Massachusetts 2023-2024 Regular Session

Massachusetts Senate Bill S662 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. 2105 FILED ON: 1/20/2023
3	3	SENATE . . . . . . . . . . . . . . No. 662
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 providing access to full spectrum addiction treatment services.
13	13	_______________
14	14	PETITION OF:
15	15	NAME:DISTRICT/ADDRESS :John F. KeenanNorfolk and PlymouthAdam Scanlon14th Bristol1/20/2023Michael J. BarrettThird Middlesex1/31/2023James B. EldridgeMiddlesex and Worcester2/17/2023 1 of 11
16	16	SENATE DOCKET, NO. 2105 FILED ON: 1/20/2023
17	17	SENATE . . . . . . . . . . . . . . No. 662
18	18	By Mr. Keenan, a petition (accompanied by bill, Senate, No. 662) of John F. Keenan, Adam
19	19	Scanlon, Michael J. Barrett and James B. Eldridge for legislation to provide access to full
20	20	spectrum addiction treatment services. Financial Services.
21	21	[SIMILAR MATTER FILED IN PREVIOUS SESSION
22	22	SEE SENATE, NO. 1292 OF 2021-2022.]
23	23	The Commonwealth of Massachusetts
24	24	_______________
25	25	In the One Hundred and Ninety-Third General Court
26	26	(2023-2024)
27	27	_______________
28	28	An Act providing access to full spectrum addiction treatment services.
29	29	Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
30	30	of the same, as follows:
31	31	1 SECTION 1. Section 17N of chapter 32A of the General Laws, as appearing in the 2020
32	32	2Official Edition, is hereby amended by inserting after the definition of “Clinical stabilization
33	33	3services” the following definition:-
34	34	4 “Transitional support services”, short-term, residential support services, as defined by the
35	35	5department of public health, usually following clinical stabilization services, which provide a
36	36	6safe and structured environment to support adults or adolescents through the addiction recovery
37	37	7process and the transition to outpatient or other step-down addiction recovery care.
38	38	8 SECTION 2. Section 17N of chapter 32A is further amended by striking out the fourth
39	39	9paragraph and inserting in place thereof the following paragraph:- 2 of 11
40	40	10 The commission shall provide for medically necessary acute treatment services,
41	41	11medically necessary clinical stabilization services and medically necessary transitional support
42	42	12services to an active or retired employee of the commonwealth who is insured under the group
43	43	13insurance commission coverage for up to 30 days and shall not require preauthorization prior to
44	44	14obtaining such acute treatment services, clinical stabilization services or transitional support
45	45	15services. The facility providing such services shall notify the carrier of admission and the initial
46	46	16treatment plan within 48 hours of admission, and within a reasonable time thereafter, shall
47	47	17provide the carrier with a projected discharge plan for the member. The carrier’s utilization
48	48	18review procedures may be initiated on day 14; provided, however, that a carrier shall not make
49	49	19any utilization review decisions that impose any restriction or deny any future medically
50	50	20necessary acute treatment, clinical stabilization or transitional support services unless a patient
51	51	21has received at least 30 consecutive days of said services; and, provided further, that the
52	52	22commission shall provide, without preauthorization, to any active or retired employee of the
53	53	23commonwealth who is insured under the group insurance commission coverage for substance use
54	54	24disorder evaluations ordered pursuant to section 51½ of chapter 111. Upon receipt of notification
55	55	25by the admitting facility and receipt of the discharge plan, the carrier may provide outreach to the
56	56	26treating clinician and member to offer care management and support services.
57	57	27 Medical necessity shall be determined by the treating clinician in consultation with the
58	58	28patient and noted in the patient’s medical record.
59	59	29 SECTION 3. Section 10H of chapter 118E of the General Laws, inserted by section 19 of
60	60	30chapter 258 of the acts of 2014, is hereby repealed. 3 of 11
61	61	31 SECTION 4. Said chapter 118E is hereby further amended by inserting after section 10N
62	62	32the following section:-
63	63	33 Section 10O. For the purposes of this section, the following words shall have the
64	64	34following meanings unless the context clearly requires otherwise:
65	65	35 “Acute treatment services”, 24-hour medically supervised addiction treatment for adults
66	66	36or adolescents provided in a medically managed or medically monitored inpatient facility, as
67	67	37defined by the department of public health, which provides evaluation and withdrawal
68	68	38management and that may include biopsychosocial assessment, individual and group counseling,
69	69	39psychoeducational groups and discharge planning.
70	70	40 “Clinical stabilization services”, 24-hour clinically managed post detoxification treatment
71	71	41for adults or adolescents, as defined by the department of public health, usually following acute
72	72	42treatment services for substance abuse for individuals beginning to engage in recovery from
73	73	43addiction, which may include intensive education and counseling regarding the nature of
74	74	44addiction and its consequences, relapse prevention, outreach to families and significant others
75	75	45and aftercare planning, for individuals beginning to engage in recovery from addiction.
76	76	46 “Transitional support services”, short-term, residential support services, as defined by the
77	77	47department of public health, usually following clinical stabilization services, which provide a
78	78	48safe and structured environment to support adults or adolescents through the addiction recovery
79	79	49process and the transition to outpatient or other step-down addiction recovery care.
80	80	50 The division and its contracted health insurers, health plans, health maintenance
81	81	51organizations, behavioral health management firms and third-party administrators under contract
82	82	52to a Medicaid managed care organization or primary care clinician plan shall cover the cost of 4 of 11
83	83	53medically necessary acute treatment services and shall not require preauthorization prior to
84	84	54obtaining treatment.
85	85	55 The division and its contracted health insurers, health plans, health maintenance
86	86	56organizations, behavioral health management firms and third-party administrators under contract
87	87	57to a Medicaid managed care organization or primary care clinician plan shall cover the cost of
88	88	58medically necessary clinical stabilization services and medically necessary transitional support
89	89	59services for up to 30 days and shall not require preauthorization prior to obtaining clinical
90	90	60stabilization services or transitional support services. The facility providing such services shall
91	91	61notify the carrier of admission and the initial treatment plan within 48 hours of admission and
92	92	62within a reasonable time thereafter shall provide the carrier with a projected discharge plan for
93	93	63the member. The carrier’s utilization review procedures may be initiated on day 14; provided,
94	94	64however, that a carrier shall not make any utilization review decisions that impose any restriction
95	95	65or deny any future medically necessary acute treatment, clinical stabilization or transitional
96	96	66support services unless a patient has received at least 30 consecutive days of said services; and,
97	97	67provided further, that the division and its contracted health insurers, health plans, health
98	98	68maintenance organizations, behavioral health management firms and third party administrators
99	99	69under contract to a Medicaid managed care organization or primary care clinician plan shall
100	100	70cover, without preauthorization, substance use disorder evaluations ordered pursuant to section
101	101	7151½ of chapter 111. Upon receipt of notification by the admitting facility and receipt of the
102	102	72discharge plan, the carrier may provide outreach to the treating clinician and member to offer
103	103	73care management and support services.
104	104	74 Medical necessity shall be determined by the treating clinician in consultation with the
105	105	75patient and noted in the patient’s medical record. 5 of 11
106	106	76 SECTION 5. Section 47GG of chapter 175 is hereby amended by inserting after the
107	107	77definition of “Clinical stabilization services” the following definition:-
108	108	78 “Transitional support services”, short-term, residential support services, as defined by the
109	109	79department of public health, usually following clinical stabilization services, which provide a
110	110	80safe and structured environment to support adults or adolescents through the addiction recovery
111	111	81process and the transition to outpatient or other step-down addiction recovery care.
112	112	82 SECTION 6. Section 47GG of said chapter 175 is hereby further amended by striking out
113	113	83the fourth paragraph and inserting in place thereof the following paragraph:-
114	114	84 Any policy, contract, agreement, plan or certificate of insurance issued, delivered or
115	115	85renewed within the commonwealth, which is considered creditable coverage under section 1 of
116	116	86chapter 111M, shall provide coverage for medically necessary acute treatment services,
117	117	87medically necessary clinical stabilization services and medically necessary transitional support
118	118	88services for up to 30 days and shall not require preauthorization prior to obtaining acute
119	119	89treatment services, clinical stabilization services or transitional support services. The facility
120	120	90providing such services shall provide the carrier notification of admission and the initial
121	121	91treatment plan within 48 hours of admission and within a reasonable time thereafter shall provide
122	122	92the carrier with a projected discharge plan for the member. The carrier’s utilization review
123	123	93procedures may be initiated on day 14; provided, however, that a carrier shall not make any
124	124	94utilization review decisions that impose any restriction or deny any future medically necessary
125	125	95acute treatment, clinical stabilization or transitional support services unless a patient has received
126	126	96at least 30 consecutive days of said services; provided further, any policy, contract, agreement,
127	127	97plan or certificate of insurance issued, delivered or renewed within the commonwealth, which is 6 of 11
128	128	98considered creditable coverage pursuant to section 1 of chapter 111M, shall cover, without
129	129	99preauthorization, a substance use disorder evaluation ordered pursuant to section 51½ of chapter
130	130	100111. Upon receipt of notification by the admitting facility and receipt of the discharge plan, the
131	131	101carrier may provide outreach to the treating clinician and member to offer care management and
132	132	102support services.
133	133	103 Medical necessity shall be determined by the treating clinician in consultation with the
134	134	104patient and noted in the patient’s medical record.
135	135	105 SECTION 7. Section 8II of chapter 176A is hereby amended by inserting after the
136	136	106definition of “Clinical stabilization services” the following definition:-
137	137	107 “Transitional support services”, short-term, residential support services, as defined by the
138	138	108department of public health, usually following clinical stabilization services, which provide a
139	139	109safe and structured environment to support adults or adolescents through the addiction recovery
140	140	110process and the transition to outpatient or other step-down addiction recovery care.
141	141	111 SECTION 8. Section 8II of said chapter 176A is hereby further amended by striking out
142	142	112the fourth paragraph and inserting in place thereof the following paragraph:-
143	143	113 Any contract between a subscriber and the corporation under an individual or group
144	144	114hospital service plan that is delivered, issued or renewed within the commonwealth shall provide
145	145	115coverage for medically necessary acute treatment services, medically necessary clinical
146	146	116stabilization services and medically necessary transitional support services for up to 30 days and
147	147	117shall not require preauthorization prior to obtaining acute treatment services, clinical stabilization
148	148	118services or transitional support services. The facility providing such services shall provide the
149	149	119carrier notification of admission and the initial treatment plan within 48 hours of admission and 7 of 11
150	150	120within a reasonable time thereafter shall provide the carrier with a projected discharge plan for
151	151	121the member. The carrier’s utilization review procedures may be initiated on day 14; provided,
152	152	122however, that a carrier shall not make any utilization review decisions that impose any restriction
153	153	123or deny any future medically necessary acute treatment, clinical stabilization or transitional
154	154	124support services unless a patient has received at least 30 consecutive days of said services;
155	155	125provided further, any contract between a subscriber and the corporation under an individual or
156	156	126group hospital service plan that is delivered, issued or renewed within the commonwealth, shall
157	157	127cover, without preauthorization, a substance use disorder evaluation ordered pursuant to section
158	158	12851½ of chapter 111. Upon receipt of notification by the admitting facility and receipt of the
159	159	129discharge plan, the carrier may provide outreach to the treating clinician and member to offer
160	160	130care management and support services.
161	161	131 Medical necessity shall be determined by the treating clinician in consultation with the
162	162	132patient and noted in the patient’s medical record.
163	163	133 SECTION 9. Section 4II of chapter 176B is hereby amended by inserting after the
164	164	134definition of “Clinical stabilization services” the following definition:-
165	165	135 “Transitional support services”, short-term, residential support services, as defined by the
166	166	136department of public health, usually following clinical stabilization services, which provide a
167	167	137safe and structured environment to support adults or adolescents through the addiction recovery
168	168	138process and the transition to outpatient or other step-down addiction recovery care.
169	169	139 SECTION 10. Section 4II of said chapter 176B is hereby further amended by striking out
170	170	140the fourth paragraph and inserting in place thereof the following paragraph:- 8 of 11
171	171	141 Any subscription certificate under an individual or group medical service agreement
172	172	142delivered, issued or renewed within the commonwealth shall provide coverage for medically
173	173	143necessary acute treatment services, medically necessary clinical stabilization services and
174	174	144medically necessary transitional support services for up to 30 days and shall not require
175	175	145preauthorization prior to obtaining acute treatment services, clinical stabilization services or
176	176	146transitional support services. The facility providing such services shall provide the carrier
177	177	147notification of admission and the initial treatment plan within 48 hours of admission and within a
178	178	148reasonable time thereafter shall provide the carrier with a projected discharge plan for the
179	179	149member. The carrier’s utilization review procedures may be initiated on day 14; provided,
180	180	150however, that a carrier shall not make any utilization review decisions that impose any restriction
181	181	151or deny any future medically necessary acute treatment, clinical stabilization or transitional
182	182	152support services unless a patient has received at least 30 consecutive days of said services;
183	183	153provided further, any subscription certificate under an individual or group medical service
184	184	154agreement delivered, issued or renewed within the commonwealth shall provide coverage for,
185	185	155without preauthorization, a substance use disorder evaluation ordered pursuant to section 51½ of
186	186	156chapter 111. Upon receipt of notification by the admitting facility and receipt of the discharge
187	187	157plan, the carrier may provide outreach to the treating clinician and member to offer care
188	188	158management and support services.
189	189	159 Medical necessity shall be determined by the treating clinician in consultation with the
190	190	160patient and noted in the patient’s medical record.
191	191	161 SECTION 11. Section 4AA of chapter 176G is hereby amended by inserting after the
192	192	162definition of “Clinical stabilization services” the following definition:- 9 of 11
193	193	163 “Transitional support services”, short-term, residential support services, as defined by the
194	194	164department of public health, usually following clinical stabilization services, which provide a
195	195	165safe and structured environment to support adults or adolescents through the addiction recovery
196	196	166process and the transition to outpatient or other step-down addiction recovery care.
197	197	167 SECTION 12. Said section 4AA is hereby further amended by striking out the fourth
198	198	168paragraph and inserting in place thereof the following paragraph:-
199	199	169 An individual or group health maintenance contract that is issued or renewed shall
200	200	170provide coverage for medically necessary acute treatment services, medically necessary clinical
201	201	171stabilization services and medically necessary transitional support services for up to 30 days and
202	202	172shall not require preauthorization prior to obtaining acute treatment services, clinical stabilization
203	203	173services or transitional support services. The facility providing such services shall provide the
204	204	174carrier notification of admission and the initial treatment plan within 48 hours of admission and
205	205	175within a reasonable time thereafter shall provide the carrier with a projected discharge plan for
206	206	176the member. The carrier’s utilization review procedures may be initiated on day 14; provided,
207	207	177however, that a carrier shall not make any utilization review decisions that impose any restriction
208	208	178or deny any future medically necessary acute treatment, clinical stabilization or transitional
209	209	179support services unless a patient has received at least 30 consecutive days of said services;
210	210	180provided further, an individual or group health maintenance contract that is issued or renewed
211	211	181shall provide coverage for, without preauthorization, a substance abuse evaluation ordered
212	212	182pursuant to section 51½ of chapter 111. Upon receipt of notification by the admitting facility and
213	213	183receipt of the discharge plan, the carrier may provide outreach to the treating clinician and
214	214	184member to offer care management and support services. 10 of 11
215	215	185 Medical necessity shall be determined by the treating clinician in consultation with the
216	216	186patient and noted in the patient’s medical record.
217	217	187 SECTION 13. The center for health information and analysis, in consultation with the
218	218	188division of insurance, the department of public health, the office of Medicaid and the health
219	219	189policy commission, shall conduct reviews on the 14 day mandated coverage of acute treatment
220	220	190services, clinical stabilization services and the long-term effects of the increase in covered days
221	221	191from 14 days to 30 days related to the mandated benefits for acute treatment services, clinical
222	222	192stabilization services and transitional support services on the following areas: (i) the continuum
223	223	193of care for substance use disorder treatment; (ii) access to the continuum of care for patients
224	224	194eligible for MassHealth and department of public health programs; (iii) access to the continuum
225	225	195of care for commercially insured patients; and (iv) any changes in costs to MassHealth, the
226	226	196department of public health and health insurance carriers. The center shall provide an initial
227	227	197report not later than October 1, 2024 on the effects of the 14 day mandated coverage of acute
228	228	198treatment services and clinical stabilization services to the areas listed above and a final report
229	229	199not later than October 1, 2026 on the effects of the 30 day mandated coverage of acute treatment
230	230	200services, clinical stabilization services and transitional support services to the areas listed above.
231	231	201 The initial report and final report shall be posted on the center’s website and shall be filed
232	232	202with the clerks of the house of representatives and senate, the house and senate chairs of the
233	233	203committee on financial services, the house and senate chairs of the committee on health care
234	234	204financing, the house and senate chairs of the committee on public health and the house and
235	235	205senate committees on ways and means not later than October 1, 2024 and October 1, 2026,
236	236	206respectively. 11 of 11
237	237	207 SECTION 14. Sections 1 through 12, inclusive, shall take effect October 1, 2024.