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HOUSE DOCKET, NO. 1089 FILED ON: 1/14/2025
HOUSE . . . . . . . . . . . . . . . No. 1277
The Commonwealth of Massachusetts
_________________
PRESENTED BY:
James J. O'Day
_________________
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 :DATE ADDED:James J. O'Day14th Worcester1/14/2025James B. EldridgeMiddlesex and Worcester2/10/2025 1 of 11
HOUSE DOCKET, NO. 1089 FILED ON: 1/14/2025
HOUSE . . . . . . . . . . . . . . . No. 1277
By Representative O'Day of West Boylston, a petition (accompanied by bill, House, No. 1277)
of James J. O'Day and James B. Eldridge relative to dual diagnosis treatment healthcare
coverage. Financial Services.
The Commonwealth of Massachusetts
_______________
In the One Hundred and Ninety-Fourth General Court
(2025-2026)
_______________
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 2022 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
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 2 of 11
13and significant others and aftercare planning, for individuals beginning to engage in recovery
14from addiction.
15
16 “Co-occurring treatment services”, inpatient medically monitored detoxification
17treatment for adults or adolescents provided in an inpatient psychiatric facility or an inpatient
18psychiatric unit within a general hospital, licensed by the department of mental health.
19
20 The commission shall provide to any active or retired employee of the commonwealth
21who is insured under the group insurance commission coverage for medically necessary acute
22treatment services, medically necessary clinical stabilization services, and medically necessary
23co-occurring treatment services for up to a total of 14 days and shall not require preauthorization
24prior to obtaining such acute treatment services, clinical stabilization services, or co-occurring
25treatment services; provided, that the facility shall notify the carrier of both admission and the
26initial treatment plan within 48 hours of admission; provided further, that utilization review
27procedures may be in initiated on day 7; and provided further, that the commission shall provide
28to any active or retired employee of the commonwealth who is insured under the group insurance
29commission coverage for, without preauthorization, substance use disorder evaluations ordered
30pursuant to section 51 1/2 of chapter 111.
31 Medical necessity shall be determined by the treating clinician in consultation with the
32patient and noted in the patient's medical record.
33 3 of 11
34 SECTION 2. Chapter 118E of the General Laws is hereby amended by striking out
35section 10H and inserting in place thereof the following section:-
36
37 Section 10H. "Acute treatment services'', 24-hour medically supervised addiction
38treatment for adults or adolescents provided in a medically managed or medically monitored
39inpatient facility, as defined by the department of public health, which provides evaluation and
40withdrawal management and that may include biopsychosocial assessment, individual and group
41counseling, psychoeducational groups and discharge planning.
42 "Clinical stabilization services'', 24-hour clinically managed post detoxification treatment
43for adults or adolescents, as defined by the department of public health, usually following acute
44treatment services for substance use, which may include intensive education and counseling
45regarding the nature of addiction and its consequences, relapse prevention, outreach to families
46and significant others and aftercare planning, for individuals beginning to engage in recovery
47from addiction.
48
49 “Co-occurring treatment services”, inpatient medically monitored detoxification
50treatment for adults or adolescents provided in an inpatient psychiatric facility or an inpatient
51psychiatric unit within a general hospital, licensed by the department of mental health.
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 11
55medically necessary acute treatment services and shall not require a preauthorization prior to
56obtaining treatment.
57 The division and its contracted health insurers, health plans, health maintenance
58organizations, behavioral health management firms and third party administrators under contract
59to a Medicaid managed care organization or primary care clinician plan shall cover the cost of
60medically necessary clinical stabilization services and co-occurring treatment services for up to
6114 days and shall not require preauthorization prior to obtaining clinical stabilization services
62and co-occurring treatment services; provided, that the facility shall provide the carrier both
63notification of admission and the initial treatment plan within 48 hours of admission; provided
64further, that utilization review procedures may be initiated on day 7; and provided further, that
65the division and its contracted health insurers, health plans, health maintenance organizations,
66behavioral health management firms and third party administrators under contract to a Medicaid
67managed care organization or primary care clinician plan shall cover, without preauthorization,
68substance use disorder evaluations ordered pursuant to section 51 1/2 of chapter 111.
69
70 Medical necessity shall be determined by the treating clinician in consultation with the
71patient and noted in the patient's medical record.
72
73 SECTION 3. Chapter 175 of the General Laws is hereby amended by striking out section
7447GG and inserting in place thereof the following section:-
75 5 of 11
76 Section 47GG. "Acute treatment services'', 24-hour medically supervised addiction
77treatment for adults or adolescents provided in a medically managed or medically monitored
78inpatient facility, as defined by the department of public health, which provides evaluation and
79withdrawal management and that may include biopsychosocial assessment, individual and group
80counseling, psychoeducational groups and discharge planning.
81
82 "Clinical stabilization services'', 24-hour clinically managed post detoxification treatment
83for adults or adolescents, as defined by the department of public health, usually following acute
84treatment services for substance use, which may include intensive education and counseling
85regarding the nature of addiction and its consequences, relapse prevention, outreach to families
86and significant others and aftercare planning, for individuals beginning to engage in recovery
87from addiction.
88
89 “Co-occurring treatment services”, inpatient medically monitored detoxification
90treatment for adults or adolescents provided in an inpatient psychiatric facility or an inpatient
91psychiatric unit within a general hospital, licensed by the department of mental health.
92
93 Any policy, contract, agreement, plan or certificate of insurance issued, delivered or
94renewed within the commonwealth, which is considered creditable coverage under section 1 of
95chapter 111M, shall provide coverage for medically necessary acute treatment services,
96medically necessary clinical stabilization services and medically necessary co-occurring 6 of 11
97treatment services for up to a total of 14 days and shall not require preauthorization prior to
98obtaining acute treatment services, clinical stabilization services, or co-occurring treatment
99services; provided, that the facility shall notify the carrier of both admission and the initial
100treatment plan within 48 hours of admission; provided further, that utilization review procedures
101may be initiated on day 7; provided further that any policy, contract, agreement, plan or
102certificate of insurance issued, delivered or renewed within the commonwealth, which is
103considered creditable coverage pursuant to section 1 of chapter 111M, shall cover, without
104preauthorization, a substance use disorder evaluation ordered pursuant to section 51 1/2 of
105chapter 111.
106
107 Medical necessity shall be determined by the treating clinician in consultation with the
108patient and noted in the patient's medical record.
109
110 SECTION 4. Chapter 176A of the General Laws, as so appearing, is hereby amended by
111striking out section 8II and inserting in place thereof the following section:-
112
113 Section 8II. "Acute treatment services'', 24-hour medically supervised addiction treatment
114for adults or adolescents provided in a medically managed or medically monitored inpatient
115facility, as defined by the department of public health, which provides evaluation and withdrawal
116management and that may include biopsychosocial assessment, individual and group counseling,
117psychoeducational groups and discharge planning. 7 of 11
118
119 "Clinical stabilization services'', 24-hour clinically managed post detoxification treatment
120for adults or adolescents, as defined by the department of public health, usually following acute
121treatment services for substance use, which may include intensive education and counseling
122regarding the nature of addiction and its consequences, relapse prevention, outreach to families
123and significant others and aftercare planning, for individuals beginning to engage in recovery
124from addiction.
125
126 “Co-occurring treatment services”, inpatient medically monitored detoxification
127treatment for adults or adolescents provided in an inpatient psychiatric facility or an inpatient
128psychiatric unit within a general hospital, licensed by the department of mental health.
129
130 Any contract between a subscriber and the corporation under an individual or group
131hospital service plan that is delivered, issued or renewed within the commonwealth shall provide
132coverage for medically necessary acute treatment services, medically necessary clinical
133stabilization services, and medically necessary co-occurring treatment services for up to a total of
13414 days and shall not require preauthorization prior to obtaining acute treatment services, clinical
135stabilization services, or co-occurring treatment services; provided, that the facility shall notify
136the carrier of both admission and the initial treatment plan within 48 hours of admission;
137provided further, that utilization review procedures may be initiated on day 7; provided further,
138any contract between a subscriber and the corporation under an individual or group hospital
139service plan that is delivered, issued or renewed within the commonwealth, shall cover, without 8 of 11
140preauthorization, a substance use disorder evaluation ordered pursuant to section 51 1/2 of
141chapter 111.
142
143 Medical necessity shall be determined by the treating clinician in consultation with the
144patient and noted in the patient's medical record.
145
146 SECTION 5. Chapter 176B of the General Laws, as so appearing, is hereby amended by
147striking out section 4II and inserting in place thereof the following section:-
148
149 Section 4II. "Acute treatment services'', 24-hour medically supervised addiction treatment
150for adults or adolescents provided in a medically managed or medically monitored inpatient
151facility, as defined by the department of public health, which provides evaluation and withdrawal
152management and that may include biopsychosocial assessment, individual and group counseling,
153psychoeducational groups and discharge planning.
154
155 "Clinical stabilization services'', 24-hour clinically managed post detoxification treatment
156for adults or adolescents, as defined by the department of public health, usually following acute
157treatment services for substance use, which may include intensive education and counseling
158regarding the nature of addiction and its consequences, relapse prevention, outreach to families
159and significant others and aftercare planning, for individuals beginning to engage in recovery
160from addiction. 9 of 11
161
162 “Co-occurring treatment services”, inpatient medically monitored detoxification
163treatment for adults or adolescents provided in an inpatient psychiatric facility or an inpatient
164psychiatric unit within a general hospital, licensed by the department of mental health.
165
166 Any subscription certificate under an individual or group medical service agreement
167delivered, issued or renewed within the commonwealth shall provide coverage for medically
168necessary acute treatment services, medically necessary clinical stabilization services, and
169medically necessary co-occurring treatment services for up to a total of 14 days and shall not
170require preauthorization prior to obtaining acute treatment services, clinical stabilization services
171or co-occurring treatment services; provided, that the facility shall provide the carrier both
172notification of admission and the initial treatment plan within 48 hours of admission; provided
173further, that utilization review procedures may be initiated on day 7; provided further, any
174subscription certificate under an individual or group medical service agreement delivered, issued
175or renewed within the commonwealth shall provide coverage for, without preauthorization, a
176substance use disorder evaluation ordered pursuant to section 51 1/2 of chapter 111.
177
178 Medical necessity shall be determined by the treating clinician in consultation with the
179patient and noted in the patient's medical record.
180 10 of 11
181 SECTION 6. Chapter 176G as so appearing, is hereby amended by striking out section
1824AA and inserting in place thereof the following section:-
183
184 Section 4AA. "Acute treatment services'', 24-hour medically supervised addiction
185treatment for adults or adolescents provided in a medically managed or medically monitored
186inpatient facility, as defined by the department of public health, that provides evaluation and
187withdrawal management and which may include biopsychosocial assessment, individual and
188group counseling, psychoeducational groups and discharge planning.
189
190 "Clinical stabilization services'', 24-hour clinically managed post detoxification treatment
191for adults or adolescents, as defined by the department of public health, usually following acute
192treatment services for substance use, which may include intensive education and counseling
193regarding the nature of addiction and its consequences, relapse prevention, outreach to families
194and significant others and aftercare planning, for individuals beginning to engage in recovery
195from addiction.
196
197 “Co-occurring treatment services”, inpatient medically monitored detoxification
198treatment for adults or adolescents provided in an inpatient psychiatric facility or an inpatient
199psychiatric unit within a general hospital, licensed by the department of mental health.
200 11 of 11
201 An individual or group health maintenance contract that is issued or renewed shall
202provide coverage for medically necessary acute treatment services, medically necessary clinical
203stabilization services, and medically necessary co-occurring treatment services for up to a total of
20414 days and shall not require preauthorization prior to obtaining acute treatment services, clinical
205stabilization services, or co-occurring treatment services; provided, that the facility shall provide
206the carrier both notification of admission and the initial treatment plan within 48 hours of
207admission; provided further, that utilization review procedures may be initiated on day 7;
208provided further, an individual or group health maintenance contract that is issued or renewed
209shall provide coverage for, without preauthorization, a substance use disorder evaluation ordered
210pursuant to section 51 1/2 of chapter 111.
211
212 Medical necessity shall be determined by the treating clinician in consultation with the
213patient and noted in the patient's medical record.