Massachusetts 2023-2024 Regular Session

Massachusetts House Bill H991 Compare Versions

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

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1	1	1 of 1
2	2	HOUSE DOCKET, NO. 3060 FILED ON: 1/20/2023
3	3	HOUSE . . . . . . . . . . . . . . . No. 991
4	4	The Commonwealth of Massachusetts
5	5	_________________
6	6	PRESENTED BY:
7	7	Marjorie C. Decker
8	8	_________________
9	9	To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
10	10	Court assembled:
11	11	The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:
12	12	An Act relative to reimbursement for recovery peer specialists.
13	13	_______________
14	14	PETITION OF:
15	15	NAME:DISTRICT/ADDRESS :DATE ADDED:Marjorie C. Decker25th Middlesex1/20/2023 1 of 7
16	16	HOUSE DOCKET, NO. 3060 FILED ON: 1/20/2023
17	17	HOUSE . . . . . . . . . . . . . . . No. 991
18	18	By Representative Decker of Cambridge, a petition (accompanied by bill, House, No. 991) of
19	19	Marjorie C. Decker relative to reimbursement for recovery peer specialists. Financial Services.
20	20	The Commonwealth of Massachusetts
21	21	_______________
22	22	In the One Hundred and Ninety-Third General Court
23	23	(2023-2024)
24	24	_______________
25	25	An Act relative to reimbursement for recovery peer specialists.
26	26	Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
27	27	of the same, as follows:
28	28	1 SECTION 1. Chapter 32A of the General Laws, as appearing in the 2020 Official
29	29	2Edition, is hereby amended by adding the following new section:-
30	30	3 Section 31. (a) The commission shall provide to any active or retired employee of the
31	31	4commonwealth who is insured under the group insurance commission coverage for the provision
32	32	5of behavioral health or substance use disorder services provided by peer support specialists,
33	33	6including but not limited to, peer recovery coaches and recovery support navigators, regardless
34	34	7of the setting these services are provided in. This coverage shall include coverage of peer
35	35	8recovery coaches and recovery support navigators who are employed by health care facilities and
36	36	9who only provide recovery coach or recovery support navigator services for patients while the
37	37	10patient is being treated in an emergency department, acute care hospital, freestanding psychiatric
38	38	11hospital, or substance use disorder facility. The commission shall include reimbursement for the
39	39	12provision of said services via telemedicine, electronic or telephonic consultation. The contractual
40	40	13rate for these services may be no less than the prevailing MassHealth rate for peer recovery 2 of 7
41	41	14coach services or recovery support navigator services. The benefits in this section shall not be
42	42	15subject to any deductible, coinsurance, copayments, or out-of-pocket limits. Peer support
43	43	16specialist services, including peer recovery coach services and recovery support navigator
44	44	17services shall be deemed medically necessary and shall not require prior authorization.
45	45	18 SECTION 2. Chapter 118E of the General Laws, as appearing in the 2020 Official
46	46	19Edition, is hereby amended by adding the following new section:-
47	47	20 Section 83. (a) The division and its contracted health insurers, health plans, health
48	48	21maintenance organizations, behavioral health management firms and third-party administrators
49	49	22under contract to a Medicaid managed care organization, accountable care organization, or
50	50	23primary care clinician plan shall provide coverage for the provision of behavioral health or
51	51	24substance use disorder services provided by peer support specialists, including but not limited to,
52	52	25peer recovery coaches, and recovery support navigators, regardless of the setting these services
53	53	26are provided in. This coverage shall include coverage of peer recovery coaches and recovery
54	54	27support navigators who are employed by health care facilities and who only provide recovery
55	55	28coach or recovery support navigator services for patients while the patient is being treated in an
56	56	29emergency department, acute care hospital, freestanding psychiatric hospital, or substance use
57	57	30disorder facility. The division and its contracted health insurers, health plans, health maintenance
58	58	31organizations, behavioral health management firms and third-party administrators shall include
59	59	32reimbursement for the provision of said services via telemedicine, electronic or telephonic
60	60	33consultation. The benefits in this section shall not be subject to any deductible, coinsurance,
61	61	34copayments, or out-of-pocket limits. Peer support specialist services, including peer recovery
62	62	35coach services and recovery support navigator services shall be deemed medically necessary and
63	63	36shall not require prior authorization by an insurer. 3 of 7
64	64	37 SECTION 3. Chapter 175 of the General Laws, as so appearing, is hereby amended by
65	65	38inserting after section 4TT the following new section:-
66	66	39 Section 47UU. (a) Any policy, contract, agreement, plan or certificate of insurance
67	67	40issued, delivered or renewed within the commonwealth, which is considered creditable coverage
68	68	41under section 1 of chapter 118M, shall provide coverage for the provision of behavioral health or
69	69	42substance use disorder services provided by peer support specialists, including but not limited to,
70	70	43peer recovery coaches and recovery support navigators, regardless of the setting these services
71	71	44are provided in. This coverage shall include coverage of peer recovery coaches and recovery
72	72	45support navigators who are employed by health care facilities and who only provide recovery
73	73	46coach or recovery support navigator services for patients while the patient is being treated in an
74	74	47emergency department, acute care hospital, freestanding psychiatric hospital, or substance use
75	75	48disorder facility. The policy, contract, agreement, plan or certificate of insurance shall include
76	76	49reimbursement for the provision of said services via telemedicine, electronic or telephonic
77	77	50consultation. The contractual rate for these services may be no less than the prevailing
78	78	51MassHealth rate for peer recovery coach services or recovery support navigator services. The
79	79	52benefits in this section shall not be subject to any deductible, coinsurance, copayments, or out-of-
80	80	53pocket limits. Peer support specialist services, including peer recovery coach services and
81	81	54recovery support navigator services shall be deemed medically necessary and shall not require
82	82	55prior authorization
83	83	56 SECTION 4. Chapter 176A of the General Laws, as so appearing, is hereby amended by
84	84	57inserting after section 8UU the following new section:- 4 of 7
85	85	58 Section 8VV. (a) Any contract between a subscriber and the corporation under an
86	86	59individual or group hospital service plan that is delivered, issued, or renewed within the
87	87	60commonwealth shall provide coverage for the provision of behavioral health or substance use
88	88	61disorder services provided by peer support specialists, including but not limited to, peer recovery
89	89	62coaches and recovery support navigators, regardless of the setting these services are provided in.
90	90	63This coverage shall include coverage of peer recovery coaches and recovery support navigators
91	91	64who are employed by health care facilities and who only provide recovery coach or recovery
92	92	65support navigator services for patients while the patient is being treated in an emergency
93	93	66department, acute care hospital, freestanding psychiatric hospital, or substance use disorder
94	94	67facility. The contract shall include reimbursement for the provision of said services via
95	95	68telemedicine, electronic or telephonic consultation. The contractual rate for these services may
96	96	69be no less than the prevailing MassHealth rate for peer recovery coach services or recovery
97	97	70support navigator services. The benefits in this section shall not be subject to any deductible,
98	98	71coinsurance, copayments, or out-of-pocket limits. Peer support specialist services, including peer
99	99	72recovery coach services and recovery support navigator services shall be deemed medically
100	100	73necessary and shall not require prior authorization.
101	101	74 SECTION 5. Chapter 176B of the General Laws, as so appearing, is hereby amended by
102	102	75adding the following new section after section 4UU:
103	103	76 Section 4VV. (a) Any subscription certificate under an individual or group medical
104	104	77service agreement delivered, issued, or renewed within the commonwealth shall provide
105	105	78coverage for the provision of behavioral health or substance use disorder services provided by
106	106	79peer support specialists, including but not limited to, peer recovery coaches and recovery support
107	107	80navigators, regardless of the setting these services are provided in. This coverage shall include 5 of 7
108	108	81coverage of peer recovery coaches and recovery support navigators who are employed by health
109	109	82care facilities and who only provide recovery coach or recovery support navigator services for
110	110	83patients while the patient is being treated in an emergency department, acute care hospital,
111	111	84freestanding psychiatric hospital, or substance use disorder facility. The subscription certificate
112	112	85shall include reimbursement for the provision of said services via telemedicine, electronic or
113	113	86telephonic consultation. The contractual rate for these services may be no less than the prevailing
114	114	87MassHealth rate for peer recovery coach services or recovery support navigator services. The
115	115	88benefits in this section shall not be subject to any deductible, coinsurance, copayments, or out-of-
116	116	89pocket limits. Peer support specialist services, including peer recovery coach services and
117	117	90recovery support navigator services shall be deemed medically necessary and shall not require
118	118	91prior authorization.
119	119	92 SECTION 6. Chapter 176G of the General Laws, as so appearing, is hereby amended by
120	120	93inserting after section 4MM the following new section:-
121	121	94 Section 4NN. (a) An individual or group health maintenance contract that is issued or
122	122	95renewed within or without the commonwealth shall provide coverage for the provision of
123	123	96behavioral health or substance use disorder services provided by peer support specialists,
124	124	97including but not limited to, peer recovery coaches and recovery support navigators, regardless
125	125	98of the setting these services are provided in. This coverage shall include coverage of peer
126	126	99recovery coaches and recovery support navigators who are employed by health care facilities and
127	127	100who only provide recovery coach or recovery support navigator services for patients while the
128	128	101patient is being treated in an emergency department, acute care hospital, freestanding psychiatric
129	129	102hospital, or substance use disorder facility. The individual or group health maintenance contract
130	130	103shall include reimbursement for the provision of said services via telemedicine, electronic or 6 of 7
131	131	104telephonic consultation. The contractual rate for these services may be no less than the prevailing
132	132	105MassHealth rate for peer recovery coach services or recovery support navigator services. The
133	133	106benefits in this section shall not be subject to any deductible, coinsurance, copayments, or out-of-
134	134	107pocket limits. Peer support specialist services, including peer recovery coach services and
135	135	108recovery support navigator services shall be deemed medically necessary and shall not require
136	136	109prior authorization.
137	137	110 SECTION 7. Notwithstanding any general or special law to the contrary, the division of
138	138	111insurance, in consultation with the division of medical assistance, shall promulgate regulations or
139	139	112issue sub-regulatory guidance to require carriers reimburse acute care hospitals and clinics
140	140	113licensed under chapter 111 of the General laws, for the provision of behavioral health or
141	141	114substance use disorder services provided by peer support specialists, including but not limited to,
142	142	115peer recovery coaches and recovery support navigators. The regulations or sub-regulatory
143	143	116guidance shall include reimbursement for the provision of said services via telemedicine,
144	144	117electronic or telephonic consultation.
145	145	118 SECTION 8. Notwithstanding any general or special law to the contrary, the bureau of
146	146	119substance addiction services within the department of public health shall conduct a
147	147	120comprehensive report addressing barriers to certification, credentialing, and other employment
148	148	121and practice requirements of peer recovery specialists, including peer recovery coaches and
149	149	122recovery support navigators. The report shall include, but not be limited to, (i) cost barriers for
150	150	123individuals with lived experience, including but not limited to, application and examination fees
151	151	124for initial certification and credentialing, (ii) cost barriers to certification and credentialing
152	152	125renewals, (iii) cost and reimbursement barriers for hospitals and clinics licensed under chapter
153	153	126111 to hire, train, and retain peer recovery coaches and peer support navigators, (iv) eligibility 7 of 7
154	154	127requirements for certification and credentialing, and (v) access to training programs and
155	155	128resources. The report shall also include recommendations to address said barriers. The
156	156	129department shall submit a copy of the report to the executive office of health and human
157	157	130services, the clerks of the senate and house of representatives, and the joint committee on mental
158	158	131health, substance use, and recovery within 90 days of the effective date of this act.
159	159	132 SECTION 9. Notwithstanding any general or special law to the contrary, the bureau of
160	160	133substance addiction services within the department of public health shall establish or arrange for
161	161	134a comprehensive peer support program to provide mentorship, technical assistance, and support
162	162	135resources for the wellbeing of peer support specialists, including, but not limited to, peer
163	163	136recovery coaches and recovery support navigators. The program shall include, but not be limited
164	164	137to, a network for peer-to-peer trainings, education, mentorship, counseling and support;
165	165	138educational and other clinical support materials; technical assistance for certification,
166	166	139credentialing, and other employment and practice requirements; and billing technical assistance
167	167	140for organizations that employ peer support specialists, including peer recovery coaches and
168	168	141recovery support navigators.