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