patients from substance
928	928	914use disorder treatment programs licensed under sections 6 and 6A of chapter 111B of the
929	929	915General Laws or section 7 of chapter 111E of the General Laws or programs established
930	930	916pursuant to sections 24 and 24D of chapter 90.
931	931	917 (b) The bureau shall examine: (i) standards used by substance use disorder treatment
932	932	918programs in determining when an administrative discharge is appropriate, including, but not
933	933	919limited to, any standard criteria, methodology or graduated sanctions based on staff and patient 44 of 47
934	934	920safety and the level of treatment and severity of the symptoms of the patient; (ii) options for
935	935	921patients following an administrative discharge from a substance use disorder treatment program,
936	936	922including, but not limited to, any programs or resources available to a patient and the frequency
937	937	923that such options are provided to said patients; and (iii) the applicability, availability and
938	938	924effectiveness of the regulations relative to the coordination of care and management of discharge
939	939	925planning for an administrative discharge pursuant to 105 CMR 164 and section 19 of chapter 17
940	940	926of the General Laws.
941	941	927 (c) Not later than December 31, 2025, the bureau shall submit its findings and any
942	942	928recommendations, including any legislative or regulatory changes that may be necessary to
943	943	929implement any recommendations, with the clerks of the house of representatives and senate, the
944	944	930house and senate committees on ways and means and the joint committee on mental health,
945	945	931substance use and recovery.
946	946	932 SECTION 21. (a) The department of public health may issue a recovery coach license to
947	947	933an applicant who: (i) is practicing in the commonwealth as a recovery coach as of the effective
948	948	934date of this act; and (ii) applies for licensure within 1 year of the effective date of this act. The
949	949	935lived experience requirement pursuant to section 1 of chapter 111J of the General Laws, as
950	950	936inserted by section 10, shall be waived for applicants who were credentialed by the
951	951	937Massachusetts Board of Substance Abuse Counselor Certification prior to the effective date of
952	952	938this act.
953	953	939 (b) The department of public health shall issue a temporary recovery coach license to an
954	954	940applicant who has received a Certified Addictions Recovery Coach certification, issued by the
955	955	941Massachusetts Board of Substance Abuse Counselor Certification and provides satisfactory proof 45 of 47
956	956	942for any test or examination that may be required for licensure; provided, that no temporary
957	957	943license shall be valid for more than 2 years. The applicants eligible for a temporary license shall
958	958	944meet all other qualifications and requirements for licensure as determined by the department of
959	959	945public health.
960	960	946 (c) The department of public health shall promulgate rules or regulations for the
961	961	947implementation of this section.
962	962	948 SECTION 21A. (a) There is hereby established a special commission to study and make
963	963	949recommendations on ways to address the public health and safety concerns posed by the
964	964	950proliferation of xylazine as an additive to illicit drugs such as fentanyl.
965	965	951 (b) The commission shall consist of the following 13 members: the chairs of the joint
966	966	952committee on mental health, substance use, and recovery, who shall serve as co-chairs; 1
967	967	953member appointed by the speaker of the house of representatives; 1 member appointed by the
968	968	954minority leader of the house of representatives; 1 member appointed by the senate president; 1
969	969	955member appointed by the minority leader of the senate; the secretary of health and human
970	970	956services, or their designee; the commissioner of public health, or their designee; the
971	971	957commissioner of mental health, or their designee; the secretary of public safety and security, or
972	972	958their designee; 1 member who is a representative of the bureau of substance addiction services
973	973	959within the department of public health; 1 member who is a representative of the Massachusetts
974	974	960Veterinary Medical Association; and 1 member appointed by the governor who shall be a
975	975	961registered nurse or licensed physician with experience in treating patients for substance use
976	976	962disorder. 46 of 47
977	977	963 (c) The commission shall consider: (i) best practices to regulate and oversee the
978	978	964production and distribution of xylazine to ensure that it is used solely for its intended purpose as
979	979	965an animal tranquilizer administered by licensed veterinarians and not for human consumption;
980	980	966(ii) whether xylazine should be classified as a controlled substance and appropriate penalties for
981	981	967its illegal production and distribution; (iii) the availability of effective outreach and treatment
982	982	968programs for patients who have been exposed to xylazine and ways to address any gaps in
983	983	969available programs and services; and (iv) any other considerations determined to be relevant by
984	984	970the commission.
985	985	971 (d) The commission shall file a report and its recommendations, including any legislation
986	986	972necessary to implement the recommendations, with the clerks of the house of representatives and
987	987	973the senate not later than June 30, 2025.
988	988	974 SECTION 22. No person shall be found to have violated section 4 of chapter 111J of the
989	989	975General Laws, as inserted by section 10, until 6 months after the department of public health first
990	990	976issues a recovery coach license pursuant to said section 4 of said chapter 111J.
991	991	977 SECTION 23. Not later than 18 months after the effective date of this act, the initial
992	992	978report consistent with the report required pursuant to section 110D of chapter 111 of the General
993	993	979Laws, as inserted by section 8, shall be filed by the department of public health, in consultation
994	994	980with the department of children and families and the office of the child advocate, with the clerks
995	995	981of the house of representatives and the senate, the house and senate committees on ways and
996	996	982means, the joint committee on children, families and person with disabilities and the joint
997	997	983committee on mental health, substance use and recovery examining the prevalence of births of 47 of 47
998	998	984infants identified as being affected by prenatal substance exposure or fetal alcohol spectrum
999	999	985disorder.
1000	1000	986 SECTION 23A. All commission members pursuant to section 21A shall be appointed
1001	1001	987within 30 days of the effective date of this act.