Massachusetts 2025-2026 Regular Session

Massachusetts House Bill H1134 Compare Versions

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

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1	1	1 of 1
2	2	HOUSE DOCKET, NO. 3239 FILED ON: 1/16/2025
3	3	HOUSE . . . . . . . . . . . . . . . No. 1134
4	4	The Commonwealth of Massachusetts
5	5	_________________
6	6	PRESENTED BY:
7	7	Marjorie C. Decker
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 to improve access and care coordination for people with pain.
13	13	_______________
14	14	PETITION OF:
15	15	NAME:DISTRICT/ADDRESS :DATE ADDED:Marjorie C. Decker25th Middlesex1/16/2025 1 of 6
16	16	HOUSE DOCKET, NO. 3239 FILED ON: 1/16/2025
17	17	HOUSE . . . . . . . . . . . . . . . No. 1134
18	18	By Representative Decker of Cambridge, a petition (accompanied by bill, House, No. 1134) of
19	19	Marjorie C. Decker for legislation to improve access and care coordination for people with pain.
20	20	Financial Services.
21	21	The Commonwealth of Massachusetts
22	22	_______________
23	23	In the One Hundred and Ninety-Fourth General Court
24	24	(2025-2026)
25	25	_______________
26	26	An Act to improve access and care coordination for people with pain.
27	27	Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
28	28	of the same, as follows:
29	29	1 SECTION 1. Chapter 118E of the General Laws is hereby amended by inserting after
30	30	2section 10Q the following new section:-
31	31	3 Section 10R. Coverage for non-opioid pain medications.
32	32	4 (a) As used in this section, the following word shall, unless the context clearly requires
33	33	5otherwise, have the following meaning:
34	34	6 “Non-opioid drug” means a non-opioid drug approved by the federal Food and Drug
35	35	7Administration for the treatment or management of pain.
36	36	8 (b) The division and its contracted health insurers, health plans, health maintenance
37	37	9organizations, behavioral health management firms and third-party administrators under contract
38	38	10to a Medicaid managed care organization or primary care clinician plan shall provide coverage
39	39	11such that no non-opioid drug shall be disadvantaged or discouraged with respect to coverage 2 of 6
40	40	12relative to any opioid or narcotic drug for the treatment or management of pain, where
41	41	13impermissible disadvantaging or discouragement includes, without limitation:
42	42	14 (1) designating any such non-opioid drug as a non-preferred drug if any opioid or
43	43	15narcotic drug is designated as a preferred drug on the MassHealth Drug List; or
44	44	16 (2) establishing more restrictive or more extensive utilization management procedures,
45	45	17including, but not limited to, more restrictive or more extensive prior authorization or step
46	46	18therapy protocols, for such non-opioid drug than the least restrictive or extensive utilization
47	47	19management procedures applicable to any such opioid or narcotic drug.
48	48	20 SECTION 2. (a) Notwithstanding any general or special law to the contrary, the division
49	49	21of medical assistance shall ensure the availability of accessible, quality health care for
50	50	22individuals with chronic pain who are enrolled in Medicaid managed care organizations or
51	51	23accountable care organizations that have a contract with the division to provide services to
52	52	24individuals enrolled under MassHealth pursuant to section 9 of chapter 118E of the General
53	53	25Laws. Such health care shall include, but not be limited to the following:
54	54	26 (1) comprehensive integrated care management for chronic pain patients, including
55	55	27primary care, medical specialty care (including but not limited to pain management specialists,
56	56	28neurologists, rheumatologists), and specialized treatment providers (including but not limited to
57	57	29physical therapists, occupational therapists, chiropractors, acupuncturists, psychologists, massage
58	58	30therapists) as specified in individualized pain treatment plans;
59	59	31 (2) social work services as well as education on chronic pain management for patients,
60	60	32caregivers, and providers; and 3 of 6
61	61	33 (3) support navigating health insurance coverage and support with transportation to
62	62	34primary care and specialty providers.
63	63	35 (b) Not later than the fiscal year 2026 contract year, the division of medical assistance
64	64	36shall require Medicaid managed care or accountable care organizations to implement a chronic
65	65	37pain quality strategy for children and adults with chronic pain that includes, but is not limited to,
66	66	38the following components:
67	67	39 (1) measurable goals to improve the identification of members with chronic pain within
68	68	4090 days after enrolling in the contracted health plan;
69	69	41 (2) to the extent practicable, adequate provider network capacity to ensure timely access
70	70	42to chronic pain specialty service providers as listed above;
71	71	43 (3) care coordination strategies and supports to help members with chronic pain access
72	72	44appropriate providers including primary care, medical specialists, other specialized care
73	73	45providers of therapies included in the treatment plan and other related care supports; and
74	74	46 (4) delivery of a training curriculum approved by the division of medical assistance to
75	75	47educate primary care providers on the treatment of those with chronic pain, including
76	76	48information on the components of comprehensive chronic pain treatment including but not
77	77	49limited to pain assessment and diagnosis, administration of a validated pain rating tool, the
78	78	50development, implementation and revision of an individualized treatment plan, medication
79	79	51management, any necessary chronic pain crisis management, and care coordination and
80	80	52communication among providers furnishing various treatments; and on multidisciplinary pain
81	81	53care encompassing the full range of evidence-based treatments in five areas: restorative 4 of 6
82	82	54therapies, medications, interventional procedures, behavioral therapies and complementary
83	83	55treatments.
84	84	56 (c) The division of medical assistance shall also, not later than January 1, 2026, and in
85	85	57partnership with Medicaid managed care organizations and accountable care organizations,
86	86	58identify, document, and share best practices regarding chronic pain care management and care
87	87	59coordination with Medicaid-enrolled primary care and specialty providers with a goal of
88	88	60improving services for members with chronic pain and their families.
89	89	61 SECTION 3. Chapter 12C of the General Laws is hereby amended by inserting after
90	90	62section 24 the following new section:-
91	91	63 Section 25. Data collection and reports on the incidence and prevalence of chronic pain in
92	92	64the commonwealth.
93	93	65 (a) The center shall utilize available federal and state data, including health care data
94	94	66collected under sections 8, 9, and 10, to clarify the incidence and prevalence of chronic pain
95	95	67experienced by individuals in the commonwealth from any source, including injuries, surgeries,
96	96	68diseases and conditions.
97	97	69 (b) The center shall also identify gaps in the available research data and collect
98	98	70deidentified population research data using medical claims and survey data to fill gaps in
99	99	71available research data.
100	100	72 (c) In its review of the relevant research data, the center shall identify information
101	101	73concerning: 5 of 6
102	102	74 (1) incidence and prevalence of chronic pain and of all specific known chronic pain
103	103	75conditions as well as of diseases and conditions that include or lead to chronic pain;
104	104	76 (2) demographics and other information, such as age, race, ethnicity, gender, and
105	105	77geographic location overall and for specific known chronic pain conditions;
106	106	78 (3) risk factors that may be associated with chronic pain conditions, such as genetic and
107	107	79environmental risk factors and other information, as appropriate;
108	108	80 (4) diagnosis and progression markers;
109	109	81 (5) direct health care costs of chronic pain treatment, both traditional and alternative, and
110	110	82indirect costs of chronic pain; (such as missed work, public and private disability, and reduction
111	111	83in productivity);
112	112	84 (6) the epidemiology of the conditions;
113	113	85 (7) the detection, management, and treatment of the conditions;
114	114	86 (8) the epidemiology, detection, management, and treatment of secondary or co-occurring
115	115	87conditions, such as depressive, anxiety, and substance use disorders;
116	116	88 (9) the utilization of medical and social services by patients with chronic pain conditions;
117	117	89and
118	118	90 (10) the effectiveness of evidence-based treatment approaches for chronic pain
119	119	91conditions.
120	120	92 (d) Not later than 2 years after the date of enactment of this Act, and every two years
121	121	93thereafter, the center shall publish a report concerning the incidence, prevalence and 6 of 6
122	122	94demographics of chronic pain and specific chronic pain conditions experienced by individuals in
123	123	95the commonwealth. Such report shall address the information outlined in subsection (c). Such
124	124	96report shall also include an analysis of any data gaps identified by the center, and any
125	125	97recommendations with respect to efforts to address such gaps.