Massachusetts 2023-2024 Regular Session

Massachusetts Senate Bill S658 Compare Versions

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

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1	1	1 of 1
2	2	SENATE DOCKET, NO. 2003 FILED ON: 1/20/2023
3	3	SENATE . . . . . . . . . . . . . . No. 658
4	4	The Commonwealth of Massachusetts
5	5	_________________
6	6	PRESENTED BY:
7	7	John F. Keenan
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 dual diagnosis treatment coverage.
13	13	_______________
14	14	PETITION OF:
15	15	NAME:DISTRICT/ADDRESS :John F. KeenanNorfolk and PlymouthJames B. EldridgeMiddlesex and Worcester3/6/2023 1 of 9
16	16	SENATE DOCKET, NO. 2003 FILED ON: 1/20/2023
17	17	SENATE . . . . . . . . . . . . . . No. 658
18	18	By Mr. Keenan, a petition (accompanied by bill, Senate, No. 658) of John F. Keenan and James
19	19	B. Eldridge for legislation relative to dual diagnosis treatment coverage. Financial Services.
20	20	[SIMILAR MATTER FILED IN PREVIOUS SESSION
21	21	SEE SENATE, NO. 685 OF 2021-2022.]
22	22	The Commonwealth of Massachusetts
23	23	_______________
24	24	In the One Hundred and Ninety-Third General Court
25	25	(2023-2024)
26	26	_______________
27	27	An Act relative to dual diagnosis treatment coverage.
28	28	Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
29	29	of the same, as follows:
30	30	1 SECTION 1. Chapter 32A of the General Laws, as appearing in the 2020 Official
31	31	2Edition, is hereby amended by striking out section 17N and inserting in place thereof the
32	32	3following section:-
33	33	4 Section 17N. "Acute treatment services'', 24-hour medically supervised addiction
34	34	5treatment for adults or adolescents provided in a medically managed or medically monitored
35	35	6inpatient facility, as defined by the department of public health, which provides evaluation and
36	36	7withdrawal management and that may include biopsychosocial assessment, individual and group
37	37	8counseling, psychoeducational groups and discharge planning.
38	38	9 “Clinical stabilization services”, 24-hour clinically managed post detoxification treatment
39	39	10for adults or adolescents, as defined by the department of public health, usually following acute 2 of 9
40	40	11treatment services for substance use, which may include intensive education and counseling
41	41	12regarding the nature of addiction and its consequences, relapse prevention, outreach to families
42	42	13and significant others and aftercare planning, for individuals beginning to engage in recovery
43	43	14from addiction.
44	44	15 “Co-occurring treatment services”, inpatient medically monitored detoxification
45	45	16treatment for adults or adolescents provided in an inpatient psychiatric facility or an inpatient
46	46	17psychiatric unit within a general hospital, licensed by the department of mental health.
47	47	18 The commission shall provide to any active or retired employee of the commonwealth
48	48	19who is insured under the group insurance commission coverage for medically necessary acute
49	49	20treatment services, medically necessary clinical stabilization services, and medically necessary
50	50	21co-occurring treatment services for up to a total of 14 days and shall not require preauthorization
51	51	22prior to obtaining such acute treatment services, clinical stabilization services, or co-occurring
52	52	23treatment services; provided, that the facility shall notify the carrier of both admission and the
53	53	24initial treatment plan within 48 hours of admission; provided further, that utilization review
54	54	25procedures may be in initiated on day 7; and provided further, that the commission shall provide
55	55	26to any active or retired employee of the commonwealth who is insured under the group insurance
56	56	27commission coverage for, without preauthorization, substance use disorder evaluations ordered
57	57	28pursuant to section 51 1/2 of chapter 111.
58	58	29 Medical necessity shall be determined by the treating clinician in consultation with the
59	59	30patient and noted in the patient's medical record.
60	60	31 SECTION 2. Chapter 118E of the General Laws is hereby amended by striking out
61	61	32section 10H and inserting in place thereof the following section:- 3 of 9
62	62	33 Section 10H. "Acute treatment services'', 24-hour medically supervised addiction
63	63	34treatment for adults or adolescents provided in a medically managed or medically monitored
64	64	35inpatient facility, as defined by the department of public health, which provides evaluation and
65	65	36withdrawal management and that may include biopsychosocial assessment, individual and group
66	66	37counseling, psychoeducational groups and discharge planning.
67	67	38 "Clinical stabilization services'', 24-hour clinically managed post detoxification treatment
68	68	39for adults or adolescents, as defined by the department of public health, usually following acute
69	69	40treatment services for substance use, which may include intensive education and counseling
70	70	41regarding the nature of addiction and its consequences, relapse prevention, outreach to families
71	71	42and significant others and aftercare planning, for individuals beginning to engage in recovery
72	72	43from addiction.
73	73	44 “Co-occurring treatment services”, inpatient medically monitored detoxification
74	74	45treatment for adults or adolescents provided in an inpatient psychiatric facility or an inpatient
75	75	46psychiatric unit within a general hospital, licensed by the department of mental health.
76	76	47 The division and its contracted health insurers, health plans, health maintenance
77	77	48organizations, behavioral health management firms and third party administrators under contract
78	78	49to a Medicaid managed care organization or primary care clinician plan shall cover the cost of
79	79	50medically necessary acute treatment services and shall not require a preauthorization prior to
80	80	51obtaining treatment.
81	81	52 The division and its contracted health insurers, health plans, health maintenance
82	82	53organizations, behavioral health management firms and third party administrators under contract
83	83	54to a Medicaid managed care organization or primary care clinician plan shall cover the cost of 4 of 9
84	84	55medically necessary clinical stabilization services and co-occurring treatment services for up to
85	85	5614 days and shall not require preauthorization prior to obtaining clinical stabilization services
86	86	57and co-occurring treatment services; provided, that the facility shall provide the carrier both
87	87	58notification of admission and the initial treatment plan within 48 hours of admission; provided
88	88	59further, that utilization review procedures may be initiated on day 7; and provided further, that
89	89	60the division and its contracted health insurers, health plans, health maintenance organizations,
90	90	61behavioral health management firms and third party administrators under contract to a Medicaid
91	91	62managed care organization or primary care clinician plan shall cover, without preauthorization,
92	92	63substance use disorder evaluations ordered pursuant to section 51 1/2 of chapter 111.
93	93	64 Medical necessity shall be determined by the treating clinician in consultation with the
94	94	65patient and noted in the patient's medical record.
95	95	66 SECTION 3. Chapter 175 of the General Laws is hereby amended by striking out section
96	96	6747GG and inserting in place thereof the following section:-
97	97	68 Section 47GG. "Acute treatment services'', 24-hour medically supervised addiction
98	98	69treatment for adults or adolescents provided in a medically managed or medically monitored
99	99	70inpatient facility, as defined by the department of public health, which provides evaluation and
100	100	71withdrawal management and that may include biopsychosocial assessment, individual and group
101	101	72counseling, psychoeducational groups and discharge planning.
102	102	73 "Clinical stabilization services'', 24-hour clinically managed post detoxification treatment
103	103	74for adults or adolescents, as defined by the department of public health, usually following acute
104	104	75treatment services for substance use, which may include intensive education and counseling
105	105	76regarding the nature of addiction and its consequences, relapse prevention, outreach to families 5 of 9
106	106	77and significant others and aftercare planning, for individuals beginning to engage in recovery
107	107	78from addiction.
108	108	79 “Co-occurring treatment services”, inpatient medically monitored detoxification
109	109	80treatment for adults or adolescents provided in an inpatient psychiatric facility or an inpatient
110	110	81psychiatric unit within a general hospital, licensed by the department of mental health.
111	111	82 Any policy, contract, agreement, plan or certificate of insurance issued, delivered or
112	112	83renewed within the commonwealth, which is considered creditable coverage under section 1 of
113	113	84chapter 111M, shall provide coverage for medically necessary acute treatment services,
114	114	85medically necessary clinical stabilization services and medically necessary co-occurring
115	115	86treatment services for up to a total of 14 days and shall not require preauthorization prior to
116	116	87obtaining acute treatment services, clinical stabilization services, or co-occurring treatment
117	117	88services; provided, that the facility shall notify the carrier of both admission and the initial
118	118	89treatment plan within 48 hours of admission; provided further, that utilization review procedures
119	119	90may be initiated on day 7; provided further that any policy, contract, agreement, plan or
120	120	91certificate of insurance issued, delivered or renewed within the commonwealth, which is
121	121	92considered creditable coverage pursuant to section 1 of chapter 111M, shall cover, without
122	122	93preauthorization, a substance use disorder evaluation ordered pursuant to section 51 1/2 of
123	123	94chapter 111.
124	124	95 Medical necessity shall be determined by the treating clinician in consultation with the
125	125	96patient and noted in the patient's medical record.
126	126	97 SECTION 4. Chapter 176A of the General Laws, as so appearing, is hereby amended by
127	127	98striking out section 8II and inserting in place thereof the following section:- 6 of 9
128	128	99 Section 8II. "Acute treatment services'', 24-hour medically supervised addiction treatment
129	129	100for adults or adolescents provided in a medically managed or medically monitored inpatient
130	130	101facility, as defined by the department of public health, which provides evaluation and withdrawal
131	131	102management and that may include biopsychosocial assessment, individual and group counseling,
132	132	103psychoeducational groups and discharge planning.
133	133	104  "Clinical stabilization services'', 24-hour clinically managed post detoxification treatment
134	134	105for adults or adolescents, as defined by the department of public health, usually following acute
135	135	106treatment services for substance use, which may include intensive education and counseling
136	136	107regarding the nature of addiction and its consequences, relapse prevention, outreach to families
137	137	108and significant others and aftercare planning, for individuals beginning to engage in recovery
138	138	109from addiction.
139	139	110 “Co-occurring treatment services”, inpatient medically monitored detoxification
140	140	111treatment for adults or adolescents provided in an inpatient psychiatric facility or an inpatient
141	141	112psychiatric unit within a general hospital, licensed by the department of mental health.
142	142	113 Any contract between a subscriber and the corporation under an individual or group
143	143	114hospital service plan that is delivered, issued or renewed within the commonwealth shall provide
144	144	115coverage for medically necessary acute treatment services, medically necessary clinical
145	145	116stabilization services, and medically necessary co-occurring treatment services for up to a total of
146	146	11714 days and shall not require preauthorization prior to obtaining acute treatment services, clinical
147	147	118stabilization services, or co-occurring treatment services; provided, that the facility shall notify
148	148	119the carrier of both admission and the initial treatment plan within 48 hours of admission;
149	149	120provided further, that utilization review procedures may be initiated on day 7; provided further, 7 of 9
150	150	121any contract between a subscriber and the corporation under an individual or group hospital
151	151	122service plan that is delivered, issued or renewed within the commonwealth, shall cover, without
152	152	123preauthorization, a substance use disorder evaluation ordered pursuant to section 51 1/2 of
153	153	124chapter 111.
154	154	125 Medical necessity shall be determined by the treating clinician in consultation with the
155	155	126patient and noted in the patient's medical record.
156	156	127 SECTION 5. Chapter 176B of the General Laws, as so appearing, is hereby amended by
157	157	128striking out section 4II and inserting in place thereof the following section:-
158	158	129 Section 4II. "Acute treatment services'', 24-hour medically supervised addiction treatment
159	159	130for adults or adolescents provided in a medically managed or medically monitored inpatient
160	160	131facility, as defined by the department of public health, which provides evaluation and withdrawal
161	161	132management and that may include biopsychosocial assessment, individual and group counseling,
162	162	133psychoeducational groups and discharge planning.
163	163	134  "Clinical stabilization services'', 24-hour clinically managed post detoxification treatment
164	164	135for adults or adolescents, as defined by the department of public health, usually following acute
165	165	136treatment services for substance use, which may include intensive education and counseling
166	166	137regarding the nature of addiction and its consequences, relapse prevention, outreach to families
167	167	138and significant others and aftercare planning, for individuals beginning to engage in recovery
168	168	139from addiction.
169	169	140 “Co-occurring treatment services”, inpatient medically monitored detoxification
170	170	141treatment for adults or adolescents provided in an inpatient psychiatric facility or an inpatient
171	171	142psychiatric unit within a general hospital, licensed by the department of mental health. 8 of 9
172	172	143 Any subscription certificate under an individual or group medical service agreement
173	173	144delivered, issued or renewed within the commonwealth shall provide coverage for medically
174	174	145necessary acute treatment services, medically necessary clinical stabilization services, and
175	175	146medically necessary co-occurring treatment services for up to a total of 14 days and shall not
176	176	147require preauthorization prior to obtaining acute treatment services, clinical stabilization services
177	177	148or co-occurring treatment services; provided, that the facility shall provide the carrier both
178	178	149notification of admission and the initial treatment plan within 48 hours of admission; provided
179	179	150further, that utilization review procedures may be initiated on day 7; provided further, any
180	180	151subscription certificate under an individual or group medical service agreement delivered, issued
181	181	152or renewed within the commonwealth shall provide coverage for, without preauthorization, a
182	182	153substance use disorder evaluation ordered pursuant to section 51 1/2 of chapter 111.
183	183	154 Medical necessity shall be determined by the treating clinician in consultation with the
184	184	155patient and noted in the patient's medical record.
185	185	156 SECTION 6. Chapter 176G as so appearing, is hereby amended by striking out section
186	186	1574AA and inserting in place thereof the following section:-
187	187	158 Section 4AA. "Acute treatment services'', 24-hour medically supervised addiction
188	188	159treatment for adults or adolescents provided in a medically managed or medically monitored
189	189	160inpatient facility, as defined by the department of public health, that provides evaluation and
190	190	161withdrawal management and which may include biopsychosocial assessment, individual and
191	191	162group counseling, psychoeducational groups and discharge planning.
192	192	163 "Clinical stabilization services'', 24-hour clinically managed post detoxification treatment
193	193	164for adults or adolescents, as defined by the department of public health, usually following acute 9 of 9
194	194	165treatment services for substance use, which may include intensive education and counseling
195	195	166regarding the nature of addiction and its consequences, relapse prevention, outreach to families
196	196	167and significant others and aftercare planning, for individuals beginning to engage in recovery
197	197	168from addiction.
198	198	169 “Co-occurring treatment services”, inpatient medically monitored detoxification
199	199	170treatment for adults or adolescents provided in an inpatient psychiatric facility or an inpatient
200	200	171psychiatric unit within a general hospital, licensed by the department of mental health.
201	201	172 An individual or group health maintenance contract that is issued or renewed shall
202	202	173provide coverage for medically necessary acute treatment services, medically necessary clinical
203	203	174stabilization services, and medically necessary co-occurring treatment services for up to a total of
204	204	17514 days and shall not require preauthorization prior to obtaining acute treatment services, clinical
205	205	176stabilization services, or co-occurring treatment services; provided, that the facility shall provide
206	206	177the carrier both notification of admission and the initial treatment plan within 48 hours of
207	207	178admission; provided further, that utilization review procedures may be initiated on day 7;
208	208	179provided further, an individual or group health maintenance contract that is issued or renewed
209	209	180shall provide coverage for, without preauthorization, a substance use disorder evaluation ordered
210	210	181pursuant to section 51 1/2 of chapter 111.
211	211	182 Medical necessity shall be determined by the treating clinician in consultation with the
212	212	183patient and noted in the patient's medical record.