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SENATE . . . . . . . . . . . . . . No. 2921
July 30, 2024 -- Text of the Senate amendment to the House Bill relative to accessing harm
reduction initiatives (House, No. 4758) (being the text of Senate, No. 2898, printed as amended)
The Commonwealth of Massachusetts
_______________
In the One Hundred and Ninety-Third General Court
(2023-2024)
_______________
1 SECTION 1. Chapter 32A of the General Laws is hereby amended by inserting after
2section 17S the following 2 sections:-
3 Section 17T. (a) Coverage offered by the commission to an active or retired employee of
4the commonwealth insured under the group insurance commission shall provide coverage for
5prescribed or dispensed opioid antagonists, as defined in section 19B of chapter 94C and used in
6the reversal of overdoses caused by opioids, which shall not require prior authorization;
7provided, however, that a prescription from a health care practitioner shall not be required for
8coverage of opioid antagonists. An opioid antagonist used in the reversal of overdoses caused by
9opioids shall not be subject to any deductible, coinsurance, copayments or out-of-pocket limits;
10provided, however, that cost-sharing shall be required if the applicable plan is governed by the
11Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on cost-
12sharing for this service.
13 (b) The commission shall provide coverage for an opioid antagonist used in the reversal
14of overdoses caused by opioids as a medical benefit when dispensed by the health care facility in
15which the opioid antagonist was prescribed and shall provide coverage as a pharmacy benefit for
16an opioid antagonist used in the reversal of overdoses caused by opioids dispensed by a 2 of 31
17pharmacist, including an opioid antagonist dispensed pursuant to section 19B of chapter 94C;
18provided, however, that the rate to be reimbursed under the medical benefit shall not exceed the
19commission’s average in-network pharmacy benefit rate and the health care facility shall not
20balance bill the patient.
21 Section 17U. The commission shall provide to any active or retired employee of the
22commonwealth who is insured under the group insurance commission coverage for the provision
23of services by a recovery coach licensed or otherwise authorized to practice pursuant to chapter
24111J, irrespective of the setting in which the services are provided; provided, however, that such
25services shall be within the lawful scope of practice of a recovery coach. The contractual rate for
26these services shall be not less than the prevailing MassHealth rate for recovery coach services.
27The benefits in this section shall not be subject to any deductible, coinsurance, copayments or
28out-of-pocket limits; provided, however, that cost-sharing shall be required if the applicable plan
29is governed by the Internal Revenue Code and would lose its tax-exempt status as a result of the
30prohibition on cost-sharing for the service. Recovery coach services shall not require prior
31authorization.
32 SECTION 2. Chapter 94C of the General Laws is hereby amended by striking out section
3319C, as appearing in the 2022 Official Edition, and inserting in place thereof the following
34section:-
35 Section 19C. The board of registration in pharmacy shall promulgate regulations
36requiring pharmacies located in areas with high incidents of opiate overdose, as determined by
37the board in consultation with the department, to maintain a continuous supply of opioid
38antagonists, as defined in section 19B; provided, however, that the continuous supply of opioid 3 of 31
39antagonists shall include opioid antagonists that are approved by the United States Food and
40Drug Administration to be sold over the counter without a prescription; provided further, that
41such pharmacies shall notify the department if the supply or stock of opioid antagonist doses is
42insufficient to enable compliance with maintaining a continuous supply of opioid antagonists.
43 SECTION 3. Said chapter 94C is hereby further amended by inserting after section 19D
44the following section:-
45 Section 19D½. (a) For the purposes of this section, the following words shall have the
46following meanings unless the context clearly requires otherwise:
47 “Opioid antagonist”, as defined in section 19B.
48 “Substance use disorder treatment facility”, a facility licensed or approved by the
49department to offer treatment for substance use disorder, including, but not limited to: (i)
50withdrawal management services; (ii) clinical stabilization services; (iii) transitional support
51services; (iv) residential support services; (v) community behavioral health center services; (vi)
52office-based opioid or addiction treatment services; or (vii) outpatient substance use disorder
53services.
54 (b) Upon discharge of a patient with an opioid use disorder from a substance use disorder
55treatment facility, the facility shall educate the patient on the use of opioid antagonists and
56dispense not less than 2 doses of an opioid antagonist to the patient or a legal guardian of the
57patient.
58 (c) The commissioner may promulgate rules and regulations necessary to implement this
59section. 4 of 31
60 SECTION 4. Section 25J½ of chapter 111 of the General Laws, as appearing in the 2022
61Official Edition, is hereby amended by inserting after the first paragraph the following
62paragraph:-
63 Upon discharge of a patient from an acute care hospital, satellite emergency facility or a
64freestanding psychiatric hospital who has: (i) a history of or is actively using opioids; (ii) been
65diagnosed with opioid use disorder; or (iii) experienced an opioid-related overdose, the acute
66care hospital or satellite emergency facility shall educate the patient on the use of opioid
67antagonists, as defined in section 19B of chapter 94C, and prescribe or dispense not less than 2
68doses of an opioid antagonist to the patient or a legal guardian of the patient.
69 SECTION 5. Said chapter 111 is hereby further amended by inserting after section 215
70the following section:-
71 Section 215A. (a) For the purposes of the section, the following words shall have the
72following meanings unless the context clearly requires otherwise:
73 “Drug testing services”, the use of testing equipment for the surveillance or identification
74of, or to analyze the strength, effectiveness or purity of, a controlled substance related to its
75injection, inhalation or ingestion by a person to determine whether the controlled substance
76contains chemicals, toxic substances or hazardous compounds.”
77 “Harm reduction program”, a department approved program or service that reduces the
78adverse consequences of substance use, including use-related mortality, stabilizes and improves
79the health of people who use substances and advances public health; provided, however, that
80programs or services may include harm reduction services, including, but not be limited to: (i)
81needle exchange programs pursuant to section 215; (ii) primary care, including disease 5 of 31
82prevention and health screenings; (iii) access or referral to evidence-based treatment options; (iv)
83drug testing services; (v) overdose reversal care; (vi) supervision of persons who consume pre-
84obtained substances; and (vii) other social support services deemed permissible by the
85department.
86 “Harm reduction program operators”, individuals directly involved in the operation,
87administration or staffing of a harm reduction program, including directors, board members,
88consultants, health care providers, service providers, staff and volunteers.
89 (b) Prior to the establishment of a harm reduction program that provides overdose
90reversal care and supervision of persons who consume pre-obtained substances, the board of
91health of the city or town in which the program is located shall vote to approve or deny such
92program. If the board approves such program the municipal legislative body shall vote to
93approve or deny such program in the manner provided for in section 4 of chapter 4not later than
943 months following the approval by the board of health. If such program is approved by each
95body, the city or town shall provide notice of such approval to the department, in a manner
96determined by the department, and upon such notice, the department shall review the proposed
97program and make a determination of whether to authorize such program; provided, however,
98that in making the determination, the department shall take into consideration the program’s
99proposed location, including, but not limited to, the location’s proximity to schools; provided,
100further that the department shall provide the determination in writing not later than 3 months
101after receiving notice of approval from the city or town and, if applicable, shall provide an
102explanation for rejecting a proposed program; and provided further, that the department shall
103submit any such program to the attorney general to ensure compliance with state and federal law. 6 of 31
104 Not later than 1 year after the implementation of a harm reduction program under this
105subsection, the department shall report the results of authorized programs pursuant to this section
106and any recommendations by filing the report with the clerks of the senate and house of
107representatives, the joint committee on mental health, substance use and recovery, the joint
108committee on public health and the senate and house committees on ways and means; provided,
109however, that the report shall include, but not be limited to, site-specific information on the: (i)
110number of participant visits; (ii) types of drugs consumed and tested; (iii) number of overdoses
111reversed; (iv) types of drugs involved in overdoses; (v) staffing levels and staff experiences; (vi)
112operating costs; (vii) number of referrals to addiction treatment; (viii) number of hypodermic
113needles and syringes collected and distributed; (ix) medical emergency and 911 calls; and (x) in
114consultation with local law enforcement, report on changes to the prevalence of crimes in the
115vicinity of the program.
116 (c) Notwithstanding any general or special law to the contrary, harm reduction program
117operators, individuals who access harm reduction program services, owners, lessors and sub-
118lessors of property used for harm reduction programs and state, county and municipal employees
119involved in approving or operating harm reduction programs shall, for actions related to the
120approval or operation of, or participation in, a harm reduction program, be immune from: (i)
121arrest, charge or prosecution, including for attempting, aiding and abetting or conspiracy to
122commit a violation, pursuant to sections 32, 32A, 32B, 32C, 32D, 32E, 32I, 34, 40, 43 and 47 of
123chapter 94C and chapter 271A; (ii) seizure or forfeiture of data, records, assets or property under
124state law; (iii) civil suit, liability or damages alleged to have been sustained by an act or omission
125by a harm reduction program operator in the course of providing harm reduction services; and
126(iv) for health care providers, disciplinary action by a professional licensing board, credentialing 7 of 31
127restriction, contractual liability, adverse employment action or denial of any professional
128privilege; provided, however, that the immunity described in this subsection shall apply only if
129the harm reduction program operates in good faith in accordance with this section and regulatory
130requirements issued by the department. Entering or exiting a harm reduction program cannot
131serve as the basis for, or a fact contributing to the existence of, reasonable suspicion or probable
132cause to conduct a search or seizure.
133 (d) The immunity provided under subsection (c) shall not apply: (i) if the damage was
134caused by an act or omission constituting gross negligence or recklessness, conduct with an
135intent to harm, discrimination based on race, ethnicity, national origin, religion, disability, sexual
136orientation or gender identity or conduct outside the scope of responsibility of a harm reduction
137program employee or volunteer, as determined by the department; (ii) to consumer protection
138actions brought by the attorney general; (iii) to false claims actions brought by or on behalf of
139the commonwealth; or (iv) privacy violations.
140 (e) Notwithstanding any general law or special law to the contrary, a person or entity
141providing harm reduction services under this section and approved by the department shall not be
142required to register their activities pursuant to section 7 of chapter 94C.
143 (f) The department shall promulgate regulations to implement this section.
144 SECTION 6. Said chapter 111 is hereby further amended by adding the following
145section:-
146 Section 245. (a) As used in this section, the following words shall have the following
147meanings unless the context clearly requires otherwise: 8 of 31
148 “Acupuncture detoxification specialist”, a qualified health care professional who is
149registered with the department to engage in the practice of auricular acupuncture detoxification
150pursuant to this section.
151 “Auricular acupuncture detoxification”, treatment by means of the subcutaneous insertion
152of sterile, disposable acupuncture needles in consistent, predetermined bilateral locations on the
153ear in accordance with the standardized auricular acupuncture detoxification protocol developed
154by National Acupuncture Detoxification Association, Inc.
155 “General supervision”, supervision by phone or other electronic means during business
156hours with in-person site visits as deemed necessary by a licensed acupuncturist.
157 “Licensed acupuncturist”, an individual who is licensed under sections 148 to 162,
158inclusive, of chapter 112 to practice as a licensed acupuncturist.
159 “National Acupuncture Detoxification Association training”, the standardized auricular
160acupuncture detoxification protocol training developed by National Acupuncture Detoxification
161Association, Inc., effective as of January 1, 2019.
162 “Qualified health care professional”, a qualified individual who: (i) is a licensed
163physician, licensed psychologist, licensed independent clinical social worker, licensed clinical
164social worker, licensed mental health counselor, licensed psychiatric clinical nurse specialist,
165certified addictions registered nurse, licensed alcohol and drug counselor I or licensed alcohol
166and drug counselor II as defined in section 1 of chapter 111J, certified alcohol and drug abuse
167counselor or certified alcohol and drug abuse counselor II as certified by the Massachusetts
168Board of Substance Abuse Counselor Certification or an equivalent certifying body or a
169registered nurse or nurse practitioner certified by the board of registration in nursing pursuant to 9 of 31
170chapter 112; and (ii) has received training and a certificate of completion from National
171Acupuncture Detoxification Association, Inc. or from a state-recognized organization or agency
172that meets or exceeds National Acupuncture Detoxification Association, Inc. training standards
173to engage in the practice of auricular acupuncture detoxification protocol for the treatment of
174addictions, mental and behavioral health, trauma as a result of a disaster and other emotional
175trauma.
176 (b) An individual who is not a licensed acupuncturist shall not engage in the practice of
177the auricular acupuncture detoxification or represent themself as an acupuncture detoxification
178specialist unless the individual: (i) has been issued: (A) an approved registration by the
179department to practice auricular acupuncture detoxification in accordance with this section; or
180(B) a license or certificate in another state with requirements that are at least equivalent to the
181requirements of this section, as determined by the commissioner; and (ii) has been trained in the
182standardized auricular acupuncture detoxification protocol in accordance with National
183Acupuncture Detoxification Association, Inc. training or an equivalent training certificate by a
184state-recognized organization.
185 To engage in the practice of auricular acupuncture detoxification within the individual’s
186designated lawful scope of practice, a qualified health care professional shall file an application
187to register as an acupuncture detoxification specialist with the department, in a form determined
188by the department. Each application may be accompanied by the payment of a fee to be
189determined by the department.
190 The applicant seeking to practice auricular acupuncture detoxification shall, at a
191minimum, furnish proof of: (i) relevant licensure or certification as a qualified health care 10 of 31
192professional; and (ii) completion of National Acupuncture Detoxification Association, Inc.
193training or an equivalent training certificate by a state-recognized organization. An applicant
194who is registered or certified in another state with requirements that are at least equivalent to the
195requirements of this section, as determined by the commissioner, shall be allowed to practice
196auricular acupuncture detoxification in accordance with this section. A registration issued under
197this section shall be valid for 2 years and subject to renewal as determined by the department.
198 (c) Auricular acupuncture detoxification shall only be performed by a licensed
199acupuncturist or a qualified health care professional within their designated lawful scope of
200practice for the purpose of providing integrated health care delivery interventions in substance
201abuse treatment and wellness promotion including, but not limited to, treating mental and
202emotional health, post and acute trauma, addiction or chemical dependency.
203 (d) A qualified health care professional registered in accordance with this section shall
204only practice under the general supervision of a licensed acupuncturist; provided, however, that
205no such individual shall use the title “acupuncturist” or otherwise represent themself or imply
206that they are a licensed acupuncturist and shall not perform or practice acupuncture outside of the
207scope of the auricular acupuncture detoxification as defined in this section.
208 (e) Nothing in this chapter or sections 149 to 162, inclusive, of chapter 112 shall prohibit,
209limit, interfere with or prevent a qualified health care professional from practicing or performing
210auricular acupuncture detoxification if the individual is acting within the lawful scope of practice
211in accordance with the individual’s license and the auricular acupuncture detoxification is
212performed in: (i) a private, freestanding facility licensed by the department that provides care or
213treatment for individuals with substance use disorders or other addictive disorders; (ii) a facility 11 of 31
214under the direction and supervision of the department of mental health; (iii) a setting approved or
215licensed by the department of mental health; or (iv) any other setting where auricular
216acupuncture detoxification is an appropriate adjunct therapy to a substance use disorder or
217behavioral health treatment program; provided, however, that individual or 1-on-1 appointments
218with a health care provider not within a setting pursuant to this subsection shall not be an
219appropriate setting in accordance with this section.
220 (f) The commissioner may promulgate regulations to implement this section.
221 SECTION 7. Chapter 111J of the General Laws is hereby amended by striking out
222sections 1 to 8, inclusive, as appearing in the 2022 Official Edition, and inserting in place thereof
223the following 9 sections:-
224 Section 1. As used in this chapter, the following words shall have the following meanings
225unless the context clearly requires otherwise:
226 “Applicant”, an individual seeking licensure under this chapter.
227 “Approved continuing education”, continuing education approved by the department,
228including research and training programs, college and university courses, in-service training
229programs, seminars and conferences, designed to maintain and enhance the skills of licensees.
230 “Approved program”, a program approved by the department for the education and
231training of licensees.
232 “Approved recovery coach supervisor”, a licensed recovery coach that has completed
233recovery coach supervision training that has been approved by the department for the supervision
234of recovery coaches. 12 of 31
235 “Approved work experience”, supervised work experience, approved by the department,
236in the practice area for which an applicant seeks licensure.
237 “Department”, the department of public health.
238 “Licensee”, an individual who is licensed under this chapter.
239 “Licensed alcohol and drug counselor I”, a person licensed by the department to conduct
240an independent practice of alcohol and drug counseling and provide supervision to other alcohol
241and drug counselors; provided, however, that a “licensed alcohol and drug counselor I” shall
242have: (i) received a master’s or doctoral degree in behavioral sciences, which included a
243supervised counseling practicum that meets the requirements established by the department, or
244such equivalent educational credits as may be established by the department; (ii) not less than 3
245years of approved work experience; and (iii) passed a licensing examination approved by the
246department.
247 “Licensed alcohol and drug counselor II”, a person licensed by the department to practice
248alcohol and drug counseling under clinical supervision; provided, however, that a “licensed
249alcohol and drug counselor II” shall have: (i) completed an approved program of education,
250which included a supervised counseling practicum that meets the requirements established by the
251department or such equivalent educational credits as may be established by the department; (ii)
252not less than 3 years of approved work experience; and (iii) passed a licensing examination
253approved by the department.
254 “Licensed recovery coach”, a person with lived experience who is licensed by the
255department to practice recovery coaching using shared understanding, respect and mutual
256empowerment to help others become and stay engaged in the process of recovery from a 13 of 31
257substance use disorder; provided, however, that a “licensed recovery coach” shall: (i) have
258completed an approved program of education, including approved work experience that meets
259the requirements established by the department; (ii) demonstrate not less than 2 years of
260sustained recovery; and (iii) have met all education, training and experience requirements and
261qualifications as established by the department.
262 “Lived experience”, the experience of addiction and recovery from a substance use
263disorder.
264 Section 2. (a) The department shall establish and administer a program for the licensure
265of alcohol and drug counselors I, alcohol and drug counselors II and recovery coaches. The
266department shall: (i) establish the licensure requirements for licensed alcohol and drug
267counselors practicing in the commonwealth; (ii) establish the licensure requirements for licensed
268recovery coaches practicing in the commonwealth; (iii) evaluate the qualifications of applicants
269for licensure; (iv) supervise licensing examinations, where applicable; (v) establish and collect
270fees for licensing and examination, where applicable; (vi) grant and issue licenses to applicants
271who satisfy the department’s requirements for licensure; (vii) establish continuing education
272requirements for licensees; (viii) investigate complaints; (ix) take appropriate disciplinary action
273to protect the public health, safety and welfare; and (x) perform other functions and duties as
274may be necessary to carry out this chapter.
275 (b) The department shall establish requirements for licensed alcohol and drug counselors
276I and licensed alcohol and drug counselors II and may establish other reasonable classifications
277for alcohol and drug counselors as it finds necessary and appropriate, including, but not limited 14 of 31
278to, counselors specializing in youth recovery counseling, taking into consideration different
279levels of education, training and work experience.
280 (c) The department shall establish requirements for licensed recovery coaches, including,
281but not limited to, establishing an ethical code of conduct for recovery coaches, and may
282establish other reasonable classifications for recovery coaches as it finds necessary and
283appropriate, taking into consideration different levels of education, training and work experience.
284 (d) The department shall approve and issue certificates of approval of programs for the
285training of alcohol and drug counselors. The department shall maintain a list of approved
286programs and a current roster of persons serving as licensed alcohol and drug counselors in the
287commonwealth.
288 (e) The department shall approve and issue certificates of approval of programs for the
289training of recovery coaches. The department shall maintain a list of approved programs and a
290current roster of persons serving as licensed recovery coaches in the commonwealth.
291 (f) The department shall promulgate rules and regulations to implement this chapter,
292including, but not limited to, rules and regulations establishing the educational and professional
293requirements for licensing individuals under this chapter, establishing fees for licensing and
294examination, where applicable, and governing the practice and employment of licensees to
295promote the public health, safety and welfare.
296 Section 3. (a) Each applicant shall furnish the department with proof of satisfactory
297completion of the educational, training and experience requirements for licensure, including
298completion of an approved program and approved work experience and proof of having passed 15 of 31
299any licensing examinations required by the department; provided, however, that the department
300may establish additional requirements for licensure and exemptions by regulation.
301 (b) A license for alcohol and drug counselor I, alcohol and drug counselor II or recovery
302coaches shall be valid for a 2-year period and licensees may apply for renewal of a license for a
303like term. A licensee seeking renewal of a license shall submit proof of having successfully
304completed the requirements for approved continuing education as may be established by the
305department.
306 (c) Applications for licenses and renewals shall be submitted in accordance with
307procedures established by the department. The department may establish fees for license
308applications and renewals.
309 Section 4. (a) Except as otherwise provided in this chapter or by regulation, a person not
310licensed or otherwise exempt from licensing shall not hold themself out as a licensed recovery
311coach and shall not use the title, initials, abbreviations, insignia or description of a licensed
312recovery coach or practice or attempt to practice recovery coaching unless otherwise authorized
313by law or rule or regulation of the department. Whoever engages in any such unauthorized action
314shall be subject to a fine of not less than $500. The department may bring a petition in superior
315court to enjoin such unauthorized action or any other violation of this chapter or regulation
316hereunder.
317 (b) Individuals working under an approved recovery coach supervisor and receiving
318approved work experience may practice without a license in order to obtain the requisite hours of
319supervised experience needed to obtain a recovery coach license. 16 of 31
320 (c) Nothing in this section shall prevent members of peer groups or self-help groups from
321performing peer support or self-help activities that may be included within the practice recovery
322coaching; provided, however, that no members of peer groups or self-help groups who are not so
323credentialed shall use a title stating or implying that such person is a licensed recovery coach.
324 Section 5. (a) Except as otherwise provided in this chapter or by regulation, a person who
325is not licensed or is otherwise exempt from licensing shall not hold themself out as a licensed
326alcohol and drug counselor and shall not use the title, initials or description of a licensed alcohol
327and drug counselor or practice or attempt to practice alcohol and drug counseling. Whoever
328engages in any such unauthorized action shall be subject to a fine of not less than $500. The
329department may bring a petition in superior court to enjoin such unauthorized action or any other
330violation of this chapter or regulation hereunder.
331 (b) The following individuals shall be exempt from the licensing requirements for alcohol
332and drug counseling under this chapter:
333 (i) an educational psychologist, marriage and family therapist, mental health counselor,
334nurse practitioner, occupational therapist, physician, physician assistant, practical nurse,
335psychologist, registered nurse, rehabilitation counselor or social worker;
336 (ii) an employee or other agent of a recognized academic institution or employee
337assistance program, a federal, state, county or local government institution, program, agency or
338facility or school committee, school district, school board or board of regents while performing
339alcohol and drug counseling duties solely for the respective entity or under the jurisdiction of
340such entity; provided, however, that a license pursuant to this chapter shall not be a requirement
341for employment in any state, county or municipal agency; and 17 of 31
342 (iii) an employee of a treatment program or facility licensed or approved by the
343department pursuant to chapters 111B and 111E; provided, however, that such individual shall
344perform alcohol and drug counseling solely within or under the jurisdiction of such program or
345facility.
346 (c) Nothing in this section shall prevent qualified members of other professions,
347including attorneys, Christian Science practitioners or members of the clergy, from providing
348alcohol or drug counseling consistent with accepted standards of their respective professions;
349provided, however, that no such person shall use a title stating or implying that such person is a
350licensed alcohol and drug counselor.
351 (d) Nothing in this section shall prevent members of peer groups or self-help groups from
352performing peer group or self-help activities; provided, however, that no such person shall use a
353title stating or implying that such person is a licensed alcohol and drug counselor.
354 Section 6. (a) The department shall establish procedures for consumers to file written
355complaints regarding an individual licensed under this chapter. The department shall investigate
356all complaints relating to the practice of a person holding a license under this chapter and all
357complaints relating to any violation of this chapter or regulation promulgated hereunder.
358 (b) The department may conduct an adjudicatory proceeding pursuant to chapter 30A but
359shall not issue, vacate, modify or enforce subpoenas pursuant to section 12 of said chapter 30A.
360The department may, after a hearing pursuant to said chapter 30A, deny, refuse renewal, revoke,
361limit or suspend a license or otherwise discipline a licensee; provided, however, that the
362department may suspend the license of a licensee who poses an imminent danger to the public
363without a hearing; provided further, that the licensee shall be afforded a hearing within 7 18 of 31
364business days of receipt of a notice of such denial, refusal to renew, revocation, limitation,
365suspension or other disciplinary action; and provided further, that the department shall conduct
366its proceedings in accordance with this chapter and said chapter 30A. Grounds for denial, refusal
367to renew, revocation, limitation, suspension or other disciplinary action shall include: (i) fraud or
368misrepresentation in obtaining a license; (ii) criminal conduct which the department determines
369to be of such a nature as to render such person unfit to practice as evidenced by criminal
370proceedings resulting in a conviction, guilty plea or plea of nolo contendere or an admission of
371sufficient facts; (iii) a violation of any law or rule or regulation of the department governing the
372practice of the licensee under this chapter; (iv) a violation of ethical standards which the
373department determines to be of such a nature as to render such person unfit to practice as a
374licensee; or (v) other just and sufficient cause that the department determines would render a
375person unfit to practice as a licensee.
376 (c) Where denial, refusal to renew, revocation or suspension is based solely on the failure
377of the licensee to timely file an application or pay prescribed fees or to maintain insurance
378coverage as required by applicable law or regulation, the department may act without first
379granting the applicant or licensee a hearing.
380 Section 7. Examinations for licensure, where applicable, shall be conducted not less than
381twice per year at times and places and in formats designated by the department. Examinations for
382licensure, where applicable, shall be written; provided, however, that portions thereof may be
383conducted orally at the department’s discretion; and provided further, that a person who fails an
384examination may be admitted to the next available examination. 19 of 31
385 Section 8. (a) The department may issue a license without examination to an applicant
386who meets the requirements for licensure; provided, however, that requirements for licensure in
387another state shall be determined by the department to be equivalent to or in excess of the
388requirements of this chapter; and provided further, that such applicant is: (i) licensed or certified
389in alcohol and drug counseling or a comparable field in another state; or (ii) licensed or certified
390in recovery coaching or a comparable field in another state.
391 (b) The department shall promulgate rules and regulations as may be necessary to
392implement this section.
393 Section 9. The bureau of substance addiction services shall establish a comprehensive
394peer support program to provide mentorship, technical assistance and resources to support the
395skill-building and credentialing of peers working in substance addition recovery services,
396including, but not limited to, peer workers and recovery coaches. The program shall include, but
397not be limited to: (i) a network for peer-to-peer trainings, education, mentorship, counseling and
398support; (ii) educational and other support materials; (iii) technical assistance for licensure,
399certification, credentialing and other employment and practice requirements; and (iv) billing
400technical assistance for organizations that employ recovery coaches. The bureau shall consult
401peers working in substance addition recovery services in the establishment of such
402comprehensive peer support program.
403 SECTION 8. Chapter 112 of the General Laws is hereby amended by inserting after
404section 155 the following section:-
405 Section 155A. Nothing in this chapter shall prohibit, limit, interfere with or prevent a
406licensed physician or acupuncturist from practicing or performing auricular acupuncture 20 of 31
407detoxification, as defined in section 245 of chapter 111, if the licensed physician or acupuncturist
408is acting within the lawful scope of practice in accordance with their license.
409 SECTION 9. Chapter 118E of the General Laws is hereby amended by inserting after
410section 10Q the following 2 sections:-
411 Section 10R. (a) The division and its contracted health insurers, health plans, health
412maintenance organizations, behavioral health management firms and third-party administrators
413under contract to a Medicaid managed care organization, accountable care organization or
414primary care clinician plan shall provide coverage for prescribed or dispensed opioid antagonists,
415as defined in section 19B of chapter 94C and used in the reversal of overdoses caused by opioids,
416which shall not require prior authorization; provided, however, that a prescription from a health
417care practitioner shall not be required for coverage of opioid antagonists. An opioid antagonist
418used in the reversal of overdoses caused by opioids shall not be subject to any deductible,
419coinsurance, copayments or out-of-pocket limits; provided, however, that cost-sharing shall be
420required if the applicable plan is governed by the Internal Revenue Code and would lose its tax-
421exempt status as a result of the prohibition on cost-sharing for this service.
422 (b) The division and its contracted health insurers, health plans, health maintenance
423organizations, behavioral health management firms and third-party administrators under contract
424to a Medicaid managed care organization, accountable care organization or primary care
425clinician plan shall provide coverage for an opioid antagonist used in the reversal of overdoses
426caused by opioids as a medical benefit when dispensed by the health care facility in which the
427opioid antagonist was prescribed and shall provide coverage as a pharmacy benefit for an opioid
428antagonist used in the reversal of overdoses caused by opioids dispensed by a pharmacist, 21 of 31
429including an opioid antagonist dispensed pursuant to section 19B of chapter 94C; provided,
430however, that the rate to be reimbursed under the medical benefit shall not exceed the carrier’s
431average in-network pharmacy benefit rate and the health care facility shall not balance bill the
432patient.
433 Section 10S. The division and its contracted health insurers, health plans, health
434maintenance organizations, behavioral health management firms and third-party administrators
435under contract to a Medicaid managed care organization, accountable care organization or
436primary care clinician plan shall provide coverage for the provision of services by a recovery
437coach licensed or otherwise authorized to practice pursuant to chapter 111J, irrespective of the
438setting in which these services are provided; provided, however, that such services shall be
439within the lawful scope of practice of a recovery coach. The benefits in this section shall not be
440subject to any deductible, coinsurance, copayments or out-of-pocket limits; and provided further,
441that recovery coach services shall not require prior authorization.
442 SECTION 10. Chapter 175 of the General Laws is hereby amended by inserting after
443section 47UU the following 2 sections:-
444 Section 47VV. (a) Any policy, contract, agreement, plan or certificate of insurance
445issued, delivered or renewed within the commonwealth, which is considered creditable coverage
446under section 1 of chapter 111M, shall provide coverage for prescribed or dispensed opioid
447antagonists, as defined in section 19B of chapter 94C and used in the reversal of overdoses
448caused by opioids, which shall not require prior authorization; provided, however, that a
449prescription from a health care practitioner shall not be required for coverage of opioid
450antagonists. An opioid antagonist used in the reversal of overdoses caused by opioids shall not be 22 of 31
451subject to any deductible, coinsurance, copayments or out-of-pocket limits; provided, however,
452that cost-sharing shall be required if the applicable plan is governed by the Internal Revenue
453Code and would lose its tax-exempt status as a result of the prohibition on cost-sharing for this
454service.
455 (b) The policy, contract, agreement, plan or certificate of insurance shall provide
456coverage for an opioid antagonist used in the reversal of overdoses caused by opioids as a
457medical benefit when dispensed by the health care facility in which the opioid antagonist was
458prescribed and shall provide coverage as a pharmacy benefit for an opioid antagonist used in the
459reversal of overdoses caused by opioids dispensed by a pharmacist, including an opioid
460antagonist dispensed pursuant to section 19B of chapter 94C; provided, however, that the rate to
461be reimbursed under the medical benefit shall not exceed the carrier’s average in-network
462pharmacy benefit rate and the health care facility shall not balance bill the patient.
463 Section 47WW. Any policy, contract, agreement, plan or certificate of insurance issued,
464delivered or renewed within the commonwealth, which is considered creditable coverage under
465section 1 of chapter 111M, shall provide coverage for the provision of services by a recovery
466coach licensed or otherwise authorized to practice under chapter 111J, irrespective of the setting
467in which these services are provided; provided, however, that such services shall be within the
468lawful scope of practice of a recovery coach. The contractual rate for these services shall be not
469less than the prevailing MassHealth rate for recovery coach services. The benefits in this section
470shall not be subject to any deductible, coinsurance, copayments or out-of-pocket limits;
471provided, however, that cost-sharing shall be required if the applicable plan is governed by the
472Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on cost- 23 of 31
473sharing for this service; and provided further, that recovery coach services shall not require prior
474authorization.
475 SECTION 11. Said chapter 175 is hereby further amended by inserting after section
476122A the following section:-
477 Section 122B. (a) No insurer authorized to issue policies on the lives of persons in the
478commonwealth shall make a distinction or otherwise discriminate between persons, reject an
479applicant, cancel a policy or demand or require a higher rate of premium for reasons based solely
480upon the fact that an applicant or insured has or had a prescription for, purchased or otherwise
481possessed an opioid antagonist, as defined in section 19B of chapter 94C.
482 (b) A violation of this section shall constitute an unfair method of competition or unfair
483and deceptive act or practice pursuant to chapters 93A and 176D.
484 SECTION 12. Section 193U of said chapter 175, as appearing in the 2022 Official
485Edition, is hereby amended by striking out, in lines 21 to 26, inclusive, the words “or (iii)
486abusive litigation against a provider concerning reproductive health care services or gender-
487affirming health care services resulted in a judgment against the provider, if such health care
488services would be lawful and consistent with good medical practice as provided if they occurred
489entirely in the commonwealth” and inserting in place thereof the following words:- (iii) abusive
490litigation against a provider concerning reproductive health care services or gender-affirming
491health care services resulted in a judgment against the provider, if such health care services
492would be lawful and consistent with good medical practice as provided if they occurred entirely
493in the commonwealth; or (iv) the health care provider provides services at a harm reduction
494program. 24 of 31
495 SECTION 13. Chapter 176A of the General Laws is hereby amended by inserting after
496section 8VV the following 2 sections:-
497 Section 8WW. (a) Any contract between a subscriber and the corporation under an
498individual or group hospital service plan that is delivered, issued or renewed within the
499commonwealth shall provide coverage for prescribed or dispensed opioid antagonists, as defined
500in section 19B of chapter 94C and used in the reversal of overdoses caused by opioids, which
501shall not require prior authorization; provided, however, that a prescription from a health care
502practitioner shall not be required for coverage of opioid antagonists. An opioid antagonist used in
503the reversal of overdoses caused by opioids shall not be subject to any deductible, coinsurance,
504copayments or out-of-pocket limits; provided, however, that cost-sharing shall be required if the
505applicable plan is governed by the Internal Revenue Code and would lose its tax-exempt status
506as a result of the prohibition on cost-sharing for this service.
507 (b) Such contracts shall provide coverage for an opioid antagonist used in the reversal of
508overdoses caused by opioids as a medical benefit when dispensed by the health care facility in
509which the opioid antagonist was prescribed and shall provide coverage as a pharmacy benefit for
510an opioid antagonist used in the reversal of overdoses caused by opioids dispensed by a
511pharmacist, including an opioid antagonist dispensed pursuant to section 19B of chapter 94C;
512provided, however, that the rate to be reimbursed under the medical benefit shall not exceed the
513carrier’s average in-network pharmacy benefit rate and the health care facility shall not balance
514bill the patient.
515 Section 8XX. Any contract between a subscriber and the corporation under an individual
516or group hospital service plan that is delivered, issued or renewed within the commonwealth 25 of 31
517shall provide coverage for the provision of services by a recovery coach licensed or otherwise
518authorized to practice under chapter 111J, irrespective of the setting in which these services are
519provided; provided, however, that such services shall be within the lawful scope of practice of a
520recovery coach. The contractual rate for these services shall be not less than the prevailing
521MassHealth rate for recovery coach services. The benefits in this section shall not be subject to
522any deductible, coinsurance, copayments or out-of-pocket limits; provided, however, that cost-
523sharing shall be required if the applicable plan is governed by the Internal Revenue Code and
524would lose its tax-exempt status as a result of the prohibition on cost-sharing for this service.
525Recovery coach services shall not require prior authorization.
526 SECTION 14. Chapter 176B of the General Laws is hereby amended by inserting after
527section 4VV the following 2 sections:-
528 Section 4WW. (a) Any subscription certificate under an individual or group medical
529service agreement delivered, issued or renewed within the commonwealth, shall provide
530coverage for prescribed or dispensed opioid antagonists, as defined in section 19B of chapter
53194C and used in the reversal of overdoses caused by opioids, which shall not require prior
532authorization; provided, however, that a prescription from a health care practitioner shall not be
533required for coverage of opioid antagonists. An opioid antagonist used in the reversal of
534overdoses caused by opioids shall not be subject to any deductible, coinsurance, copayments or
535out-of-pocket limits; provided, however, that cost-sharing shall be required if the applicable plan
536is governed by the Internal Revenue Code and would lose its tax-exempt status as a result of the
537prohibition on cost-sharing for this service. 26 of 31
538 (b) The policy, contract, agreement, plan or certificate of insurance shall provide
539coverage for an opioid antagonist used in the reversal of overdoses caused by opioids as a
540medical benefit when dispensed by the health care facility in which the opioid antagonist was
541prescribed and shall provide coverage as a pharmacy benefit for an opioid antagonist used in the
542reversal of overdoses caused by opioids dispensed by a pharmacist, including an opioid
543antagonist dispensed pursuant to section 19B of chapter 94C; provided, however, that the rate to
544be reimbursed under the medical benefit shall not exceed the carrier’s average in-network
545pharmacy benefit rate and the health care facility shall not balance bill the patient.
546 Section 4XX. Any subscription certificate under an individual or group medical service
547agreement delivered, issued or renewed within the commonwealth shall provide coverage for the
548provision of services by a recovery coach licensed or otherwise authorized to practice under
549chapter 111J, irrespective of the setting in which these services are provided; provided, however,
550that such services shall be within the lawful scope of practice of a recovery coach. The
551contractual rate for these services shall be not less than the prevailing MassHealth rate for
552recovery coach services. The benefits in this section shall not be subject to any deductible,
553coinsurance, copayments or out-of-pocket limits; provided, however, that cost-sharing shall be
554required if the applicable plan is governed by the Internal Revenue Code and would lose its tax-
555exempt status as a result of the prohibition on cost-sharing for this service. Recovery coach
556services shall not require prior authorization.
557 SECTION 15. Chapter 176G of the General Laws is hereby amended by inserting after
558section 4NN the following 2 sections:- 27 of 31
559 Section 4OO. (a) An individual or group health maintenance contract that is issued or
560renewed within or without the commonwealth shall provide coverage for prescribed or dispensed
561opioid antagonists, as defined in section 19B of chapter 94C and used in the reversal of
562overdoses caused by opioids, which shall not require prior authorization; provided, however, that
563a prescription from a health care practitioner shall not be required for coverage of opioid
564antagonists. An opioid antagonist used in the reversal of overdoses caused by opioids shall not be
565subject to any deductible, coinsurance, copayments or out-of-pocket limits; provided, however,
566that cost-sharing shall be required if the applicable plan is governed by the Internal Revenue
567Code and would lose its tax-exempt status as a result of the prohibition on cost-sharing for this
568service.
569 (b) The individual or group health maintenance contract shall provide coverage for an
570opioid antagonist used in the reversal of overdoses caused by opioids as a medical benefit when
571dispensed by the health care facility in which the opioid antagonist was prescribed and shall
572provide coverage as a pharmacy benefit for an opioid antagonist used in the reversal of
573overdoses caused by opioids dispensed by a pharmacist, including an opioid antagonist
574dispensed pursuant to section 19B of chapter 94C; provided, however, that the rate to be
575reimbursed under the medical benefit shall not exceed the carrier’s average in-network pharmacy
576benefit rate and the health care facility shall not balance bill the patient.
577 Section 4PP. An individual or group health maintenance contract that is issued or
578renewed within or without the commonwealth shall provide coverage for the provision of
579services by a recovery coach licensed or otherwise authorized to practice under chapter 111J,
580irrespective of the setting in which these services are provided; provided, however, that such
581services shall be within the lawful scope of practice of a recovery coach. The contractual rate for 28 of 31
582these services shall be not less than the prevailing MassHealth rate for recovery coach services.
583The benefits in this section shall not be subject to any deductible, coinsurance, copayments or
584out-of-pocket limits; provided, however, that cost-sharing shall be required if the applicable plan
585is governed by the Internal Revenue Code and would lose its tax-exempt status as a result of the
586prohibition on cost-sharing for this service. Recovery coach services shall not require prior
587authorization.
588 SECTION 16. A “Certified Addictions Recovery Coach (CARC)” certification issued by
589the Massachusetts Board of Substance Abuse Counselor Certification or other comparable
590certifying body shall serve as satisfactory proof for recovery coach application requirements,
591including test exemptions, for a limited period following the effective date of this act as
592determined by the department of public health; provided, however, that the department shall
593waive the lived experience requirement for a recovery coach license pursuant to section 1 of
594chapter 111J of the General Laws for an applicant who was credentialed by the Massachusetts
595Board of Substance Abuse Counselor Certification prior to the effective date of this act. The
596eligible applicants shall meet all other qualifications and requirements for licensure as
597determined by the department. The department shall promulgate rules and regulations for the
598implementation of this section.
599 SECTION 17. (a) The department of public health shall study sober homes in the
600commonwealth, including the safety and recovery of sober home residents. The study shall
601include, but not be limited to: (i) appropriate training for operators and staff of sober homes and
602whether such training should be required; (ii) evidence-based methods to creating safe and health
603recovery environments; (iii) current oversight and additional oversight needed for sober homes;
604(iv) barriers to sober home facility improvements, including, but not limited to, fiscal constraints; 29 of 31
605and (v) different aspects, if any, between certified and noncertified sober homes. The department
606shall hold at least 1 public hearing as part of its study under this section.
607 (b) The department shall submit a report detailing the results of the study, along with
608recommendations and any proposed legislation necessary to carry out its recommendations, to
609the clerks of the senate and house of representatives, the joint committee on health care
610financing, the joint committee on public health, the joint committee on mental health, substance
611use and recovery and the senate and house committees on ways and means not later than July 31,
6122025.
613 SECTION 18. (a) There shall be a special commission to study prescribing practices for
614benzodiazepines and non-benzodiazepine hypnotics.
615 (b) The commission shall meet not less than 4 times and shall invite the public and
616medical experts in the field to offer testimony. The commission shall study and make
617recommendations on topics including, but not limited to: (i) current and best prescribing
618practices for benzodiazepines and non-benzodiazepine hypnotics; (ii) proper labeling of
619benzodiazepines and non-benzodiazepine hypnotics; and (iii) protocols to safely discontinue the
620use of benzodiazepines and non-benzodiazepine hypnotics and minimize the patient’s symptoms
621of withdrawal.
622 (c) The commission shall consist of: the commissioner of public health or a designee,
623who shall serve as chair; the secretary of health and human services or a designee; 4 members to
624be appointed by the governor, 1 of whom shall be a psychiatrist licensed to practice in the
625commonwealth, 1 of whom shall be a representative from the bureau of substance abuse services, 30 of 31
6261 of whom shall be a representative from the Center for Addiction Medicine at Massachusetts
627General Hospital and 1 of whom shall be an advocate from the addiction treatment community.
628 (d) The commission shall report its findings and recommendations, including any
629proposed legislation, to the clerks of the senate and the house of representatives, the joint
630committee on mental health, substance use and recovery and the senate and house committees on
631ways and means not later than 1 year after the commission’s first meeting.
632 SECTION 19. (a) The bureau of substance use addiction services shall conduct a study
633on the potential benefits of expanding collaborative practice agreements between physicians and
634pharmacists to allow for the prescription of schedule II to VI, inclusive, controlled substances by
635pharmacists outside of the hospital or health care institution setting to treat patients with
636substance use disorders.
637 (b) The bureau shall study and report on: (i) collaborative practice agreements between
638physicians and pharmacists for the prescription of substances in collaborative practice
639agreements in other states; and (ii) the positive and negative impacts of allowing a collaborative
640practice agreement for schedule II to VI, inclusive, controlled substances.
641 (c) The department shall submit a report detailing the results of the study, along with
642recommendations and any proposed legislation necessary to carry out its recommendations, to
643the clerks of the senate and house of representatives, the joint committee on mental health,
644substance use and recovery, the joint committee on public health and the senate and house
645committees on ways and means not later than January 1, 2025.
646 SECTION 20. The department of public health shall issue regulations pursuant to section
6477 not later than 6 months after the effective date of this act. 31 of 31
648 SECTION 21. Sections 1, 9, 10, 13, 14 and 15 shall take effect 6 months after the
649effective date of this act.
650 SECTION 22. No person shall be found to have violated section 4 of chapter 111J of the
651General Laws until 6 months after the department of public health first establishes a recovery
652coach license pursuant to section 2 of said chapter 111J.