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SENATE DOCKET, NO. 1146 FILED ON: 1/18/2023
SENATE . . . . . . . . . . . . . . No. 81
The Commonwealth of Massachusetts
_________________
PRESENTED BY:
Paul R. Feeney
_________________
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 requiring licensure for use of graduated electronic decelerators.
_______________
PETITION OF:
NAME:DISTRICT/ADDRESS :Paul R. FeeneyBristol and NorfolkHannah Kane11th Worcester1/25/2023 1 of 17
SENATE DOCKET, NO. 1146 FILED ON: 1/18/2023
SENATE . . . . . . . . . . . . . . No. 81
By Mr. Feeney, a petition (accompanied by bill, Senate, No. 81) of Paul R. Feeney and Hannah
Kane for legislation relative to licensure for the use of graduated electronic decelerators to alter
behavior of persons with disabilities. Children, Families and Persons with Disabilities.
[SIMILAR MATTER FILED IN PREVIOUS SESSION
SEE HOUSE, NO. 4956 OF 2021-2022.]
The Commonwealth of Massachusetts
_______________
In the One Hundred and Ninety-Third General Court
(2023-2024)
_______________
An Act requiring licensure for use of graduated electronic decelerators.
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 edition,
2is hereby amended by inserting after section 17R the following section:-
3 Section 17S. (a) For purposes of this section, the following terms shall have the following
4meanings:-
5 “Acquired brain injury (ABI)” is any injury to the brain which occurs after birth and can
6be caused by infectious diseases, metabolic disorders, endocrine disorders or diminished oxygen,
7brain tumors, toxins, disease that affects the blood supply to the brain, stroke or a traumatic brain
8injury. 2 of 17
9 “Cognitive communication therapy” treats problems with communication which have an
10underlying cause in a cognitive deficit rather than a primary language or speech deficit.
11 “Cognitive rehabilitation therapy (CRT)” is a process of re-learning cognitive skills
12essential for daily living through the coordinated specialized, integrated therapeutic treatments
13which are provided in dynamic settings designed for efficient and effective re-learning following
14damage to brain cells or brain chemistry due to brain injury.
15 “Community reintegration services” provide incremental guided real-world therapeutic
16training to develop skills essential for an individual to participate in life: to re-enter employment;
17to go to school and engage in other productive activity; to safely live independently; and to
18participate in their community while avoiding re-hospitalization and long-term support needs.
19 “Functional rehabilitation therapy and remediation” is a structured approach to
20rehabilitation for brain disorders which emphasizes learning by doing, and focuses re-learning a
21specific task in a prescribed format, with maximum opportunity for repeated correct practice.
22Compensatory strategies are developed for those skills which are persistently impaired and
23individuals are trained on daily implementation. To ensure acquisition and use, focus is set on re-
24learning those skills essential for safe daily living in the environment in which they will be used:
25home and community settings.
26 “Medical necessity” or “medically necessary,” health care services that are consistent
27with generally accepted principles of professional medical practice.
28 “Neurobehavioral therapy” is a set of medical and therapeutic assessment and treatments
29focused on behavioral impairments associated with brain disease or injury and the amelioration
30of these impairments through the development of pro-social behavior. 3 of 17
31 “Neurocognitive therapy” is treatment of disorders in which the primary clinical deficit is
32in cognitive function which has not been present since birth and is a decline from a previously
33attained level of function.
34 “Neurofeedback therapy” is a direct training of brain function to enhance self-regulatory
35capacity or an individual’s ability to exert control over behavior, thoughts and feelings. It is a
36form of biofeedback whereby a patient can learn to control brain activity that is measured and
37recorded by an electroencephalogram.
38 “Neuropsychological testing” is a set of medical and therapeutic assessment and
39treatments focused on amelioration of cognitive, emotional, psychosocial and behavioral deficits
40caused by brain injury.
41 “Psychophysiological testing and treatment” is a set of medical and therapeutic
42assessment and treatments focused on psychophysiological disorders or physical disorders with
43psychological overlay.
44 “Post-acute residential treatment” includes integrated medical and therapeutic services,
45treatment, education, and skills training within a 24/7 real-world environment of care- a home
46and community setting. Maximum opportunity to for correct practice of skill in the context of
47use develops new neural pathways which ensure ongoing skill use and avoidance of re-
48hospitalization and long term care.
49 (b) Any coverage offered by the commission to an active or retired employee of the
50commonwealth insured under the group insurance commission shall provide coverage for
51medically necessary treatment related to or as a result of an acquired brain injury. Medically
52necessary treatment shall include, but is not limited to, cognitive rehabilitation therapy; cognitive 4 of 17
53communication therapy; neurocognitive therapy and rehabilitation; neurobehavioral,
54neurophysiological, neuropsychological and psychophysiological testing and treatment;
55neurofeedback therapy; functional rehabilitation therapy and remediation; community
56reintegration services; post-acute residential treatment services; inpatient services; outpatient and
57day treatment services; home and community based treatment. The benefits in this section shall
58not include any lifetime limitation or unreasonable annual limitation of the number of days or
59sessions of treatment services. Any limitations shall be separately stated by the commission. The
60benefits in this section shall not be subject to any greater deductible, coinsurance, copayments, or
61out-of-pocket limits than any other benefit provided by the commission.
62 (c) The commissioner of insurance shall require a health benefit plan issuer to provide
63adequate training to personnel responsible for preauthorization of coverage or utilization review
64for services under this section, in consultation with the Brain Injury Association of
65Massachusetts.
66 (d) Individual practitioners and treatment facilities shall be qualified to provide acute care
67and post-acute care rehabilitation services through possession of the appropriate licenses,
68accreditation, training and experience deemed customary and routine in the trade practice.
69 SECTION 2. Chapter 175 of the General Laws, as so appearing, is hereby amended by
70inserting after section 47KK, the following section:-
71 Section 47LL. (a) For purposes of this section, the following terms shall have the
72following meanings:-
73 “Acquired brain injury (ABI)” is any injury to the brain which occurs after birth and can
74be caused by infectious diseases, metabolic disorders, endocrine disorders or diminished oxygen, 5 of 17
75brain tumors, toxins, disease that affects the blood supply to the brain, stroke or a traumatic brain
76injury.
77 “Cognitive communication therapy” treats problems with communication which have an
78underlying cause in a cognitive deficit rather than a primary language or speech deficit.
79 “Cognitive rehabilitation therapy (CRT)” is a process of relearning cognitive skills
80essential for daily living through the coordinated specialized, integrated therapeutic treatments
81which are provided in dynamic settings designed for efficient and effective re-learning following
82damage to brain cells or brain chemistry due to brain injury.
83 “Community reintegration services” provide incremental guided real-world therapeutic
84training to develop skills essential for an individual to participate in life: to re-enter employment;
85to go to school and engage in other productive activity; to safely live independently; and to
86participate in their community while avoiding re-hospitalization and long-term support needs.
87 “Functional rehabilitation therapy and remediation” is a structured approach to
88rehabilitation for brain disorders which emphasizes learning by doing, and focuses relearning a
89specific task in a prescribed format, with maximum opportunity for repeated correct practice.
90Compensatory strategies are developed for those skills which are persistently impaired and
91individuals are trained on daily implementation. To ensure acquisition and use, focus is set on re-
92learning those skills essential for safe daily living in the environment in which they will be used:
93home and community settings.
94 “Medical necessity” or “medically necessary,” health care services that are consistent
95with generally accepted principles of professional medical practice. 6 of 17
96 “Neurobehavioral therapy” is a set of medical and therapeutic assessment and treatments
97focused on behavioral impairments associated with brain disease or injury and the amelioration
98of these impairments through the development of pro-social behavior.
99 “Neurocognitive therapy” is treatment of disorders in which the primary clinical deficit is
100in cognitive function which has not been present since birth and is a decline from a previously
101attained level of function.
102 “Neurofeedback therapy” is a direct training of brain function to enhance self-regulatory
103capacity or an individual’s ability to exert control over behavior, thoughts and feelings. It is a
104form of biofeedback whereby a patient can learn to control brain activity that is measured and
105recorded by an electroencephalogram.
106 “Neuropsychological testing” is a set of medical and therapeutic assessment and
107treatments focused on amelioration of cognitive, emotional, psychosocial and behavioral deficits
108caused by brain injury.
109 “Psychophysiological testing and treatment” is a set of medical and therapeutic
110assessment and treatments focused on psychophysiological disorders or physical disorders with
111psychological overlay.
112 “Post-acute residential treatment” includes integrated medical and therapeutic services,
113treatment, education, and skills training within a 24/7 real-world environment of care - a home
114and community setting. Maximum opportunity for correct practice of skill in the context of use
115develops new neural pathways which ensure ongoing skill use and avoidance of re-
116hospitalization and long term care. 7 of 17
117 (b) The following shall provide coverage for medically necessary treatment related to or
118as a result of an acquired brain injury: (ii)any policy of accident and sickness insurance, as
119described in section 108, which provides hospital expense and surgical expense insurance and
120which is delivered, issued or subsequently renewed by agreement between the insurer and
121policyholder in the commonwealth; (ii) any blanket or general policy of insurance described in
122subdivision (A), (C) or (D) of section 110 which provides hospital expense and surgical expense
123insurance and which is delivered, issued or subsequently renewed by agreement between the
124insurer and the policyholder in or outside of the commonwealth; or (iii) any employees’ health
125and welfare fund which provides hospital expense and surgical expense benefits and which is
126delivered, issued or renewed to any person or group of persons in the commonwealth. Medically
127necessary treatment shall include, but is not limited to, cognitive rehabilitation therapy; cognitive
128communication therapy; neurocognitive therapy and rehabilitation; neurobehavioral,
129neurophysiological, neuropsychological and psychophysiological testing and treatment;
130neurofeedback therapy; functional rehabilitation therapy and remediation; community
131reintegration services; post-acute residential treatment services; inpatient services; outpatient and
132day treatment services; home and community based treatment. The benefits in this section shall
133not include any lifetime limitation or unreasonable annual limitation of the number of days or
134sessions of treatment services. Any limitations shall be separately stated by the insurer. The
135benefits in this section shall not be subject to any greater deductible, coinsurance, copayments, or
136out-of-pocket limits than any other benefit provided by the insurer.
137 (c) The commissioner of insurance shall require a health benefit plan issuer to provide
138adequate training to personnel responsible for preauthorization of coverage or utilization review 8 of 17
139for services under this section, in consultation with the Brain Injury Association of
140Massachusetts.
141 (d) Individual practitioners and treatment facilities shall be qualified to provide acute care
142and post-acute care rehabilitation services through possession of the appropriate licenses,
143accreditation, training and experience deemed customary and routine in the trade practice.
144 SECTION 3. Chapter 176A of the General Law, as so appearing, is hereby amended by
145inserting after section 8MM the following section:-
146 Section 8NN. (a) For purposes of this section, the following terms shall have the
147following meanings:-
148 “Acquired brain injury (ABI)” is any injury to the brain which occurs after birth and can
149be caused by infectious diseases, metabolic disorders, endocrine disorders or diminished oxygen,
150brain tumors, toxins, disease that affects the blood supply to the brain, stroke or a traumatic brain
151injury.
152 “Cognitive communication therapy” treats problems with communication which have an
153underlying cause in a cognitive deficit rather than a primary language or speech deficit.
154 “Cognitive rehabilitation therapy (CRT)” is a process of re-learning cognitive skills
155essential for daily living through the coordinated specialized, integrated therapeutic treatments
156which are provided in dynamic settings designed for efficient and effective re-learning following
157damage to brain cells or brain chemistry due to brain injury.
158 “Community reintegration services” provide incremental guided real-world therapeutic
159training to develop skills essential for an individual to participate in life: to re-enter employment; 9 of 17
160to go to school and engage in other productive activity; to safely live independently; and to
161participate in their community while avoiding re-hospitalization and long term support needs.
162 “Functional rehabilitation therapy and remediation” is a structured approach to
163rehabilitation for brain disorders which emphasizes learning by doing, and focuses re-learning a
164specific task in a prescribed format with maximum opportunity for repeated correct practice.
165Compensatory strategies are developed for those skills which are persistently impaired and
166individuals are trained on daily implementation. To ensure acquisition and use, focus is set on re-
167learning those skills essential for safe daily living in the environment in which they will be used:
168home and community settings.
169 “Medical necessity” or “medically necessary,” health care services that are consistent
170with generally accepted principles of professional medical practice.
171 “Neurobehavioral therapy” is a set of medical and therapeutic assessment and treatments
172focused on behavioral impairments associated with brain disease or injury and the amelioration
173of these impairments through the development of pro-social behavior.
174 “Neurocognitive therapy” is treatment of disorders in which the primary clinical deficit is
175in cognitive function which has not been present since birth and is a decline from a previously
176attained level of function.
177 “Neurofeedback therapy” is a direct training of brain function to enhance self-regulatory
178capacity or an individual’s ability to exert control over behavior, thoughts and feelings. It is a
179form of biofeedback whereby a patient can learn to control brain activity that is measured and
180recorded by an electroencephalogram. 10 of 17
181 “Neuropsychological testing” is a set of medical and therapeutic assessment and
182treatments focused on amelioration of cognitive, emotional, psychosocial and behavioral deficits
183caused by brain injury.
184 “Psychophysiological testing and treatment” is a set of medical and therapeutic
185assessment and treatments focused on psychophysiological disorders or physical disorders with
186psychological overlay.
187 “Post-acute residential treatment” includes integrated medical and therapeutic services,
188treatment, education, and skills training within a 24/7 real-world environment of care- a home
189and community setting. Maximum opportunity for correct practice of skill in the context of use
190develops new neural pathways which ensure ongoing skill use and avoidance of re-
191hospitalization and long term care.
192 (b) Any contract between a subscriber and the corporation under an individual or group
193hospital service plan which is delivered, issued or renewed within the commonwealth shall
194provide coverage for medically necessary treatment related to or as a result of an acquired brain
195injury. Medically necessary treatment shall include, but is not limited to, cognitive rehabilitation
196therapy; cognitive communication therapy; neurocognitive therapy and rehabilitation;
197neurobehavioral, neurophysiological, neuropsychological and psychophysiological testing and
198treatment; neurofeedback therapy; functional rehabilitation therapy and remediation; community
199reintegration services; post-acute residential treatment services; inpatient services; outpatient and
200day treatment services; home and community based treatment. The benefits in this section shall
201not include any lifetime limitation or unreasonable annual limitation of the number of days or
202sessions of treatment services. Any limitations shall be separately stated by the insurer. The 11 of 17
203benefits in this section shall not be subject to any greater deductible, coinsurance, copayments, or
204out-of-pocket limits than any other benefit provided by the insurer.
205 (c) The commissioner of insurance shall require a health benefit plan issuer to provide
206adequate training to personnel responsible for preauthorization of coverage or utilization review
207for services under this section, in consultation with the Brain Injury Association of
208Massachusetts.
209 (d) Individual practitioners and treatment facilities shall be qualified to provide acute care
210and post-acute care rehabilitation services through possession of the appropriate licenses,
211accreditation, training and experience deemed customary and routine in the trade practice.
212 SECTION 4. Chapter 176B of the General Laws, as so appearing, is hereby amended by
213inserting after section 4MM the following section:-
214 Section 4NN. (a) For purposes of this section, the following terms shall have the
215following meanings:-
216 “Acquired brain injury (ABI)” is any injury to the brain which occurs after birth and can
217be caused by infectious diseases, metabolic disorders, endocrine disorders or diminished oxygen,
218brain tumors, toxins, disease that affects the blood supply to the brain, stroke or a traumatic brain
219injury.
220 “Cognitive communication therapy” treats problems with communication which have an
221underlying cause in a cognitive deficit rather than a primary language or speech deficit.
222 “Cognitive rehabilitation therapy (CRT)” is a process of relearning cognitive skills
223essential for daily living through the coordinated specialized, integrated therapeutic treatments 12 of 17
224which are provided in dynamic settings designed for efficient and effective re-learning following
225damage to brain cells or brain chemistry due to brain injury.
226 “Community reintegration services” provide incremental guided real-world therapeutic
227training to develop skills essential for an individual to participate in life: to re-enter employment;
228to go to school and engage in other productive activity; to safely live independently; and to
229participate in their community while avoiding re-hospitalization and long term support needs.
230 “Functional rehabilitation therapy and remediation” is a structured approach to
231rehabilitation for brain disorders which emphasizes learning by doing, and focuses re-learning a
232specific task in a prescribed format, with maximum opportunity for repeated correct practice.
233Compensatory strategies are developed for those skills which are persistently impaired and
234individuals are trained on daily implementation. To ensure acquisition and use, focus is set on re-
235learning those skills essential for safe on daily living in the environment in which they will be
236used: home and community settings.
237 “Medical necessity” or “medically necessary,” health care services that are consistent
238with generally accepted principles of professional medical practice.
239 “Neurobehavioral therapy” is a set of medical and therapeutic assessment and treatments
240focused on behavioral impairments associated with brain disease or injury and the amelioration
241of these impairments through the development of pro-social behavior.
242 “Neurocognitive therapy” is treatment of disorders in which the primary clinical deficit is
243in cognitive function which has not been present since birth and is a decline from a previously
244attained level of function. 13 of 17
245 “Neurofeedback therapy” is a direct training of brain function to enhance self-regulatory
246capacity or an individual’s ability to exert control over behavior, thoughts and feelings. It is a
247form of biofeedback whereby a patient can learn to control brain activity that is measured and
248recorded by an electroencephalogram.
249 “Neuropsychological testing” is a set of medical and therapeutic assessment and
250treatments focused on amelioration of cognitive, emotional, psychosocial and behavioral deficits
251caused by brain injury;
252 “Psychophysiological testing and treatment” is a set of medical and therapeutic
253assessment and treatments focused on psychophysiological disorders or physical disorders with
254psychological overlay.
255 “Post-acute residential treatment” includes integrated medical and therapeutic services,
256treatment, education, and skills training within a 24/7 real-world environment of care, – a home
257and community setting. Maximum opportunity for correct practice of skill in the context of use
258develops new neural pathways which ensure ongoing skill use and avoidance of re-
259hospitalization and long term care.
260 (b) Any subscription certificate under an individual or group medical service agreement
261delivered, issued or renewed within the commonwealth shall provide coverage for medically
262necessary treatment related to or as a result of an acquired brain injury. Medically necessary
263treatment shall include, but is not limited to, cognitive rehabilitation therapy; cognitive
264communication therapy; neurocognitive therapy and rehabilitation; neurobehavioral,
265neurophysiological, neuropsychological and psychophysiological testing and treatment;
266neurofeedback therapy; functional rehabilitation therapy and remediation; community 14 of 17
267reintegration services; post-acute residential treatment services; inpatient services; outpatient and
268day treatment services; home and community based treatment. The benefits in this section shall
269not include any lifetime limitation or unreasonable annual limitation of the number of days or
270sessions of treatment services. Any limitations shall be separately stated by the insurer. The
271benefits in this section shall not be subject to any greater deductible, coinsurance, copayments, or
272out-of-pocket limits than any other benefit provided by the insurer.
273 (c) The commissioner of insurance shall require a health benefit plan issuer to provide
274adequate training to personnel responsible for preauthorization of coverage or utilization review
275for services under this section, in consultation with the Brain Injury Association of
276Massachusetts.
277 (d) Individual practitioners and treatment facilities shall be qualified to provide acute care
278and post-acute care rehabilitation services through possession of the appropriate licenses,
279accreditation, training and experience deemed customary and routine in the trade practice.
280 SECTION 5. Chapter 176G of the General Laws, as so appearing, is hereby amended by
281inserting after section 4EE the following section:-
282 Section 4FF. (a) For purposes of this section, the following terms shall have the following
283meanings:-
284 “Acquired brain injury (ABI)” is any injury to the brain which occurs after birth and can
285be caused by infectious diseases, metabolic disorders, endocrine disorders or diminished oxygen,
286brain tumors, toxins, disease that affects the blood supply to the brain, stroke or a traumatic brain
287injury. 15 of 17
288 “Cognitive communication therapy” treats problems with communication which have an
289underlying cause in a cognitive deficit rather than a primary language or speech deficit.
290 “Cognitive rehabilitation therapy (CRT)” is a process of relearning cognitive skills
291essential for daily living through the coordinated specialized, integrated therapeutic treatments
292which are provided in dynamic settings designed for efficient and effective re-learning following
293damage to brain cells or brain chemistry due to brain injury.
294 “Community reintegration services” provide incremental guided real-world therapeutic
295training to develop skills essential for an individual to participate in life: to re-enter employment;
296to go to school or engage in other productive activity; to safely live independently; and to
297participate in their community while avoiding re-hospitalization and long term support needs.
298 “Functional rehabilitation therapy and remediation” is a structured approach to
299rehabilitation for brain disorders which emphasizes learning by doing, and focuses re-learning a
300specific task in a prescribed format, with maximum opportunity for repeated correct practice.
301Compensatory strategies are developed for those skills which are persistently impaired and
302individuals are trained on daily implementation. To ensure acquisition and use, focus is set on re-
303learning those skills essential for safe daily living in the environment in which they will be used:
304home and community settings.
305 “Medical necessity” or “medically necessary,” health care services that are consistent
306with generally accepted principles of professional medical practice.
307 “Neurobehavioral therapy” is a set of medical and therapeutic assessment and treatments
308focused on behavioral impairments associated with brain disease or injury and the amelioration
309of these impairments through the development of pro-social behavior. 16 of 17
310 “Neurocognitive therapy” is treatment of disorders in which the primary clinical deficit is
311in cognitive function which has not been present since birth and is a decline from a previously
312attained level of function.
313 “Neurofeedback therapy” is a direct training of brain function to enhance self-regulatory
314capacity or an individual’s ability to exert control over behavior, thoughts and feelings. It is a
315form of biofeedback whereby a patient can learn to control brain activity that is measured and
316recorded by an electroencephalogram.
317 “Neuropsychological testing” is a set of medical and therapeutic assessment and
318treatments focused on amelioration of cognitive, emotional, psychosocial and behavioral deficits
319caused by brain injury.
320 “Psychophysiological testing and treatment” is a set of medical and therapeutic
321assessment and treatments focused on psychophysiological disorders or physical disorders with
322psychological overlay.
323 “Post-acute residential treatment” includes integrated medical and therapeutic services,
324treatment, education, and skills training within a 24/7 real-world environment of care – a home
325and community setting. Maximum opportunity for correct practice of skill in the context of use
326develops new neural pathways which ensure ongoing skill use and avoidance of re-
327hospitalization and long term care.
328 (b) Any individual or group health maintenance contract shall provide coverage for
329medically necessary treatment related to or as a result of an acquired brain injury. Medically
330necessary treatment shall include, but is not limited to, cognitive rehabilitation therapy; cognitive
331communication therapy; neurocognitive therapy and rehabilitation; neurobehavioral, 17 of 17
332neurophysiological, neuropsychological and psychophysiological testing and treatment;
333neurofeedback therapy; functional rehabilitation therapy and remediation; community
334reintegration services; post-acute residential treatment services; inpatient services; outpatient and
335day treatment services; home and community based treatment. The benefits in this section shall
336not include any lifetime limitation or unreasonable annual limitation of the number of days or
337sessions of treatment services. Any limitations shall be separately stated by the insurer. The
338benefits in this section shall not be subject to any greater deductible, coinsurance, copayments, or
339out-of-pocket limits than any other benefit provided by the insurer.
340 (c) The commissioner of insurance shall require a health benefit plan issuer to provide
341adequate training to personnel responsible for preauthorization of coverage or utilization review
342for services under this section, in consultation with the Brain Injury Association of
343Massachusetts.
344 (d) Individual practitioners and treatment facilities shall be qualified to provide acute care
345and post-acute care rehabilitation services through possession of the appropriate licenses,
346accreditation, training and experience deemed customary and routine in the trade practice.