Massachusetts 2023-2024 Regular Session

Massachusetts House Bill H5143 Compare Versions

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

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1	1	HOUSE . . . . . . . . . . . . . . No. 5143
2	2	The Commonwealth of Massachusetts
3	3	_______________
4	4	The committee of conference on the disagreeing votes of the two branches with reference
5	5	to the Senate amendments (striking out all after the enacting clause and inserting in place thereof
6	6	the text contained in Senate document numbered 2921; and striking out the title and inserting in
7	7	place thereof the following title: “An Act relative to accessing harm reduction initiatives.”) of the
8	8	House Bill relative to treatments and coverage for substance use disorder and recovery coach
9	9	licensure (House, No. 4758), reports recommending passage of the accompanying bill (House, No.
10	10	5143). December 17, 2024.
11	11	Adrian C. MadaroBrenden P. CrightonAlice Hanlon PeischJohn C. VelisMichael J. SoterRyan C. Fattman 1 of 51
12	12	FILED ON: 12/17/2024
13	13	HOUSE . . . . . . . . . . . . . . . No. 5143
14	14	The Commonwealth of Massachusetts
15	15	_______________
16	16	In the One Hundred and Ninety-Third General Court
17	17	(2023-2024)
18	18	_______________
19	19	An Act relative to treatments and coverage for substance use disorder and recovery coach
20	20	licensure.
21	21	Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
22	22	of the same, as follows:
23	23	1SECTION 1. Chapter 32A of the General Laws is hereby amended by striking out section 17Q,
24	24	2as appearing in the 2022 Official Edition, and inserting in place thereof the following section:-
25	25	3 Section 17Q. (a) The commission shall develop a plan to provide active or retired
26	26	4employees insured under the group insurance commission adequate coverage and access to a
27	27	5broad spectrum of pain management services, including, but not limited to, non-medication,
28	28	6nonsurgical treatment modalities and non-opioid medication treatment options that serve as
29	29	7alternatives to opioid prescribing, in accordance with guidelines developed by the division of
30	30	8insurance.
31	31	9 (b) No such coverage offered by the commission shall, relative to pain management
32	32	10services identified by the commission pursuant to subsection (a), require a member to obtain
33	33	11prior authorization for non-medication, nonsurgical treatment modalities that include restorative
34	34	12therapies, behavioral health approaches or integrative health therapies, including acupuncture,
35	35	13chiropractic treatments, massage and movement therapies. 2 of 51
36	36	14 (c)(1) The plan developed pursuant to subsection (a) shall be subject to review by the
37	37	15division of insurance. In its review, the division shall consider the adequacy of access to a broad
38	38	16spectrum of pain management services and any policies that may create unduly preferential
39	39	17coverage to prescribing opioids without other pain management modalities.
40	40	18 (2) No coverage offered by the commission to an active or retired employee of the
41	41	19commonwealth insured under the group insurance commission shall establish utilization
42	42	20controls, including prior authorization or step therapy requirements, for clinically appropriate
43	43	21non-opioid drugs approved by the United States Food and Drug Administration for the treatment
44	44	22or management of pain that are more restrictive or extensive than the least restrictive or
45	45	23extensive utilization controls applicable to any clinically appropriate opioid drug.
46	46	24 (d) The commission shall annually distribute educational materials to providers within
47	47	25their network and to members about the pain management access plan developed pursuant to
48	48	26subsection (a) and shall make information about the plan publicly available on its website.
49	49	27 SECTION 2. Said chapter 32A is hereby further amended by inserting after section 17W
50	50	28the following 2 sections:-
51	51	29 Section 17X. (a) Coverage offered by the commission to an active or retired employee of
52	52	30the commonwealth insured under the group insurance commission shall provide coverage for
53	53	31prescribed, ordered or dispensed opioid antagonists, as defined in section 19B of chapter 94C
54	54	32and used in the reversal of overdoses caused by opioids; provided, however, that the coverage for
55	55	33such prescribed, ordered or dispensed opioid antagonists shall not require prior authorization;
56	56	34and provided further, that a prescription from a health care practitioner shall not be required for
57	57	35coverage or reimbursement of opioid antagonists under this section. An opioid antagonist used in 3 of 51
58	58	36the reversal of overdoses caused by opioids shall not be subject to any deductible, coinsurance,
59	59	37copayments or out-of-pocket limits; provided, however, that cost-sharing shall be required if the
60	60	38applicable plan is governed by the federal Internal Revenue Code and would lose its tax-exempt
61	61	39status as a result of the prohibition on cost-sharing for this service.
62	62	40 (b) The commission shall provide coverage and reimbursement for an opioid antagonist
63	63	41used in the reversal of overdoses caused by opioids as a medical benefit when dispensed by the
64	64	42health care facility in which the opioid antagonist was prescribed or ordered and shall provide
65	65	43coverage as a pharmacy benefit for an opioid antagonist used in the reversal of overdoses caused
66	66	44by opioids dispensed by a pharmacist, including an opioid antagonist dispensed pursuant to
67	67	45section 19B of chapter 94C; provided, however, that the rate to be reimbursed under the medical
68	68	46benefit shall not exceed the commission’s average in-network pharmacy benefit rate and the
69	69	47health care facility shall not balance bill the patient.
70	70	48 Section 17Y. The commission shall provide to any active or retired employee of the
71	71	49commonwealth who is insured under the group insurance commission coverage for the provision
72	72	50of services by a recovery coach licensed or otherwise authorized to practice pursuant to chapter
73	73	51111J, regardless of the setting in which the services are provided; provided, however, that such
74	74	52services shall be within the lawful scope of practice of a recovery coach. The contractual rate for
75	75	53these services shall be not less than the prevailing MassHealth rate for recovery coach services.
76	76	54The benefits in this section shall not be subject to any deductible, coinsurance, copayments or
77	77	55out-of-pocket limits; provided, however, that cost-sharing shall be required if the applicable plan
78	78	56is governed by the federal Internal Revenue Code and would lose its tax-exempt status as a result
79	79	57of the prohibition on cost-sharing for the service. Recovery coach services shall not require prior
80	80	58authorization. 4 of 51
81	81	59 SECTION 3. Section 18 of chapter 94C of the General Laws, as appearing in the 2022
82	82	60Official Edition, is hereby amended by striking out subsection (e) and inserting in place thereof
83	83	61the following subsection:-
84	84	62 (e) Practitioners who prescribe controlled substances, except veterinarians, shall be
85	85	63required, as a prerequisite to obtaining or renewing their professional licenses, to complete
86	86	64appropriate training relative to: (i) effective pain management including, but not limited to: (A)
87	87	65appropriate, available non-opioid alternatives for the treatment of pain; (B) the advantages and
88	88	66disadvantages of the use of non-opioid treatment alternatives, considering a patient’s risk of
89	89	67substance misuse; and (C) the options for referring or prescribing appropriate non-opioid
90	90	68treatment alternatives based on the practitioner’s clinical judgment and following generally
91	91	69accepted clinical guidelines, taking into consideration the preference and consent of the patient
92	92	70and the educational information described in section 21; (ii) the risks of misuse and addiction
93	93	71associated with opioid medication; (iii) the identification of patients at risk for substance misuse;
94	94	72(iv) counseling patients about the side effects, risks, addictive nature and proper storage and
95	95	73disposal of prescription medications; (v) the appropriate prescription quantities for prescription
96	96	74medications that have an increased risk of misuse and addiction, including a patient’s option to
97	97	75fill a prescription for a schedule II controlled substance in a lesser quantity than indicated on the
98	98	76prescription pursuant to subsection (d¾); and (vi) opioid antagonists, overdose prevention
99	99	77treatments and information to advise patients on both the use of and ways to access opioid
100	100	78antagonists and overdose prevention treatments. The boards of registration for each professional
101	101	79license that require this training shall, in consultation with the department, relevant stakeholders
102	102	80and experts in the treatment and management of acute and chronic pain, develop the standards
103	103	81for appropriate training programs. For the purposes of this section, non-opioid treatment 5 of 51
104	104	82alternatives shall include, but shall not be limited to, medications, restorative therapies,
105	105	83interventional procedures, behavioral health approaches and complementary and integrative
106	106	84treatments.
107	107	85 SECTION 4. Said chapter 94C is hereby further amended by striking out section 19C, as
108	108	86so appearing, and inserting in place thereof the following section:-
109	109	87 Section 19C. The board of registration in pharmacy shall promulgate regulations
110	110	88requiring pharmacies located in areas with high incidence of opiate overdose, as determined by
111	111	89the board in consultation with the department, to maintain a continuous supply of opioid
112	112	90antagonists, as defined in section 19B; provided, however, that the continuous supply of opioid
113	113	91antagonists shall include opioid antagonists that are approved by the United States Food and
114	114	92Drug Administration to be sold over the counter without a prescription; and provided further,
115	115	93that such pharmacies shall notify the department if the supply or stock of opioid antagonist doses
116	116	94is insufficient to enable compliance with maintaining a continuous supply of opioid antagonists.
117	117	95 SECTION 5. Said chapter 94C is hereby further amended by inserting after section 19D
118	118	96the following section:-
119	119	97 Section 19D½. (a) For the purposes of this section, the following words shall, unless the
120	120	98context clearly requires otherwise, have the following meanings:
121	121	99 “Opioid antagonist”, as defined in section 19B.
122	122	100 “Substance use disorder treatment facility”, a facility licensed or approved by the
123	123	101department or the department of mental health to offer treatment for substance use disorder,
124	124	102including, but not limited to: (i) withdrawal management services; (ii) clinical stabilization 6 of 51
125	125	103services; (iii) transitional support services; (iv) residential support services; (v) community
126	126	104behavioral health center services; (vi) office-based opioid or addiction treatment services; or (vii)
127	127	105inpatient or outpatient substance use disorder services.
128	128	106 (b) A substance use disorder treatment facility shall, upon discharge of a patient who has:
129	129	107(i) a history of using opioids; (ii) been diagnosed with opioid use disorder; or (iii) experienced an
130	130	108opioid-related overdose, educate the patient on the use of opioid antagonists and dispense not
131	131	109less than 2 doses of an opioid antagonist to the patient or a legal guardian.
132	132	110 (c) The commissioner may promulgate rules and regulations necessary to implement this
133	133	111section.
134	134	112 SECTION 6. Section 21 of said chapter 94C, as appearing in the 2022 Official Edition, is
135	135	113hereby amended by striking out the third paragraph and inserting in place thereof the following
136	136	114paragraph:-
137	137	115 The department, in consultation with relevant stakeholders and experts in the treatment
138	138	116and management of acute and chronic pain, and based in part on the Pain Management Best
139	139	117Practices Inter-Agency Task Force Report issued by the United States Department of Health and
140	140	118Human Services, shall produce and distribute, either in written or electronic form, to pharmacies,
141	141	119not including institutional pharmacies, pamphlets for consumers relative to narcotic drugs,
142	142	120including opiates, that shall include educational information related to: (i) pain management and
143	143	121the use and availability of non-opioid alternatives for the treatment of acute and chronic pain,
144	144	122including, but not limited to: (A) information on available non-opioid alternatives for the
145	145	123treatment of pain, including non-opioid medications and non-pharmacological therapies; and (B)
146	146	124the advantages and disadvantages of the use of such non-opioid treatment alternatives; (ii) the 7 of 51
147	147	125consumer’s option to fill a prescription for a schedule II controlled substance in a lesser quantity
148	148	126than indicated on the prescription pursuant to subsection (d¾) of section 18; (iii) misuse and
149	149	127abuse of narcotics by adults and children; (iv) the risk of dependency and addiction associated
150	150	128with narcotics use; (v) proper storage and disposal of narcotics; (vi) addiction support and
151	151	129treatment resources; (vii) the telephone helpline operated by the bureau of substance addiction
152	152	130services established in section 18 of chapter 17; (viii) the risks of unintended overdoses
153	153	131associated with prescription opioid use, including, but not limited to: (A) mixing any opioid with
154	154	132stimulants or respiratory depressants, including, but not limited to, alcohol and benzodiazepines;
155	155	133and (B) changes in personal tolerance levels for persons with a history of overdose; and (ix) risk
156	156	134reduction measures to prevent, respond to and reverse an opioid overdose. A pharmacist shall
157	157	135distribute the pamphlet when dispensing a narcotic or controlled substance contained in schedule
158	158	136II or III; provided, however, that pharmacists shall not be required to distribute the pamphlet if:
159	159	137(1) the patient is receiving outpatient palliative care pursuant to section 227 of chapter 111; (2)
160	160	138the patient is a resident of a long-term care facility; or (3) the narcotic or controlled substance is
161	161	139prescribed for use in the treatment of substance use disorder or opioid dependence. For the
162	162	140purposes of this section, non-opioid treatment alternatives shall include, but shall not be limited
163	163	141to, medications, restorative therapies, interventional procedures, behavioral health approaches
164	164	142and complementary and integrative treatments.
165	165	143 SECTION 7. Said chapter 94C is hereby further amended by inserting after section 34A
166	166	144the following section:-
167	167	145 Section 34A½. (a) As used in this section, the following words shall, unless the context
168	168	146clearly requires otherwise, have the following meanings: 8 of 51
169	169	147 “Drug testing services”, the use of testing equipment to identify or analyze the strength,
170	170	148effectiveness or purity of a controlled substance to determine whether the controlled substance
171	171	149contains chemicals, toxic substances or hazardous compounds prior to its injection, inhalation or
172	172	150ingestion by another person.
173	173	151 “Testing equipment”, including, but not limited to: fentanyl test strips, colorimetric
174	174	152reagents, high-performance liquid chromatography, gas chromatography and mass spectrometry.
175	175	153 (b)(1) A person acting in good faith and within the scope of such person’s role providing
176	176	154or assisting in the provision of harm reduction services as an owner, employee, intern, volunteer
177	177	155or third-party contractor of an entity providing harm reduction services may provide or assist in
178	178	156the provision of drug testing services to an individual to ensure that a controlled substance in the
179	179	157possession of the individual and exclusively for that individual’s personal use does not contain
180	180	158dangerous chemicals, toxic substances or hazardous compounds likely to cause an accidental
181	181	159overdose.
182	182	160 (2) A person acting in good faith and within the scope of such person’s role providing or
183	183	161assisting in the provision of harm reduction services as an owner, employee, intern, volunteer or
184	184	162third-party contractor of an entity providing harm reduction services who provides or assists in
185	185	163the provision of drug testing services pursuant to this section shall not be charged or prosecuted
186	186	164pursuant to sections 32I, 34 or 40.
187	187	165 (3) A person acting in good faith and within the scope of such person’s role providing or
188	188	166assisting in the provision of harm reduction services as an owner, employee, intern, volunteer or
189	189	167third-party contractor of an entity providing harm reduction services who provides or assists in
190	190	168the provision of drug testing services pursuant to this section shall not be subject to any criminal 9 of 51
191	191	169or civil liability or any professional disciplinary action as a result of any act or omission related
192	192	170to the provision of drug testing services; provided, however, that this paragraph shall not apply to
193	193	171acts or omissions of gross negligence or willful or wanton misconduct.
194	194	172 (c) An individual acting in good faith who seeks drug testing services of a controlled
195	195	173substance in such individual’s possession and intended exclusively for such individual’s personal
196	196	174use from a person acting in good faith and within the scope of the person’s role providing or
197	197	175assisting in the provision of harm reduction services as an owner, employee, intern, volunteer or
198	198	176third-party contractor of an entity providing harm reduction services shall not be charged or
199	199	177prosecuted pursuant to sections 32I, 34 or 40 while on the premises where the drug testing
200	200	178services are conducted.
201	201	179 SECTION 8. Section 25J½ of chapter 111 of the General Laws, as appearing in the 2022
202	202	180Official Edition, is hereby amended by inserting after the first paragraph the following
203	203	181paragraph:-
204	204	182 Upon discharge of a patient from an acute care hospital, a satellite emergency facility or a
205	205	183freestanding psychiatric hospital who has: (i) a history of or is actively using opioids; (ii) been
206	206	184diagnosed with opioid use disorder; or (iii) experienced an opioid-related overdose, the acute
207	207	185care hospital, satellite emergency facility or freestanding psychiatric hospital shall educate the
208	208	186patient on the use of opioid antagonists, as defined in section 19B of chapter 94C, and prescribe
209	209	187or dispense not less than 2 doses of an opioid antagonist to the patient or a legal guardian of the
210	210	188patient.
211	211	189 SECTION 9. Said chapter 111 is hereby further amended by inserting after section 110C
212	212	190the following 2 sections:- 10 of 51
213	213	191 Section 110D. (a) The department shall collect and provide data to the department of
214	214	192children and families on all births of infants affected by prenatal substance exposure in a form
215	215	193and manner consistent with any requirements of the federal Child Abuse Prevention and
216	216	194Treatment Act, 42 U.S.C. § 5101 et seq. and 42 U.S.C. § 5116 et seq.
217	217	195 (b) Annually, not later than April 1, the department, in consultation with the department
218	218	196of children and families and the office of the child advocate, shall file with the clerks of the
219	219	197house of representatives and the senate, the house and senate committees on ways and means, the
220	220	198joint committee on children, families and person with disabilities and the joint committee on
221	221	199mental health, substance use and recovery a report, along with any recommendations, examining
222	222	200the prevalence of births of infants identified as affected by prenatal substance exposure or fetal
223	223	201alcohol spectrum disorder, including, but not limited to: (i) any gaps in services for perinatal
224	224	202patients or such infants; (ii) an examination of child abuse and neglect reports related to an
225	225	203infant’s prenatal exposure to substances, including those that were ultimately screened out by the
226	226	204department of children and families; (iii) an examination of child abuse and neglect reports made
227	227	205pursuant to section 51A of chapter 119 related to an infant’s prenatal exposure to substances; and
228	228	206(iv) any recommended changes, including legislative or regulatory changes, that may be
229	229	207necessary to ensure the ongoing health, safety and wellbeing of perinatal patients and infants. If
230	230	208applicable, the department, in consultation with the department of children and families and the
231	231	209office of the child advocate, shall provide recommendations to address disparate impacts on the
232	232	210safety and wellbeing of infants identified as affected by prenatal substance exposure or fetal
233	233	211alcohol spectrum disorder.
234	234	212 Section 110E. (a) The department, in consultation with the department of children and
235	235	213families and the office of the child advocate, shall promulgate regulations on the requirements of 11 of 51
236	236	214health care providers involved in the delivery or care of infants identified as being affected by
237	237	215prenatal substance exposure or fetal alcohol spectrum disorder. The regulations shall cover topics
238	238	216including, but not limited to: (i) assessment for prenatal substance exposure and fetal alcohol
239	239	217spectrum disorder; (ii) assessment for prenatal substance exposure from a medication prescribed
240	240	218by a licensed health care provider; and (iii) the roles and responsibilities of health care providers
241	241	219and staff who care for perinatal patients or infants in relation to the requirements of 42 U.S.C. §
242	242	2205106a(b)(2)(B)(ii) and in accordance with the federal Child Abuse Prevention and Treatment
243	243	221Act, 42 U.S.C. § 5101 et seq. and 42 U.S.C. § 5116 et seq., including, but not limited to, the
244	244	222development and implementation of plans of safe care, if indicated, and referrals for appropriate
245	245	223services.
246	246	224 (b) Such regulations may: (i) reflect current accepted standards of health care and
247	247	225substance use treatment practices; (ii) enable data collection in a form and manner consistent
248	248	226with the reporting requirements under the federal Child Abuse Prevention and Treatment Act, 42
249	249	227U.S.C. § 5101 et seq. and 42 U.S.C. § 5116 et seq.; and (iii) to the extent possible, enable data
250	250	228collection regarding racial disparities in maternal and child health care, the number of patients
251	251	229identified for plans of safe care and appropriate service referrals pursuant to the federal Child
252	252	230Abuse Prevention and Treatment Act, 42 U.S.C. § 5101 et seq. and 42 U.S.C. § 5116 et seq.
253	253	231 (c) Such regulations shall be developed with input from relevant stakeholders, including,
254	254	232but not limited to: (i) medical professional associations and health care providers with expertise
255	255	233in the provision of care to pregnant people; (ii) individuals who have lived experience of seeking
256	256	234or receiving behavioral health services or treatment prior to, during and after pregnancy; (iii)
257	257	235professional associations and organizations with expertise in prenatal substance exposure,
258	258	236perinatal and child health, treatment of substance use disorder and racial equity in access to 12 of 51
259	259	237health care; and (iv) behavioral health professionals with expertise in providing culturally-
260	260	238competent care.
261	261	239 SECTION 10. Section 7 of chapter 111E of the General Laws, as appearing in the 2022
262	262	240Official Edition, is hereby amended by inserting after the word “basis”, in line 28, the following
263	263	241words:- , as determined by the department to be consistent with section 4 of chapter 151B and
264	264	242sufficient to ensure the needs of such residents are met and such residents have adequate access
265	265	243to such a facility.
266	266	244 SECTION 11. The General Laws are hereby amended by striking out chapter 111J, as so
267	267	245appearing, and inserting in place thereof the following chapter:-
268	268	246 CHAPTER 111J.
269	269	247 ALCOHOL AND DRUG COUNSELORS; RECOVERY COACHES.
270	270	248 Section 1. As used in this chapter, the following words shall, unless the context clearly
271	271	249requires otherwise, have the following meanings:
272	272	250 “Applicant”, an individual seeking licensure under this chapter.
273	273	251 “Approved continuing education”, continuing education approved by the department,
274	274	252including research and training programs, college and university courses, in-service training
275	275	253programs, seminars and conferences, designed to maintain and enhance the skills of licensees.
276	276	254 “Approved program”, a program approved by the department for the education and
277	277	255training of applicants. 13 of 51
278	278	256 “Approved recovery coach supervisor”, a licensed recovery coach who has completed
279	279	257recovery coach supervision training that has been approved by the department.
280	280	258 “Approved work experience”, supervised work experience, approved by the department,
281	281	259in the practice area for which an applicant seeks licensure.
282	282	260 “Department”, the department of public health.
283	283	261 “Licensee”, an individual who is licensed under this chapter.
284	284	262 “Licensed alcohol and drug counselor I”, a person licensed by the department to conduct
285	285	263an independent practice of alcohol and drug counseling and to provide supervision to other
286	286	264alcohol and drug counselors; provided, however, that a licensed alcohol and drug counselor I
287	287	265shall have: (i) received a master’s or doctoral degree in behavioral sciences, which included a
288	288	266supervised counseling practicum that meets the requirements established by the department or
289	289	267such equivalent educational credits as may be established by the department; (ii) not less than 3
290	290	268years of approved work experience; and (iii) passed a licensing examination approved by the
291	291	269department.
292	292	270 “Licensed alcohol and drug counselor II”, a person licensed by the department to practice
293	293	271alcohol and drug counseling under clinical supervision; provided, however, that a licensed
294	294	272alcohol and drug counselor II shall have: (i) completed an approved program of education, which
295	295	273included a supervised counseling practicum that meets the requirements established by the
296	296	274department or such equivalent educational credits as may be established by the department; (ii)
297	297	275not less than 3 years of approved work experience; and (iii) passed a licensing examination
298	298	276approved by the department. 14 of 51
299	299	277 “Licensed recovery coach”, a person with lived experience who is licensed by the
300	300	278department to practice recovery coaching using shared understanding, respect and mutual
301	301	279empowerment to help others become and stay engaged in the process of recovery from a
302	302	280substance use disorder; provided, however, that a licensed recovery coach shall: (i) have
303	303	281completed an approved program of education, including approved work experience that meets
304	304	282the requirements established by the department; (ii) demonstrate not less than 2 years of
305	305	283sustained recovery; and (iii) have met all education, training and experience requirements and
306	306	284qualifications as established by the department.
307	307	285 “Lived experience”, the experience of addiction and recovery from a substance use
308	308	286disorder.
309	309	287 Section 2. (a) The department shall establish and administer a program for the licensure
310	310	288of alcohol and drug counselors and recovery coaches. The department shall: (i) establish the
311	311	289licensure requirements for licensed alcohol and drug counselors practicing in the commonwealth;
312	312	290(ii) establish the licensure requirements for licensed recovery coaches practicing in the
313	313	291commonwealth; (iii) evaluate the qualifications of applicants for licensure; (iv) supervise
314	314	292licensing examinations, where applicable; (v) establish and collect fees for licensing and
315	315	293examination, where applicable; (vi) grant and issue licenses to applicants who satisfy the
316	316	294department’s requirements for licensure; (vii) establish continuing education requirements; (viii)
317	317	295investigate complaints; (ix) take appropriate disciplinary action to protect the public health,
318	318	296safety and welfare; and (x) perform other functions and duties as may be necessary to carry out
319	319	297this chapter. 15 of 51
320	320	298 (b) The department shall establish requirements for licensed alcohol and drug counselors
321	321	299I and licensed alcohol and drug counselors II and may establish other reasonable classifications
322	322	300for alcohol and drug counselors as it finds necessary and appropriate, including, but not limited
323	323	301to, alcohol and drug counselors specializing in youth recovery counseling, taking into
324	324	302consideration different levels of education, training and work experience.
325	325	303 (c) The department shall establish requirements for licensed recovery coaches, including,
326	326	304but not limited to, establishing an ethical code of conduct for recovery coaches, and may
327	327	305establish other reasonable classifications for recovery coaches as it finds necessary and
328	328	306appropriate, taking into consideration different levels of education, training and work experience.
329	329	307 (d) The department shall approve and issue certificates of approval of programs for the
330	330	308training of alcohol and drug counselors. The department shall maintain a list of approved
331	331	309programs and a current roster of persons serving as licensed alcohol and drug counselors in the
332	332	310commonwealth.
333	333	311 (e) The department shall approve and issue certificates of approval of programs for the
334	334	312training of recovery coaches. The department shall maintain a list of approved programs and a
335	335	313current roster of persons serving as licensed recovery coaches in the commonwealth.
336	336	314 (f) The department shall promulgate rules and regulations to implement this chapter,
337	337	315including, but not limited to, rules and regulations establishing the educational and professional
338	338	316requirements for licensing individuals under this chapter, establishing fees for licensing and
339	339	317examination, where applicable, and governing the practice and employment of licensees to
340	340	318promote the public health, safety and welfare. 16 of 51
341	341	319 Section 3. (a) Each applicant shall furnish the department with proof of satisfactory
342	342	320completion of the educational, training and experience requirements for licensure, including
343	343	321completion of an approved program and approved work experience and proof of having passed
344	344	322any licensing examinations required by the department; provided, however, that the department
345	345	323may establish additional requirements for licensure and exemptions by regulation.
346	346	324 (b) A license under this chapter shall be valid for a 2-year period and licensees may apply
347	347	325for renewal of a license for a like term. A licensee seeking license renewal shall submit proof of
348	348	326having successfully completed the requirements for approved continuing education as may be
349	349	327established by the department.
350	350	328 (c) Applications for licenses and renewals thereof shall be submitted in accordance with
351	351	329procedures established by the department. The department may establish fees for license
352	352	330applications and renewals.
353	353	331 Section 4. (a) Except as otherwise provided in this chapter or by regulation, a person not
354	354	332licensed or otherwise exempt from licensing shall not hold themself out as a licensed recovery
355	355	333coach and shall not use the title, initials, abbreviations, insignia or description of a licensed
356	356	334recovery coach or practice or attempt to practice recovery coaching unless otherwise authorized
357	357	335by law or rule or regulation of the department. Whoever engages in any such unauthorized action
358	358	336shall be subject to a fine of not less than $500. The department may bring a petition in superior
359	359	337court to enjoin such action or any other violation of this chapter or a regulation hereunder.
360	360	338 (b) Individuals working under an approved recovery coach supervisor and receiving
361	361	339approved work experience may practice without a license in order to obtain the requisite hours of
362	362	340supervised experience needed to obtain a recovery coach license; provided, however, that such 17 of 51
363	363	341individuals shall meet all other requirements for recovery coach applicants provided for in this
364	364	342chapter or by regulation.
365	365	343 (c) Nothing in this section shall prevent members of peer groups or self-help groups from
366	366	344performing peer support or self-help activities that may be included within the practice of
367	367	345recovery coaching; provided, however, that no members of peer groups or self-help groups who
368	368	346are not so credentialed shall use a title stating or implying that such person is a licensed recovery
369	369	347coach.
370	370	348 Section 5. (a) Except as otherwise provided for in this chapter or by regulation, a person
371	371	349who is not licensed or is otherwise exempt from licensing shall not hold themself out as a
372	372	350licensed alcohol and drug counselor and shall not use the title, initials or description of a licensed
373	373	351alcohol and drug counselor or practice or attempt to practice alcohol and drug counseling.
374	374	352Whoever engages in any such unauthorized action shall be subject to a fine of not less than $500.
375	375	353The department may bring a petition in superior court to enjoin such unauthorized action or any
376	376	354other violation of this chapter or a regulation hereunder.
377	377	355 (b) The following individuals shall be exempt from the licensing requirements for alcohol
378	378	356and drug counseling under this chapter:
379	379	357 (i) an educational psychologist, marriage and family therapist, mental health counselor,
380	380	358nurse practitioner, occupational therapist, physician, physician assistant, practical nurse,
381	381	359psychologist, registered nurse, rehabilitation counselor or social worker;
382	382	360 (ii) an employee or other agent of a recognized academic institution or employee
383	383	361assistance program, a federal, state, county or local government institution, program, agency or
384	384	362facility or school committee, school district, school board or board of regents while performing 18 of 51
385	385	363alcohol and drug counseling duties solely for the respective entity or under the jurisdiction of
386	386	364such entity; provided, however, that a license pursuant to this chapter need not be a requirement
387	387	365for employment in any state, county or municipal agency; and
388	388	366 (iii) an employee of a treatment program or facility licensed or approved by the
389	389	367department pursuant to chapters 111B and 111E; provided, however, that such individual shall
390	390	368perform alcohol and drug counseling solely within or under the jurisdiction of such program or
391	391	369facility.
392	392	370 (c) Nothing in this section shall prevent qualified members of other professions,
393	393	371including attorneys, Christian Science practitioners or members of the clergy, from providing
394	394	372alcohol or drug counseling consistent with accepted standards of their respective professions;
395	395	373provided, however, that no such person shall use a title stating or implying that such person is a
396	396	374licensed alcohol and drug counselor.
397	397	375 (d) Nothing in this section shall prevent members of peer groups or self-help groups from
398	398	376performing peer group or self-help activities; provided, however, that no such person shall use a
399	399	377title stating or implying that such person is a licensed alcohol and drug counselor.
400	400	378 Section 6. (a) The department shall establish procedures for consumers to file written
401	401	379complaints regarding licensees. The department shall investigate all complaints relating to the
402	402	380proper practice of a licensee under this chapter and all complaints relating to any violation of this
403	403	381chapter or regulation promulgated hereunder.
404	404	382 (b) The department may conduct an adjudicatory proceeding pursuant to chapter 30A but
405	405	383shall not issue, vacate, modify or enforce subpoenas pursuant to section 12 of said chapter 30A.
406	406	384The department may, after a hearing pursuant to said chapter 30A, deny, refuse renewal, revoke, 19 of 51
407	407	385limit or suspend a license or otherwise discipline a licensee; provided, however, that the
408	408	386department may suspend the license of a licensee who poses an imminent danger to the public
409	409	387without a hearing; provided further, that the licensee shall be afforded a hearing within 7
410	410	388business days of receipt of a notice of such denial, refusal to renew, revocation, limitation,
411	411	389suspension or other disciplinary action; and provided further, that the department shall conduct
412	412	390its proceedings in accordance with the provisions of this chapter and said chapter 30A. Grounds
413	413	391for denial, refusal to renew, revocation, limitation, suspension or other discipline shall include:
414	414	392(i) fraud or misrepresentation in obtaining a license; (ii) criminal conduct which the department
415	415	393determines to be of such a nature as to render such person unfit to practice as evidenced by
416	416	394criminal proceedings resulting in a conviction, guilty plea or plea of nolo contendere or an
417	417	395admission of sufficient facts; (iii) violation of any law or rule or regulation of the department
418	418	396governing the practice of the licensee under this chapter; (iv) violation of ethical standards which
419	419	397the department determines to be of such a nature as to render such person unfit to practice as a
420	420	398licensee; or (v) other just and sufficient cause that the department determines would render a
421	421	399person unfit to practice as a licensee.
422	422	400 (c) Where denial, refusal to renew, revocation or suspension is based solely on the failure
423	423	401of the licensee to timely file an application or pay prescribed fees or to maintain insurance
424	424	402coverage as required by applicable law or regulation, the department may act without first
425	425	403granting the applicant or licensee a hearing.
426	426	404 Section 7. Examinations for licensure, where applicable, shall be conducted not less than
427	427	405twice per year at times and places and in formats designated by the department. Examinations for
428	428	406licensure, where applicable, shall be written; provided, however, that portions thereof may be 20 of 51
429	429	407conducted orally at the department’s discretion; and provided further, that a person who fails an
430	430	408examination may be admitted to the next available examination.
431	431	409 Section 8. (a) The department may issue a license without examination to an applicant
432	432	410who meets the requirements for licensure established by the department if such applicant is
433	433	411licensed or certified in alcohol and drug counseling or in recovering coaching or a comparable
434	434	412field in another state wherein the requirements for licensure shall be determined by the
435	435	413department to be equivalent to or in excess of the requirements of this chapter.
436	436	414 (b) The department shall promulgate rules and regulations as may be necessary to
437	437	415implement this section.
438	438	416 Section 9. The bureau of substance addiction services within the department shall
439	439	417establish a comprehensive peer support program to provide mentorship, technical assistance and
440	440	418resources to support the skill-building and credentialing of peers working in substance addiction
441	441	419recovery services, including, but not limited to, peer workers and recovery coaches. The program
442	442	420shall include, but shall not be limited to: (i) a network for peer-to-peer trainings, education,
443	443	421mentorship, counseling and support; (ii) educational and other support materials; (iii) technical
444	444	422assistance for licensure, certification, credentialing and other employment and practice
445	445	423requirements; and (iv) billing technical assistance for organizations that employ recovery
446	446	424coaches. The bureau shall consult peers working in substance addiction recovery services in the
447	447	425establishment of such comprehensive peer support program.
448	448	426 SECTION 12. Chapter 112 of the General Laws is hereby amended by inserting after
449	449	427section 52G the following section:- 21 of 51
450	450	428 Section 52H. (a) For the purpose of this section, the following words shall, unless the
451	451	429context clearly requires otherwise, have the following meanings:
452	452	430 “Board”, the board of registration in dentistry established in section 19 of chapter 13.
453	453	431 “Unified recovery and monitoring program” or “Program”, the program for monitoring
454	454	432the rehabilitation of licensed health care professionals established by the department pursuant to
455	455	433section 65G.
456	456	434 (b)(1) The board shall participate in the unified recovery and monitoring program and
457	457	435shall make appropriate referrals to said unified recovery and monitoring program of dentists and
458	458	436dental hygienists who seek support for their mental health or substance use as a voluntary
459	459	437alternative to disciplinary actions.
460	460	438 (2) The board shall: (i) establish criteria for the referral of registered dentists and dental
461	461	439hygienists; (ii) establish an outreach program to identify registered dentists and dental hygienists
462	462	440who may have a qualifying mental health condition or substance use disorder; and (iii) provide
463	463	441education about the program to promote early identification, intervention, evaluation and
464	464	442monitoring; provided, however, that the outreach program required under this paragraph shall
465	465	443notify dentists and dental hygienists of the opportunity to apply directly with the department to
466	466	444participate in the program.
467	467	445 (c) A registered dentist or dental hygienist who requests to participate in the program
468	468	446shall cooperate with the individualized rehabilitation plan recommended by the program. The
469	469	447program director employed pursuant to subsection (e) of section 65G may report to the board: (i)
470	470	448information concerning a participant in the program; (ii) aggregate data on program compliance; 22 of 51
471	471	449and (iii) the name and license number of a registered dentist or dental hygienist who fails to
472	472	450comply with an individualized remediation plan.
473	473	451 (d) Upon admission of a dentist or dental hygienist into the program, the board may
474	474	452dismiss any pending investigation or complaint against the participant that arises from or relates
475	475	453to the participant’s mental health or substance use. The board may change the participant’s
476	476	454publicly-available license status to reflect the existence of non-disciplinary restrictions or
477	477	455conditions. The board may immediately suspend the participant’s license as is necessary to
478	478	456protect the public health, safety and welfare upon receipt of notice that the participant has
479	479	457withdrawn or been terminated from the program before completion.
480	480	458 (e) The record of participation in the program shall not be a public record and shall be
481	481	459exempt from disclosure pursuant to clause Twenty-sixth of section 7 of chapter 4 and chapter 66.
482	482	460If a dentist or dental hygienist referred to the program by the board fails to complete the
483	483	461application process, the board may use information and documents in the record of participation
484	484	462as evidence in a disciplinary proceeding as necessary to protect public health, safety and welfare.
485	485	463In all other instances, the record of participation or application to the program shall be kept
486	486	464confidential and shall not be subject to subpoena or discovery in any civil, criminal, legislative or
487	487	465administrative proceeding without the prior written consent of the participant or applicant. Upon
488	488	466the determination by the rehabilitation evaluation committee established pursuant section 65G
489	489	467that a participant has successfully completed the program and their ability to safely practice their
490	490	468profession is not impaired or affected by their mental health or substance use, the department, the
491	491	469program, the rehabilitation evaluation committee and the board, if applicable, shall seal all
492	492	470records pertaining to the participant's participation in the program. The records of participation of 23 of 51
493	493	471participants who successfully complete the program shall be destroyed 3 years following the date
494	494	472of successful completion.
495	495	473 SECTION 13. Said chapter 112 is hereby further amended by inserting after section 162
496	496	474the following section:-
497	497	475 Section 162A. (a) For the purposes of this section, the following words shall, unless the
498	498	476context clearly requires otherwise, have the following meanings:
499	499	477 “Acupuncture detoxification specialist”, a qualified health care professional who is
500	500	478registered with the department to engage in the practice of auricular acupuncture detoxification
501	501	479pursuant to this section.
502	502	480 “Auricular acupuncture detoxification”, treatment by means of the subcutaneous insertion
503	503	481of sterile, disposable acupuncture needles in consistent, predetermined bilateral locations on the
504	504	482ear in accordance with the standardized auricular acupuncture detoxification protocol developed
505	505	483by the National Acupuncture Detoxification Association.
506	506	484 “General supervision”, supervision by phone or other electronic means during business
507	507	485hours with in-person site visits as deemed necessary by a licensed acupuncturist.
508	508	486 “Licensed acupuncturist”, an individual who is licensed under sections 148 to 162,
509	509	487inclusive, to practice as a licensed acupuncturist.
510	510	488 “National Acupuncture Detoxification Association training”, the most current
511	511	489standardized auricular acupuncture detoxification protocol training developed by the National
512	512	490Acupuncture Detoxification Association. 24 of 51
513	513	491 “Qualified health care professional”, a qualified individual who: (i) is a licensed
514	514	492physician, licensed psychologist, licensed independent clinical social worker, licensed clinical
515	515	493social worker, licensed mental health counselor, licensed psychiatric clinical nurse specialist,
516	516	494certified addictions registered nurse, licensed alcohol and drug counselor I or licensed alcohol
517	517	495and drug counselor II as defined in section 1 of chapter 111J, certified alcohol and drug abuse
518	518	496counselor or certified alcohol and drug abuse counselor II as certified by the Massachusetts
519	519	497Board of Substance Abuse Counselor Certification or an equivalent certifying body or a
520	520	498registered nurse or nurse practitioner certified by the board of registration in nursing pursuant to
521	521	499this chapter; and (ii) has received training and a certificate of completion from the National
522	522	500Acupuncture Detoxification Association or from a state-recognized organization or agency that
523	523	501meets or exceeds the National Acupuncture Detoxification Association training standards to
524	524	502engage in the practice of auricular acupuncture detoxification protocol for the treatment of
525	525	503substance use disorder, mental and behavioral health conditions and trauma.
526	526	504 (b)(1) An individual who is not a licensed acupuncturist shall not engage in the practice
527	527	505of the auricular acupuncture detoxification or represent themself as an acupuncture detoxification
528	528	506specialist unless the individual: (i) has been issued: (A) an approved registration by the
529	529	507department to practice auricular acupuncture detoxification in accordance with this section; or
530	530	508(B) a license or certificate in another state with requirements that are at least equivalent to the
531	531	509requirements of this section, as determined by the commissioner; and (ii) has been trained in the
532	532	510standardized auricular acupuncture detoxification protocol in accordance with the National
533	533	511Acupuncture Detoxification Association training or an equivalent training certificate by a state-
534	534	512recognized organization. 25 of 51
535	535	513 (2) To engage in the practice of auricular acupuncture detoxification within the
536	536	514individual’s designated lawful scope of practice, a qualified health care professional shall file an
537	537	515application to register as an acupuncture detoxification specialist with the department, in a form
538	538	516determined by the department. Each application may be accompanied by the payment of a fee to
539	539	517be determined by the department.
540	540	518 (3) The applicant seeking to practice auricular acupuncture detoxification shall, at a
541	541	519minimum, furnish proof of: (i) relevant licensure or certification as a qualified health care
542	542	520professional; and (ii) completion of the National Acupuncture Detoxification Association
543	543	521training or an equivalent training certificate by a state-recognized organization; provided,
544	544	522however, that an applicant who is registered or certified in another state with requirements that
545	545	523are at least equivalent to the requirements of this section, as determined by the commissioner,
546	546	524shall be allowed to practice auricular acupuncture detoxification in accordance with this section.
547	547	525A registration issued under this section shall be valid for 2 years and subject to renewal as
548	548	526determined by the department.
549	549	527 (c) Auricular acupuncture detoxification shall only be performed by a licensed
550	550	528acupuncturist or a qualified health care professional within their designated lawful scope of
551	551	529practice for the purpose of providing integrated health care delivery interventions in substance
552	552	530use disorder treatment and wellness promotion including, but not limited to, treating mental and
553	553	531behavioral health conditions or trauma.
554	554	532 (d) A qualified health care professional registered in accordance with this section shall
555	555	533only practice under the general supervision of a licensed acupuncturist; provided, however, that
556	556	534no such individual shall use the title acupuncturist or otherwise represent themself or imply that 26 of 51
557	557	535they are a licensed acupuncturist and shall not perform or practice acupuncture outside of the
558	558	536scope of the auricular acupuncture detoxification as defined in this section.
559	559	537 (e) Nothing in this chapter shall prohibit, limit, interfere with or prevent a qualified health
560	560	538care professional from practicing or performing auricular acupuncture detoxification if the
561	561	539individual is acting within the lawful scope of practice in accordance with the individual’s
562	562	540license and the auricular acupuncture detoxification is performed in: (i) a private, freestanding
563	563	541facility licensed by the department that provides care or treatment for individuals with substance
564	564	542use disorders or other addictive disorders; (ii) a facility under the direction and supervision of the
565	565	543department of mental health; (iii) a setting approved or licensed by the department of mental
566	566	544health; or (iv) any other setting where auricular acupuncture detoxification is an appropriate
567	567	545adjunct therapy to a substance use disorder or behavioral health treatment program; provided,
568	568	546however, that individual or 1-on-1 appointments with a health care provider shall occur within a
569	569	547setting permissible under this subsection.
570	570	548 (f) Nothing in this chapter shall prohibit, limit, interfere with or prevent a licensed
571	571	549physician or acupuncturist from practicing or performing auricular acupuncture detoxification if
572	572	550the licensed physician or acupuncturist is acting within the lawful scope of practice in
573	573	551accordance with their license.
574	574	552 (g) The commissioner may promulgate regulations to implement this section.
575	575	553 SECTION 14. Chapter 118E of the General Laws is hereby amended by inserting after
576	576	554section 10W the following 2 sections:-
577	577	555 Section 10X. (a) The division and its contracted health insurers, health plans, health
578	578	556maintenance organizations, behavioral health management firms and third-party administrators 27 of 51
579	579	557under contract to a Medicaid managed care organization, accountable care organization or
580	580	558primary care clinician plan shall provide coverage for prescribed, ordered or dispensed opioid
581	581	559antagonists, as defined in section 19B of chapter 94C and used in the reversal of overdoses
582	582	560caused by opioids; provided, however, that the coverage for such prescribed, ordered or
583	583	561dispensed opioid antagonists shall not require prior authorization; and provided further, that a
584	584	562prescription from a health care practitioner shall not be required for coverage or reimbursement
585	585	563of opioid antagonists under this section. An opioid antagonist used in the reversal of overdoses
586	586	564caused by opioids shall not be subject to any deductible, coinsurance, copayments or out-of-
587	587	565pocket limits.
588	588	566 (b) The division and its contracted health insurers, health plans, health maintenance
589	589	567organizations, behavioral health management firms and third-party administrators under contract
590	590	568to a Medicaid managed care organization, accountable care organization or primary care
591	591	569clinician plan shall provide coverage and reimbursement for an opioid antagonist used in the
592	592	570reversal of overdoses caused by opioids as a medical benefit when dispensed by the health care
593	593	571facility in which the opioid antagonist was prescribed or ordered and shall provide coverage as a
594	594	572pharmacy benefit for an opioid antagonist used in the reversal of overdoses caused by opioids
595	595	573dispensed by a pharmacist, including an opioid antagonist dispensed pursuant to section 19B of
596	596	574chapter 94C; provided, however, that the rate to be reimbursed under the medical benefit shall
597	597	575not exceed the carrier’s average in-network pharmacy benefit rate and the health care facility
598	598	576shall not balance bill the patient.
599	599	577 Section 10Y. The division and its contracted health insurers, health plans, health
600	600	578maintenance organizations, behavioral health management firms and third-party administrators
601	601	579under contract to a Medicaid managed care organization, accountable care organization or 28 of 51
602	602	580primary care clinician plan shall provide coverage for the provision of services by a recovery
603	603	581coach licensed or otherwise authorized to practice pursuant to chapter 111J, regardless of the
604	604	582setting in which these services are provided; provided, however, that such services shall be
605	605	583within the lawful scope of practice of a recovery coach. The benefits in this section shall not be
606	606	584subject to any deductible, coinsurance, copayments or out-of-pocket limits. Recovery coach
607	607	585services shall not require prior authorization.
608	608	586 SECTION 15. Subsection (a) of section 51A of chapter 119 of the General Laws, as
609	609	587appearing in the 2022 Official Edition, is hereby amended by striking out the first paragraph and
610	610	588inserting in place thereof the following paragraph:-
611	611	589 A mandated reporter shall immediately communicate with the department orally and
612	612	590shall, within 48 hours, file a written report with the department detailing suspected abuse or
613	613	591neglect if, in their professional capacity, they have reasonable cause to believe that a child is: (i)
614	614	592suffering physical or emotional injury resulting from abuse inflicted upon them which causes
615	615	593harm or substantial risk of harm to the child’s health or welfare including, but not limited to,
616	616	594sexual abuse; (ii) suffering physical or emotional injury resulting from neglect including, but not
617	617	595limited to, malnutrition; (iii) a sexually exploited child; or (iv) a human trafficking victim, as
618	618	596defined by section 20M of chapter 233; provided, however, that an indication of prenatal
619	619	597substance exposure shall not solely meet the requirements of this section.
620	620	598 SECTION 16. Section 35 of chapter 123 of the General Laws, as so appearing, is hereby
621	621	599amended by inserting after the definition of “Facility” the following definition:-
622	622	600 “Secure facility”, a facility that provides care and treatment for a person with alcohol or
623	623	601substance use disorder funded, controlled or administered by a county sheriff or a facility so 29 of 51
624	624	602designated by the department of public health or the department of mental health that provides a
625	625	603comparable level of security.
626	626	604 SECTION 17. Said section 35 of said chapter 123, as so appearing, is hereby further
627	627	605amended by striking out the fourth to sixth paragraphs, inclusive, and inserting in place thereof
628	628	606the following 3 paragraphs:-
629	629	607 The secretary of health and human services shall ensure an adequate supply of suitable
630	630	608beds for the treatment of alcohol or substance use disorders at facilities licensed or approved by
631	631	609the department of public health or the department of mental health for persons ordered to be
632	632	610committed under this section.
633	633	611 If the department of public health informs the court that there are no suitable facilities
634	634	612available for treatment licensed or approved by the department of public health or the department
635	635	613of mental health, or if the court makes a specific finding that the only appropriate setting for
636	636	614treatment for the person is a secure facility, the person may be committed to a secure facility
637	637	615licensed or approved by the department of public health or the department of mental health;
638	638	616provided, however, that any person so committed shall be housed and treated separately from
639	639	617persons currently serving a criminal sentence.
640	640	618 A person committed under this section shall, upon release, be encouraged to consent to
641	641	619further treatment and shall be allowed voluntarily to remain in the facility or the secure facility
642	642	620for such purpose. The department of public health shall maintain a roster of facilities and secure
643	643	621facilities available, together with the number of beds currently available and the level of security
644	644	622at each facility, for the care and treatment of alcohol use disorder and substance use disorder and
645	645	623shall make the roster available to the trial court. 30 of 51
646	646	624 SECTION 18. Said section 35 of said chapter 123, as so appearing, is hereby further
647	647	625amended by inserting after the word “facility”, in line 133, the following words:- or secure
648	648	626facility.
649	649	627 SECTION 19. Section 1 of chapter 151B of the General Laws, as so appearing, is hereby
650	650	628amended by striking out subsection 17 and inserting in place thereof the following subsection:-
651	651	629 17. The term “handicap” means: (a) a physical or mental impairment which substantially
652	652	630limits 1 or more major life activities of a person; (b) a record of having such impairment; (c)
653	653	631being regarded as having such impairment; or (d) the lawful possession and clinically
654	654	632appropriate taking of any medication that is: (i) approved by the United States Food and Drug
655	655	633Administration for the treatment of an opioid-related substance use disorder, including, but not
656	656	634limited to, an opioid agonist or a partial opioid agonist and used for the treatment of an opioid-
657	657	635related substance use disorder; (ii) obtained directly or pursuant to a valid prescription or order
658	658	636from a practitioner, as defined in section 1 of chapter 94C; (iii) determined to be medically
659	659	637necessary by a practitioner while acting in the course of professional practice; and (iv) offered in
660	660	638accordance with a treatment plan that is reviewed by a practitioner at a frequency consistent with
661	661	639appropriate clinical standards; provided, however, that the term “handicap” shall not include
662	662	640current, illegal use of a controlled substance, as defined in said section 1 of said chapter 94C. For
663	663	641the purposes of this subsection, the words “clinically appropriate” shall mean the taking of a
664	664	642prescribed medication for the treatment of an opioid-related substance use disorder when such
665	665	643drug is medically indicated and intake is proportioned to the medical need.
666	666	644 SECTION 20. Chapter 175 of the General Laws is hereby amended by striking out
667	667	645section 47KK, as so appearing, and inserting in place thereof the following section:- 31 of 51
668	668	646 Section 47KK. (a) A policy, contract, agreement, plan or certificate of insurance issued,
669	669	647delivered or renewed within the commonwealth, which is considered creditable coverage under
670	670	648section 1 of chapter 111M, shall develop a plan to provide adequate coverage and access to a
671	671	649broad spectrum of pain management services, including, but not limited to, non-medication,
672	672	650nonsurgical treatment modalities and non-opioid medication treatment options that serve as
673	673	651alternatives to opioid prescribing, in accordance with guidelines developed by the division of
674	674	652insurance.
675	675	653 (b) No such policy, contract, agreement, plan or certificate of insurance shall, relative to
676	676	654pain management services identified by the carrier pursuant to subsection (a), require a member
677	677	655to obtain prior authorization for non-medication, nonsurgical treatment modalities that include
678	678	656restorative therapies, behavioral health approaches or integrative health therapies, including
679	679	657acupuncture, chiropractic treatments, massage and movement therapies.
680	680	658 (c)(1) The plan developed pursuant to subsection (a) shall be subject to approval by the
681	681	659division of insurance and shall be a component of carrier accreditation by the division pursuant
682	682	660to section 2 of chapter 176O. In its review, the division shall consider the adequacy of access to a
683	683	661broad spectrum of pain management services and any carrier policies that may create unduly
684	684	662preferential coverage to prescribing opioids without other pain management modalities.
685	685	663 (2) No policy, contract, agreement, plan or certificate of insurance issued, delivered or
686	686	664renewed within the commonwealth, which is considered creditable coverage under section 1 of
687	687	665chapter 111M, shall establish utilization controls, including prior authorization or step therapy
688	688	666requirements, for clinically appropriate non-opioid drugs approved by the United States Food
689	689	667and Drug Administration for the treatment or management of pain, that are more restrictive or 32 of 51
690	690	668extensive than the least restrictive or extensive utilization controls applicable to any clinically
691	691	669appropriate opioid drug.
692	692	670 (d) Carriers shall annually distribute educational materials to providers within their
693	693	671networks and to members about the pain management access plans developed pursuant to
694	694	672subsection (a) and shall make information about the plans publicly available on their websites.
695	695	673 SECTION 21. Said chapter 175 is hereby further amended by inserting after section
696	696	67447ZZ the following 2 sections:-
697	697	675 Section 47AAA. (a) A policy, contract, agreement, plan or certificate of insurance issued,
698	698	676delivered or renewed within the commonwealth, which is considered creditable coverage under
699	699	677section 1 of chapter 111M, shall provide coverage for prescribed, ordered or dispensed opioid
700	700	678antagonists, as defined in section 19B of chapter 94C and used in the reversal of overdoses
701	701	679caused by opioids; provided, however, that the coverage for such prescribed, ordered or
702	702	680dispensed opioid antagonists shall not require prior authorization; and provided further, that a
703	703	681prescription from a health care practitioner shall not be required for coverage or reimbursement
704	704	682of opioid antagonists under this section. An opioid antagonist used in the reversal of overdoses
705	705	683caused by opioids shall not be subject to any deductible, coinsurance, copayments or out-of-
706	706	684pocket limits; provided, however, that cost-sharing shall be required if the applicable plan is
707	707	685governed by the federal Internal Revenue Code and would lose its tax-exempt status as a result
708	708	686of the prohibition on cost-sharing for this service.
709	709	687 (b) The policy, contract, agreement, plan or certificate of insurance shall provide
710	710	688coverage and reimbursement for an opioid antagonist used in the reversal of overdoses caused by
711	711	689opioids as a medical benefit when dispensed by the health care facility in which the opioid 33 of 51
712	712	690antagonist was prescribed or ordered and shall provide coverage as a pharmacy benefit for an
713	713	691opioid antagonist used in the reversal of overdoses caused by opioids dispensed by a pharmacist,
714	714	692including an opioid antagonist dispensed pursuant to section 19B of chapter 94C; provided,
715	715	693however, that the rate to be reimbursed under the medical benefit shall not exceed the carrier’s
716	716	694average in-network pharmacy benefit rate and the health care facility shall not balance bill the
717	717	695patient.
718	718	696 Section 47BBB. A policy, contract, agreement, plan or certificate of insurance issued,
719	719	697delivered or renewed within the commonwealth, which is considered creditable coverage under
720	720	698section 1 of chapter 111M, shall provide coverage for the provision of services by a recovery
721	721	699coach licensed or otherwise authorized to practice under chapter 111J, regardless of the setting in
722	722	700which these services are provided; provided, however, that such services shall be within the
723	723	701lawful scope of practice of a recovery coach. The contractual rate for these services shall be not
724	724	702less than the prevailing MassHealth rate for recovery coach services. The benefits in this section
725	725	703shall not be subject to any deductible, coinsurance, copayments or out-of-pocket limits;
726	726	704provided, however, that cost-sharing shall be required if the applicable plan is governed by the
727	727	705federal Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition
728	728	706on cost-sharing for this service. Recovery coach services shall not require prior authorization.
729	729	707 SECTION 22. Said chapter 175 is hereby further amended by inserting after section
730	730	708122A the following section:-
731	731	709 Section 122B. (a) No insurer authorized to issue policies on the lives of persons in the
732	732	710commonwealth shall make a distinction or otherwise discriminate between persons, reject an
733	733	711applicant, cancel a policy or demand or require a higher rate of premium for reasons based solely 34 of 51
734	734	712upon the fact that an applicant or insured has or had a prescription for, purchased or otherwise
735	735	713possessed an opioid antagonist, as defined in section 19B of chapter 94C.
736	736	714 (b) A violation of this section shall constitute an unfair method of competition or unfair
737	737	715and deceptive act or practice pursuant to chapters 93A and 176D.
738	738	716 SECTION 23. Section 193U of said chapter 175, as appearing in the 2022 Official
739	739	717Edition, is hereby amended by inserting after the word “that”, in line 17, following words:- the
740	740	718health care provider provides services at a harm reduction program or.
741	741	719 SECTION 24. Chapter 176A of the General Laws is hereby amended by striking out
742	742	720section 8MM, as so appearing, and inserting in place thereof the following section:-
743	743	721 Section 8MM. (a) A contract between a subscriber and the corporation under an
744	744	722individual or group hospital service plan that is delivered, issued or renewed within the
745	745	723commonwealth shall develop a plan to provide adequate coverage and access to a broad
746	746	724spectrum of pain management services, including, but not limited to, non-medication,
747	747	725nonsurgical treatment modalities and non-opioid medication treatment options that serve as
748	748	726alternatives to opioid prescribing, in accordance with guidelines developed by the division of
749	749	727insurance.
750	750	728 (b) No such contract shall, relative to pain management services identified by the carrier
751	751	729pursuant to subsection (a), require a member to obtain prior authorization for non-medication,
752	752	730nonsurgical treatment modalities that include restorative therapies, behavioral health approaches
753	753	731or integrative health therapies, including acupuncture, chiropractic treatments, massage and
754	754	732movement therapies. 35 of 51
755	755	733 (c)(1) The plan developed pursuant to subsection (a) shall be subject to approval by the
756	756	734division of insurance and shall be a component of carrier accreditation by the division pursuant
757	757	735to section 2 of chapter 176O. In its review, the division shall consider the adequacy of access to a
758	758	736broad spectrum of pain management services and any carrier policies that may create unduly
759	759	737preferential coverage to prescribing opioids without other pain management modalities.
760	760	738 (2) No contract between a subscriber and the corporation under an individual or group
761	761	739hospital service plan that is delivered, issued or renewed within the commonwealth shall
762	762	740establish utilization controls, including prior authorization or step therapy requirements, for
763	763	741clinically appropriate non-opioid drugs approved by the United States Food and Drug
764	764	742Administration for the treatment or management of pain, that are more restrictive or extensive
765	765	743than the least restrictive or extensive utilization controls applicable to any clinically appropriate
766	766	744opioid drug.
767	767	745 (d) Carriers shall annually distribute educational materials to providers within their
768	768	746networks and to members about the pain management access plans developed pursuant to
769	769	747subsection (a) and shall make information about the plans publicly available on their websites.
770	770	748 SECTION 25. Said chapter 176A is hereby further amended by inserting after section
771	771	7498AAA the following 2 sections:-
772	772	750 Section 8BBB. (a) Any contract between a subscriber and the corporation under an
773	773	751individual or group hospital service plan that is delivered, issued or renewed within the
774	774	752commonwealth shall provide coverage for prescribed, ordered or dispensed opioid antagonists,
775	775	753as defined in section 19B of chapter 94C and used in the reversal of overdoses caused by
776	776	754opioids; provided, however, that the coverage for such prescribed, ordered or dispensed opioid 36 of 51
777	777	755antagonists shall not require prior authorization; and provided further, that a prescription from a
778	778	756health care practitioner shall not be required for coverage or reimbursement of opioid antagonists
779	779	757under this section. An opioid antagonist used in the reversal of overdoses caused by opioids shall
780	780	758not be subject to any deductible, coinsurance, copayments or out-of-pocket limits; provided,
781	781	759however, that cost-sharing shall be required if the applicable plan is governed by the federal
782	782	760Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on cost-
783	783	761sharing for this service.
784	784	762 (b) Such contracts shall provide coverage and reimbursement for an opioid antagonist
785	785	763used in the reversal of overdoses caused by opioids as a medical benefit when dispensed by the
786	786	764health care facility in which the opioid antagonist was prescribed or ordered and shall provide
787	787	765coverage as a pharmacy benefit for an opioid antagonist used in the reversal of overdoses caused
788	788	766by opioids dispensed by a pharmacist, including an opioid antagonist dispensed pursuant to
789	789	767section 19B of chapter 94C; provided, however, that the rate to be reimbursed under the medical
790	790	768benefit shall not exceed the carrier’s average in-network pharmacy benefit rate and the health
791	791	769care facility shall not balance bill the patient.
792	792	770 Section 8CCC. Any contract between a subscriber and the corporation under an
793	793	771individual or group hospital service plan that is delivered, issued or renewed within the
794	794	772commonwealth shall provide coverage for the provision of services by a recovery coach licensed
795	795	773or otherwise authorized to practice under chapter 111J, regardless of the setting in which these
796	796	774services are provided; provided, however, that such services shall be within the lawful scope of
797	797	775practice of a recovery coach. The contractual rate for these services shall be not less than the
798	798	776prevailing MassHealth rate for recovery coach services. The benefits in this section shall not be
799	799	777subject to any deductible, coinsurance, copayments or out-of-pocket limits; provided, however, 37 of 51
800	800	778that cost-sharing shall be required if the applicable plan is governed by the federal Internal
801	801	779Revenue Code and would lose its tax-exempt status as a result of the prohibition on cost-sharing
802	802	780for this service. Recovery coach services shall not require prior authorization.
803	803	781 SECTION 26. Chapter 176B of the General Laws is hereby amended by striking out
804	804	782section 4MM, as so appearing, and inserting in place thereof the following section:-
805	805	783 Section 4MM. (a) A subscription certificate under an individual or group medical service
806	806	784agreement delivered, issued or renewed within the commonwealth shall develop a plan to
807	807	785provide adequate coverage and access to a broad spectrum of pain management services,
808	808	786including, but not limited to, non-medication, nonsurgical treatment modalities and non-opioid
809	809	787medication treatment options that serve as alternatives to opioid prescribing, in accordance with
810	810	788guidelines developed by the division of insurance.
811	811	789 (b) No such subscription certificate shall, relative to pain management services identified
812	812	790by the carrier pursuant to subsection (a), require a member to obtain prior authorization for non-
813	813	791medication, nonsurgical treatment modalities that include restorative therapies, behavioral health
814	814	792approaches or integrative health therapies, including acupuncture, chiropractic treatments,
815	815	793massage and movement therapies.
816	816	794 (c)(1) The plan developed pursuant to subsection (a) shall be subject to approval by the
817	817	795division of insurance and shall be a component of carrier accreditation by the division pursuant
818	818	796to section 2 of chapter 176O. In its review, the division shall consider the adequacy of access to a
819	819	797broad spectrum of pain management services and any carrier policies that may create unduly
820	820	798preferential coverage to prescribing opioids without other pain management modalities. 38 of 51
821	821	799 (2) No subscription certificate under an individual or group medical service agreement
822	822	800delivered, issued or renewed within the commonwealth shall establish utilization controls,
823	823	801including prior authorization or step therapy requirements, for clinically appropriate non-opioid
824	824	802drugs approved by the United States Food and Drug Administration for the treatment or
825	825	803management of pain, that are more restrictive or extensive than the least restrictive or extensive
826	826	804utilization controls applicable to any clinically appropriate opioid drug.
827	827	805 (d) Carriers shall annually distribute educational materials to providers within their
828	828	806networks and to members about the pain management access plans developed pursuant to
829	829	807subsection (a) and shall make information about the plans publicly available on their websites.
830	830	808 SECTION 27. Said chapter 176B is hereby further amended by inserting after section
831	831	8094AAA the following 2 sections:-
832	832	810 Section 4BBB. (a) A subscription certificate under an individual or group medical service
833	833	811agreement delivered, issued or renewed within the commonwealth, shall provide coverage for
834	834	812prescribed, ordered or dispensed opioid antagonists, as defined in section 19B of chapter 94C
835	835	813and used in the reversal of overdoses caused by opioids; provided, however, that the coverage for
836	836	814such prescribed, ordered or dispensed opioid antagonists shall not require prior authorization;
837	837	815and provided further, that a prescription from a health care practitioner shall not be required for
838	838	816coverage or reimbursement of opioid antagonists under this section. An opioid antagonist used in
839	839	817the reversal of overdoses caused by opioids shall not be subject to any deductible, coinsurance,
840	840	818copayments or out-of-pocket limits; provided, however, that cost-sharing shall be required if the
841	841	819applicable plan is governed by the federal Internal Revenue Code and would lose its tax-exempt
842	842	820status as a result of the prohibition on cost-sharing for this service. 39 of 51
843	843	821 (b) The policy, contract, agreement, plan or certificate of insurance shall provide
844	844	822coverage and reimbursement for an opioid antagonist used in the reversal of overdoses caused by
845	845	823opioids as a medical benefit when dispensed by the health care facility in which the opioid
846	846	824antagonist was prescribed or ordered and shall provide coverage as a pharmacy benefit for an
847	847	825opioid antagonist used in the reversal of overdoses caused by opioids dispensed by a pharmacist,
848	848	826including an opioid antagonist dispensed pursuant to section 19B of chapter 94C; provided,
849	849	827however, that the rate to be reimbursed under the medical benefit shall not exceed the carrier’s
850	850	828average in-network pharmacy benefit rate and the health care facility shall not balance bill the
851	851	829patient.
852	852	830 Section 4CCC. Any subscription certificate under an individual or group medical service
853	853	831agreement delivered, issued or renewed within the commonwealth shall provide coverage for the
854	854	832provision of services by a recovery coach licensed or otherwise authorized to practice under
855	855	833chapter 111J, regardless of the setting in which these services are provided; provided, however,
856	856	834that such services shall be within the lawful scope of practice of a recovery coach. The
857	857	835contractual rate for these services shall be not less than the prevailing MassHealth rate for
858	858	836recovery coach services. The benefits in this section shall not be subject to any deductible,
859	859	837coinsurance, copayments or out-of-pocket limits; provided, however, that cost-sharing shall be
860	860	838required if the applicable plan is governed by the federal Internal Revenue Code and would lose
861	861	839its tax-exempt status as a result of the prohibition on cost-sharing for this service. Recovery
862	862	840coach services shall not require prior authorization.
863	863	841 SECTION 28. Chapter 176G of the General Laws is hereby amended by striking out
864	864	842section 4EE, as appearing in the 2022 Official Edition, and inserting in place thereof the
865	865	843following section:- 40 of 51
866	866	844 Section 4EE. (a) Any individual or group health maintenance contract that is issued or
867	867	845renewed within or without the commonwealth shall develop a plan to provide adequate coverage
868	868	846and access to a broad spectrum of pain management services, including, but not limited to, non-
869	869	847medication, nonsurgical treatment modalities and non-opioid medication treatment options that
870	870	848serve as alternatives to opioid prescribing, in accordance with guidelines developed by the
871	871	849division of insurance.
872	872	850 (b) No such contract shall, relative to pain management services identified by the carrier
873	873	851pursuant to subsection (a), require a member to obtain prior authorization for non-medication,
874	874	852nonsurgical treatment modalities that include restorative therapies, behavioral health approaches
875	875	853or integrative health therapies, including acupuncture, chiropractic treatments, massage, and
876	876	854movement therapies.
877	877	855 (c)(1) The plan developed pursuant to subsection (a) shall be subject to approval by the
878	878	856division of insurance and shall be a component of carrier accreditation by the division pursuant
879	879	857to section 2 of chapter 176O. In its review, the division shall consider the adequacy of access to a
880	880	858broad spectrum of pain management services and any carrier policies that may create unduly
881	881	859preferential coverage to prescribing opioids without other pain management modalities.
882	882	860 (2) No individual or group health maintenance contract that is issued or renewed within
883	883	861or without the commonwealth shall establish utilization controls, including prior authorization or
884	884	862step therapy requirements, for clinically appropriate non-opioid drugs approved by the United
885	885	863States Food and Drug Administration for the treatment or management of pain, that are more
886	886	864restrictive or extensive than the least restrictive or extensive utilization controls applicable to any
887	887	865clinically appropriate opioid drug. 41 of 51
888	888	866 (d) Carriers shall annually distribute educational materials to providers within their
889	889	867networks and to members about the pain management access plans developed pursuant to
890	890	868subsection (a) and shall make information about the plans publicly available on their websites.
891	891	869 SECTION 29. Said chapter 176G is hereby further amended by inserting after section
892	892	8704SS the following 2 sections:-
893	893	871 Section 4TT. (a) An individual or group health maintenance contract that is issued or
894	894	872renewed within or without the commonwealth shall provide coverage for prescribed, ordered or
895	895	873dispensed opioid antagonists, as defined in section 19B of chapter 94C and used in the reversal
896	896	874of overdoses caused by opioids; provided, however, that the coverage for such prescribed,
897	897	875ordered or dispensed opioid antagonists shall not require prior authorization; and provided
898	898	876further, that a prescription from a health care practitioner shall not be required for coverage or
899	899	877reimbursement of opioid antagonists under this section. An opioid antagonist used in the reversal
900	900	878of overdoses caused by opioids shall not be subject to any deductible, coinsurance, copayments
901	901	879or out-of-pocket limits; provided, however, that cost-sharing shall be required if the applicable
902	902	880plan is governed by the federal Internal Revenue Code and would lose its tax-exempt status as a
903	903	881result of the prohibition on cost-sharing for this service.
904	904	882 (b) The individual or group health maintenance contract shall provide coverage and
905	905	883reimbursement for an opioid antagonist used in the reversal of overdoses caused by opioids as a
906	906	884medical benefit when dispensed by the health care facility in which the opioid antagonist was
907	907	885prescribed or ordered and shall provide coverage as a pharmacy benefit for an opioid antagonist
908	908	886used in the reversal of overdoses caused by opioids dispensed by a pharmacist, including an
909	909	887opioid antagonist dispensed pursuant to section 19B of chapter 94C; provided, however, that the 42 of 51
910	910	888rate to be reimbursed under the medical benefit shall not exceed the carrier’s average in-network
911	911	889pharmacy benefit rate and the health care facility shall not balance bill the patient.
912	912	890 Section 4UU. An individual or group health maintenance contract that is issued or
913	913	891renewed within or without the commonwealth shall provide coverage for the provision of
914	914	892services by a recovery coach licensed or otherwise authorized to practice under chapter 111J,
915	915	893regardless of the setting in which these services are provided; provided, however, that such
916	916	894services shall be within the lawful scope of practice of a recovery coach. The contractual rate for
917	917	895these services shall be not less than the prevailing MassHealth rate for recovery coach services.
918	918	896The benefits in this section shall not be subject to any deductible, coinsurance, copayments or
919	919	897out-of-pocket limits; provided, however, that cost-sharing shall be required if the applicable plan
920	920	898is governed by the federal Internal Revenue Code and would lose its tax-exempt status as a result
921	921	899of the prohibition on cost-sharing for this service. Recovery coach services shall not require prior
922	922	900authorization.
923	923	901 SECTION 30. (a) Notwithstanding any general or special law to the contrary, the
924	924	902Massachusetts alcohol and substance abuse center, hereinafter referred to as the center, shall be
925	925	903considered a secure facility under section 35 of chapter 123 of the General Laws for the purposes
926	926	904of commitments under said section 35 of said chapter 123 until December 31, 2026 or such time
927	927	905as the secretary of health and human services determines there is an adequate supply of beds
928	928	906pursuant to subsection (b).
929	929	907 (b) The secretary of health and human services shall develop a plan to end operations at
930	930	908the center as a secure facility accepting persons committed for treatment for alcohol or substance
931	931	909use disorder by not later than December 31, 2026; provided, however, that persons may continue 43 of 51
932	932	910to be committed to the center until the department of public health or the department of mental
933	933	911health have identified, licensed or approved facilities with sufficient capacity to ensure an
934	934	912adequate supply of beds for the treatment of individuals committed under said section 35 of said
935	935	913chapter 123. In developing the plan, the secretary shall consider geographic distribution of
936	936	914facilities when identifying, licensing or approving facilities.
937	937	915 (c) The secretary shall submit the plan required under subsection (b) to the clerks of the
938	938	916senate and house of representatives and to the joint committee on mental health, substance use
939	939	917and recovery not later than 180 days after the effective date of this act. The secretary shall submit
940	940	918interim reports quarterly detailing the progress towards ending operations at the center to the
941	941	919clerks of the senate and house of representatives and to the joint committee on mental health,
942	942	920substance use and recovery. The quarterly reports shall include, but shall not be limited to the
943	943	921following: (i) a census of persons being treated at the center; (ii) the number of persons
944	944	922transferred from the center to other facilities licensed or approved by the department of public
945	945	923health or department of mental health; (iii) the location and bed capacity of each newly licensed
946	946	924or approved facility or existing facility that increases capacity; (iv) the type of facility and
947	947	925location of newly committed persons under section 35 of chapter 123 of the General Laws since
948	948	926the most recent quarterly report; and (v) the anticipated fiscal impact, if any, of complying with
949	949	927this section.
950	950	928 SECTION 31. (a) The department of public health shall study alcohol and drug free
951	951	929housing, as defined in section 18A of chapter 17 of the Generals Laws, commonly known as
952	952	930sober homes in the commonwealth, including the safety and recovery of sober home residents.
953	953	931The study shall include, but not be limited to: (i) appropriate training for operators and staff of
954	954	932sober homes and whether such training should be required; (ii) evidence-based methods for 44 of 51
955	955	933creating safe and health recovery environments; (iii) current oversight and additional oversight
956	956	934needed for sober homes; (iv) barriers to sober home facility improvements, including, but not
957	957	935limited to, fiscal constraints; and (v) different aspects, if any, between certified and noncertified
958	958	936sober homes. The department shall hold at least 1 public hearing as part of its study under this
959	959	937section.
960	960	938 (b) The department shall submit a report detailing the results of the study, along with
961	961	939recommendations and any proposed legislation necessary to carry out its recommendations, to
962	962	940the clerks of the senate and house of representatives, the joint committee on health care
963	963	941financing, the joint committee on public health, the joint committee on mental health, substance
964	964	942use and recovery and the senate and house committees on ways and means not later than July 31,
965	965	9432025.
966	966	944 SECTION 32. The bureau of substance addiction services within the department of
967	967	945public health shall conduct a comprehensive review of barriers to certification, credentialing and
968	968	946other employment and practice requirements of recovery coaches, including, but not limited to,
969	969	947peer support specialists, peer recovery coaches and recovery support navigators, and issue a
970	970	948report on its findings. The report shall include, but shall not be limited to: (i) cost barriers for
971	971	949individuals with lived experience as defined in section 1 of chapter 111J of the General Laws,
972	972	950including, but not limited to, application and examination fees for initial certification and
973	973	951credentialing; (ii) cost barriers to certification and credentialing renewals; (iii) cost and
974	974	952reimbursement barriers for hospitals and clinics licensed under chapter 111 of the General Laws
975	975	953and other employers to hire, train and retain recovery coaches, including, but not limited to, peer
976	976	954support specialists, peer recovery coaches and recovery support navigators; (iv) eligibility
977	977	955requirements for certification and credentialing; (v) access to training programs and resources; 45 of 51
978	978	956(vi) any additional barriers to obtaining and maintaining authorization to practice recovery
979	979	957coaching; and (vii) recommendations to address said barriers. The bureau shall submit a copy of
980	980	958the report to the secretary of health and human services, the clerks of the house of representatives
981	981	959and the senate and the joint committee on mental health, substance use and recovery within 90
982	982	960days after the effective date of this act.
983	983	961 SECTION 33. (a) The bureau of substance addiction services within the department of
984	984	962public health shall review and study the disparate impacts and disparities of substance use
985	985	963disorder, overdoses, overdose deaths and clinical outcomes for members of historically
986	986	964marginalized communities, including, but not limited to, impacts based on race, ethnicity,
987	987	965language, gender, gender identity, sexual orientation, age, disability and other social
988	988	966determinants of health as identified by the bureau.
989	989	967 (b) The bureau shall: (i) review current data and trends regarding substance use and
990	990	968overdose rates, disparities in treatment access and corresponding causes within historically
991	991	969marginalized communities; (ii) evaluate the effectiveness of current treatment interventions
992	992	970within historically marginalized communities; (iii) identify barriers to accessing treatment,
993	993	971including, but not limited to, access to necessary resources, education and access to appropriate
994	994	972care and interventions; and (iv) identify evidence-based strategies to reduce overdose deaths and
995	995	973improve access, treatment and education within historically marginalized communities.
996	996	974 (c) Not later than June 30, 2025, the bureau shall submit a report of its findings and any
997	997	975recommendations, including any legislative or regulatory changes that may be necessary to carry
998	998	976out such recommendations, to the clerks of the house of representatives and the senate, the joint 46 of 51
999	999	977committee on mental health, substance use and recovery and the joint committee on racial equity,
1000	1000	978civil rights, and inclusion.
1001	1001	979 SECTION 34. (a) For the purposes of this section, the words “administrative discharge”
1002	1002	980shall mean the termination of treatment of a patient determined by a health care provider to have
1003	1003	981a substance use disorder and related treatment needs despite a lack of clinical improvement in the
1004	1004	982patient due to a violation of an administrative rule of a licensed substance use disorder treatment
1005	1005	983program.
1006	1006	984 (b) The bureau of substance addiction services within the department of public health
1007	1007	985shall study the circumstances and effects of administrative discharges of patients from substance
1008	1008	986use disorder treatment programs licensed under sections 6 and 6A of chapter 111B of the
1009	1009	987General Laws or section 7 of chapter 111E of the General Laws or programs established
1010	1010	988pursuant to sections 24 and 24D of chapter 90 of the General Laws.
1011	1011	989 (c) The bureau shall examine: (i) standards used by substance use disorder treatment
1012	1012	990programs in determining when an administrative discharge is appropriate, including, but not
1013	1013	991limited to, any standard criteria, methodology or graduated sanctions based on staff and patient
1014	1014	992safety and the level of treatment and severity of the symptoms of the patient; (ii) options for
1015	1015	993patients following an administrative discharge from a substance use disorder treatment program,
1016	1016	994including, but not limited to, any programs or resources available to a patient and the frequency
1017	1017	995with which such options are provided to said patients; and (iii) the applicability, availability and
1018	1018	996effectiveness of regulations relative to the coordination of care and management of discharge
1019	1019	997planning for an administrative discharge pursuant to 105 CMR 164 and section 19 of chapter 17
1020	1020	998of the General Laws. 47 of 51
1021	1021	999 (d) Not later than December 31, 2025, the bureau shall submit its findings and any
1022	1022	1000recommendations, including any legislative or regulatory changes that may be necessary to
1023	1023	1001implement any recommendations, with the clerks of the house of representatives and senate, the
1024	1024	1002house and senate committees on ways and means and the joint committee on mental health,
1025	1025	1003substance use and recovery.
1026	1026	1004 SECTION 35. (a) The bureau of substance addiction services within the department of
1027	1027	1005public health shall conduct a study on the potential benefits of expanding collaborative practice
1028	1028	1006agreements between physicians and pharmacists to allow for the prescription of schedules II to
1029	1029	1007VI, inclusive, controlled substances by pharmacists outside of the hospital or other health care
1030	1030	1008setting to treat patients with substance use disorders.
1031	1031	1009 (b) The bureau shall study and report on: (i) collaborative practice agreements between
1032	1032	1010physicians and pharmacists for the prescription of substances in collaborative practice
1033	1033	1011agreements in other states; and (ii) the positive and negative impacts of allowing a collaborative
1034	1034	1012practice agreement for schedules II to VI, inclusive, controlled substances.
1035	1035	1013 (c) The bureau shall submit a report detailing the results of the study, along with its
1036	1036	1014recommendations and any proposed legislation necessary to carry out its recommendations, to
1037	1037	1015the clerks of the senate and house of representatives, the joint committee on mental health,
1038	1038	1016substance use and recovery, the joint committee on public health and the senate and house
1039	1039	1017committees on ways and means not later than June 30, 2025.
1040	1040	1018 SECTION 36. (a) There shall be a special commission to study and make
1041	1041	1019recommendations on ways to address the public health and safety concerns posed by the
1042	1042	1020proliferation of xylazine as an additive to illicit drugs, including, but not limited to, fentanyl. 48 of 51
1043	1043	1021 (b) The commission shall consist of: the chairs of the joint committee on mental health,
1044	1044	1022substance use and recovery, who shall serve as co-chairs; 1 member appointed by the speaker of
1045	1045	1023the house of representatives; 1 member appointed by the minority leader of the house of
1046	1046	1024representatives; 1 member appointed by the senate president; 1 member appointed by the
1047	1047	1025minority leader of the senate; the secretary of health and human services or a designee; the
1048	1048	1026commissioner of public health or a designee; the commissioner of mental health or a designee;
1049	1049	1027the secretary of public safety and security or a designee; 1 member who shall be a representative
1050	1050	1028of the bureau of substance addiction services within the department of public health; 1 member
1051	1051	1029who shall be a representative of the Massachusetts Veterinary Medical Association; and 1
1052	1052	1030member appointed by the governor who shall be a registered nurse or licensed physician with
1053	1053	1031experience in treating patients for substance use disorder.
1054	1054	1032 (c) The commission shall consider: (i) best practices to regulate and oversee the
1055	1055	1033production and distribution of xylazine to ensure that it is used solely for its intended purpose as
1056	1056	1034an animal tranquilizer administered by licensed veterinarians and not for human consumption;
1057	1057	1035(ii) whether xylazine should be classified as a controlled substance and appropriate penalties for
1058	1058	1036its illegal production and distribution; (iii) the availability of effective outreach and treatment
1059	1059	1037programs for patients who have been exposed to xylazine and ways to address any gaps in
1060	1060	1038available programs and services; and (iv) any other considerations determined to be relevant by
1061	1061	1039the commission.
1062	1062	1040 (d) The commission shall file a report and its recommendations, including any legislation
1063	1063	1041necessary to implement its recommendations, with the clerks of the house of representatives and
1064	1064	1042the senate not later than June 30, 2025. 49 of 51
1065	1065	1043 SECTION 37. (a) There shall be a special commission to study prescribing practices for
1066	1066	1044benzodiazepines and non-benzodiazepine hypnotics.
1067	1067	1045 (b) The commission shall meet not less than 4 times and shall invite the public and
1068	1068	1046medical experts in the field to offer testimony. The commission shall study and make
1069	1069	1047recommendations on topics including but not limited to: (i) current and best prescribing practices
1070	1070	1048for benzodiazepines and non-benzodiazepine hypnotics; (ii) proper labeling of benzodiazepines
1071	1071	1049and non-benzodiazepine hypnotics; and (iii) protocols to safely discontinue the use of
1072	1072	1050benzodiazepines and non-benzodiazepine hypnotics and minimize the patient’s symptoms of
1073	1073	1051withdrawal.
1074	1074	1052 (c) The commission shall consist of: the commissioner of public health or a designee,
1075	1075	1053who shall serve as chair; the secretary of health and human services or a designee; the director of
1076	1076	1054the bureau of substance addiction services or a designee; and 4 members to be appointed by the
1077	1077	1055governor, 1 of whom shall be a psychiatrist licensed to practice in the commonwealth, 1 of
1078	1078	1056whom shall be a representative from the Center for Addiction Medicine at Massachusetts
1079	1079	1057General Hospital, 1 of whom shall be a licensed clinician specializing in substance use disorder
1080	1080	1058and 1 of whom shall be an advocate from the substance use disorder treatment community.
1081	1081	1059 (d) The commission shall report its findings and recommendations, including any
1082	1082	1060proposed legislation, to the clerks of the senate and the house of representatives, the joint
1083	1083	1061committee on mental health, substance use and recovery and the senate and house committees on
1084	1084	1062ways and means not later than 1 year after the commission’s first meeting.
1085	1085	1063 SECTION 38. A Certified Addictions Recovery Coach certification issued by the
1086	1086	1064Massachusetts Board of Substance Abuse Counselor Certification or other comparable certifying 50 of 51
1087	1087	1065body shall serve as satisfactory proof for recovery coach application requirements, including test
1088	1088	1066exemptions, for a limited period following the effective date of this act as determined by the
1089	1089	1067department of public health; provided, however, that the department shall waive the lived
1090	1090	1068experience requirement for a recovery coach license pursuant to section 1 of chapter 111J of the
1091	1091	1069General Laws for an applicant who was credentialed by the Massachusetts Board of Substance
1092	1092	1070Abuse Counselor Certification prior to the effective date of this act. The eligible applicants shall
1093	1093	1071meet all other qualifications and requirements for licensure as determined by the department. The
1094	1094	1072department shall promulgate rules and regulations for the implementation of this section.
1095	1095	1073 SECTION 39. The plans required pursuant to section 17Q of chapter 32A of the General
1096	1096	1074Laws, amended by section 1; section 47KK of chapter 175 of the General Laws, amended by
1097	1097	1075section 20; section 8MM of chapter 176A of the General Laws, amended by section 24; section
1098	1098	10764MM of chapter 176B of the General Laws, amended by section 26; and section 4EE of chapter
1099	1099	1077176G of the General Laws, amended by section 28, shall be submitted to the division of
1100	1100	1078insurance by not later than May 1, 2025.
1101	1101	1079 SECTION 40. Not later than 18 months after the effective date of this act, the initial
1102	1102	1080report required pursuant to section 110D of chapter 111 of the General Laws shall be filed with
1103	1103	1081the clerks of the house of representatives and the senate, the house and senate committees on
1104	1104	1082ways and means, the joint committee on children, families and persons with disabilities and the
1105	1105	1083joint committee on mental health, substance use and recovery.
1106	1106	1084 SECTION 41. The department of public health shall promulgate regulations pursuant to
1107	1107	1085section 110E of chapter 111 of the General Laws not later than 60 days after the effective date of
1108	1108	1086this act. 51 of 51
1109	1109	1087 SECTION 42. The department of public health shall issue regulations pursuant to section
1110	1110	10888 of chapter 111J of the General Laws not later than 90 days after the effective date of this act.
1111	1111	1089 SECTION 43. No person shall be found to have violated section 4 of chapter 111J of the
1112	1112	1090General Laws until 6 months after the department of public health first establishes a recovery
1113	1113	1091coach license pursuant to section 2 of said chapter 111J.
1114	1114	1092 SECTION 44. All commission members pursuant to section 36 shall be appointed within
1115	1115	109330 days after the effective date of this act.
1116	1116	1094 SECTION 45. Section 17X of chapter 32A of the General Laws, section 10X of chapter
1117	1117	1095118E of the General Laws, section 47AAA of chapter 175 of the General Laws, section 8BBB of
1118	1118	1096chapter 176A of the General Laws, section 4BBB of chapter 176B of the General Laws, and
1119	1119	1097section 4TT of chapter 176G of the General Laws shall apply to all contracts entered into,
1120	1120	1098renewed or amended on or after July 1, 2025.
1121	1121	1099 SECTION 46. Section 17Y of chapter 32A of the General Laws, section 10Y of chapter
1122	1122	1100118E of the General Laws, section 47BBB of chapter 175 of the General Laws, section 8CCC of
1123	1123	1101chapter 176A of the General Laws, section 4CCC of chapter 176B of the General Laws, and
1124	1124	1102section 4UU of chapter 176G of the General Laws shall apply to all contracts entered into,
1125	1125	1103renewed or amended on or after January 1, 2026.
1126	1126	1104 SECTION 47. Sections 1, 20, 24, 26, and 28 shall apply to all contracts entered into,
1127	1127	1105renewed or amended on or after July 1, 2025.
1128	1128	1106 SECTION 48. Sections 5 and 8 shall take effect on July 1, 2025.