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