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