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