Massachusetts 2025-2026 Regular Session

Massachusetts House Bill H1319 Compare Versions

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

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2	2	HOUSE DOCKET, NO. 375 FILED ON: 1/8/2025
3	3	HOUSE . . . . . . . . . . . . . . . No. 1319
4	4	The Commonwealth of Massachusetts
5	5	_________________
6	6	PRESENTED BY:
7	7	Adam J. Scanlon and Kate Donaghue
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 related to comprehensive clinical and extended support services.
13	13	_______________
14	14	PETITION OF:
15	15	NAME:DISTRICT/ADDRESS :DATE ADDED:Adam J. Scanlon14th Bristol1/8/2025James B. EldridgeMiddlesex and Worcester2/9/2025James K. Hawkins2nd Bristol2/12/2025 1 of 11
16	16	HOUSE DOCKET, NO. 375 FILED ON: 1/8/2025
17	17	HOUSE . . . . . . . . . . . . . . . No. 1319
18	18	By Representatives Scanlon of North Attleborough and Donaghue of Westborough, a petition
19	19	(accompanied by bill, House, No. 1319) of Adam J. Scanlon, James B. Eldridge and James K.
20	20	Hawkins relative to insurance coverage for comprehensive clinical and extended support
21	21	services. Financial Services.
22	22	The Commonwealth of Massachusetts
23	23	_______________
24	24	In the One Hundred and Ninety-Fourth General Court
25	25	(2025-2026)
26	26	_______________
27	27	An Act related to comprehensive clinical and extended support services.
28	28	Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
29	29	of the same, as follows:
30	30	1 SECTION 1. Section 17N of chapter 32A of the General Laws, as appearing in the 2022
31	31	2Official Edition, is hereby amended by inserting after the definition of “Clinical stabilization
32	32	3services” the following definition:-
33	33	4 “Transitional support services”, short-term, residential support services, as
34	34	5defined by the department of public health, usually following clinical stabilization services,
35	35	6which provide a safe and structured environment to support adults or adolescents through the
36	36	7addiction recovery process and the transition to outpatient or other step-down addiction recovery
37	37	8care.
38	38	9 SECTION 2. Section 17N of chapter 32A is further amended by striking out the
39	39	10fourth paragraph and inserting in place thereof the following paragraph:- 2 of 11
40	40	11 The commission shall provide for medically necessary acute treatment services,
41	41	12medically necessary clinical stabilization services and medically necessary transitional support
42	42	13services to an active or retired employee of the commonwealth who is insured under the group
43	43	14insurance commission coverage for up to 30 days and shall not require preauthorization prior to
44	44	15obtaining such acute treatment services, clinical stabilization services or transitional support
45	45	16services. The facility providing such services shall notify the carrier of admission and the initial
46	46	17treatment plan within 48 hours of admission, and within a reasonable time thereafter, shall
47	47	18provide the carrier with a projected discharge plan for the member. The carrier’s utilization
48	48	19review procedures may be initiated on day 14; provided, however, that a carrier shall not make
49	49	20any utilization review decisions that impose any restriction or deny any future medically
50	50	21necessary acute treatment, clinical stabilization or transitional support services unless a patient
51	51	22has received at least 30 consecutive days of said services; and, provided further, that the
52	52	23commission shall provide, without preauthorization, to any active or retired employee of the
53	53	24commonwealth who is insured under the group insurance commission coverage for substance use
54	54	25disorder evaluations ordered pursuant to section 51½ of chapter 111. Upon receipt of notification
55	55	26by the admitting facility and receipt of the discharge plan, the carrier may provide outreach to the
56	56	27treating clinician and member to offer care management and support services.
57	57	28 Medical necessity shall be determined by the treating clinician in consultation
58	58	29with the patient and noted in the patient’s medical record.
59	59	30 SECTION 3. Section 10H of chapter 118E of the General Laws, inserted by
60	60	31section 19 of chapter 258 of the acts of 2014, is hereby repealed. 3 of 11
61	61	32 SECTION 4. Said chapter 118E is hereby further amended by inserting after
62	62	33section 10N the following section:-
63	63	34 Section 10O. For the purposes of this section, the following words shall have the
64	64	35following meanings unless the context clearly requires otherwise:
65	65	36 “Acute treatment services”, 24-hour medically supervised addiction treatment for
66	66	37adults or adolescents provided in a medically managed or medically monitored inpatient facility,
67	67	38as defined by the department of public health, which provides evaluation and withdrawal
68	68	39management and that may include biopsychosocial assessment, individual and group counseling,
69	69	40psychoeducational groups and discharge planning.
70	70	41 “Clinical stabilization services”, 24-hour clinically managed post detoxification
71	71	42treatment for adults or adolescents, as defined by the department of public health, usually
72	72	43following acute treatment services for substance abuse for individuals beginning to engage in
73	73	44recovery from addiction, which may include intensive education and counseling regarding the
74	74	45nature of addiction and its consequences, relapse prevention, outreach to families and significant
75	75	46others and aftercare planning, for individuals beginning to engage in recovery from addiction.
76	76	47 “Transitional support services”, short-term, residential support services, as
77	77	48defined by the department of public health, usually following clinical stabilization services,
78	78	49which provide a safe and structured environment to support adults or adolescents through the
79	79	50addiction recovery process and the transition to outpatient or other step-down addiction recovery
80	80	51care.
81	81	52 The division and its contracted health insurers, health plans, health maintenance
82	82	53organizations, behavioral health management firms and third-party administrators under contract 4 of 11
83	83	54to a Medicaid managed care organization or primary care clinician plan shall cover the cost of
84	84	55medically necessary acute treatment services and shall not require preauthorization prior to
85	85	56obtaining treatment.
86	86	57 The division and its contracted health insurers, health plans, health maintenance
87	87	58organizations, behavioral health management firms and third-party administrators under contract
88	88	59to a Medicaid managed care organization or primary care clinician plan shall cover the cost of
89	89	60medically necessary clinical stabilization services and medically necessary transitional support
90	90	61services for up to 30 days and shall not require preauthorization prior to obtaining clinical
91	91	62stabilization services or transitional support services. The facility providing such services shall
92	92	63notify the carrier of admission and the initial treatment plan within 48 hours of admission and
93	93	64within a reasonable time thereafter shall provide the carrier with a projected discharge plan for
94	94	65the member. The carrier’s utilization review procedures may be initiated on day 14; provided,
95	95	66however, that a carrier shall not make any utilization review decisions that impose any restriction
96	96	67or deny any future medically necessary acute treatment, clinical stabilization or transitional
97	97	68support services unless a patient has received at least 30 consecutive days of said services; and,
98	98	69provided further, that the division and its contracted health insurers, health plans, health
99	99	70maintenance organizations, behavioral health management firms and third party administrators
100	100	71under contract to a Medicaid managed care organization or primary care clinician plan shall
101	101	72cover, without preauthorization, substance use disorder evaluations ordered pursuant to section
102	102	7351½ of chapter 111. Upon receipt of notification by the admitting facility and receipt of the
103	103	74discharge plan, the carrier may provide outreach to the treating clinician and member to offer
104	104	75care management and support services. 5 of 11
105	105	76 Medical necessity shall be determined by the treating clinician in consultation
106	106	77with the patient and noted in the patient’s medical record.
107	107	78 SECTION 5. Section 47GG of chapter 175 is hereby amended by inserting after
108	108	79the definition of “Clinical stabilization services” the following definition:-
109	109	80 “Transitional support services”, short-term, residential support services, as
110	110	81defined by the department of public health, usually following clinical stabilization services,
111	111	82which provide a safe and structured environment to support adults or adolescents through the
112	112	83addiction recovery process and the transition to outpatient or other step-down addiction recovery
113	113	84care.
114	114	85 SECTION 6. Section 47GG of said chapter 175 is hereby further amended by
115	115	86striking out the fourth paragraph and inserting in place thereof the following paragraph:-
116	116	87 Any policy, contract, agreement, plan or certificate of insurance issued, delivered
117	117	88or renewed within the commonwealth, which is considered creditable coverage under section 1
118	118	89of chapter 111M, shall provide coverage for medically necessary acute treatment services,
119	119	90medically necessary clinical stabilization services and medically necessary transitional support
120	120	91services for up to 30 days and shall not require preauthorization prior to obtaining acute
121	121	92treatment services, clinical stabilization services or transitional support services. The facility
122	122	93providing such services shall provide the carrier notification of admission and the initial
123	123	94treatment plan within 48 hours of admission and within a reasonable time thereafter shall provide
124	124	95the carrier with a projected discharge plan for the member. The carrier’s utilization review
125	125	96procedures may be initiated on day 14; provided, however, that a carrier shall not make any
126	126	97utilization review decisions that impose any restriction or deny any future medically necessary 6 of 11
127	127	98acute treatment, clinical stabilization or transitional support services unless a patient has received
128	128	99at least 30 consecutive days of said services; provided further, any policy, contract, agreement,
129	129	100plan or certificate of insurance issued, delivered or renewed within the commonwealth, which is
130	130	101considered creditable coverage pursuant to section 1 of chapter 111M, shall cover, without
131	131	102preauthorization, a substance use disorder evaluation ordered pursuant to section 51½ of chapter
132	132	103111. Upon receipt of notification by the admitting facility and receipt of the discharge plan, the
133	133	104carrier may provide outreach to the treating clinician and member to offer care management and
134	134	105support services.
135	135	106 Medical necessity shall be determined by the treating clinician in consultation
136	136	107with the patient and noted in the patient’s medical record.
137	137	108 SECTION 7. Section 8II of chapter 176A is hereby amended by inserting after the
138	138	109definition of “Clinical stabilization services” the following definition:-
139	139	110 “Transitional support services”, short-term, residential support services, as
140	140	111defined by the department of public health, usually following clinical stabilization services,
141	141	112which provide a safe and structured environment to support adults or adolescents through the
142	142	113addiction recovery process and the transition to outpatient or other step-down addiction recovery
143	143	114care.
144	144	115 SECTION 8. Section 8II of said chapter 176A is hereby further amended by
145	145	116striking out the fourth paragraph and inserting in place thereof the following paragraph:-
146	146	117 Any contract between a subscriber and the corporation under an individual or
147	147	118group hospital service plan that is delivered, issued or renewed within the commonwealth shall
148	148	119provide coverage for medically necessary acute treatment services, medically necessary clinical 7 of 11
149	149	120stabilization services and medically necessary transitional support services for up to 30 days and
150	150	121shall not require preauthorization prior to obtaining acute treatment services, clinical stabilization
151	151	122services or transitional support services. The facility providing such services shall provide the
152	152	123carrier notification of admission and the initial treatment plan within 48 hours of admission and
153	153	124within a reasonable time thereafter shall provide the carrier with a projected discharge plan for
154	154	125the member. The carrier’s utilization review procedures may be initiated on day 14; provided,
155	155	126however, that a carrier shall not make any utilization review decisions that impose any restriction
156	156	127or deny any future medically necessary acute treatment, clinical stabilization or transitional
157	157	128support services unless a patient has received at least 30 consecutive days of said services;
158	158	129provided further, any contract between a subscriber and the corporation under an individual or
159	159	130group hospital service plan that is delivered, issued or renewed within the commonwealth, shall
160	160	131cover, without preauthorization, a substance use disorder evaluation ordered pursuant to section
161	161	13251½ of chapter 111. Upon receipt of notification by the admitting facility and receipt of the
162	162	133discharge plan, the carrier may provide outreach to the treating clinician and member to offer
163	163	134care management and support services.
164	164	135 Medical necessity shall be determined by the treating clinician in consultation
165	165	136with the patient and noted in the patient’s medical record.
166	166	137 SECTION 9. Section 4II of chapter 176B is hereby amended by inserting after the
167	167	138definition of “Clinical stabilization services” the following definition:-
168	168	139 “Transitional support services”, short-term, residential support services, as
169	169	140defined by the department of public health, usually following clinical stabilization services,
170	170	141which provide a safe and structured environment to support adults or adolescents through the 8 of 11
171	171	142addiction recovery process and the transition to outpatient or other step-down addiction recovery
172	172	143care.
173	173	144 SECTION 10. Section 4II of said chapter 176B is hereby further amended by
174	174	145striking out the fourth paragraph and inserting in place thereof the following paragraph:-
175	175	146 Any subscription certificate under an individual or group medical service
176	176	147agreement delivered, issued or renewed within the commonwealth shall provide coverage for
177	177	148medically necessary acute treatment services, medically necessary clinical stabilization services
178	178	149and medically necessary transitional support services for up to 30 days and shall not require
179	179	150preauthorization prior to obtaining acute treatment services, clinical stabilization services or
180	180	151transitional support services. The facility providing such services shall provide the carrier
181	181	152notification of admission and the initial treatment plan within 48 hours of admission and within a
182	182	153reasonable time thereafter shall provide the carrier with a projected discharge plan for the
183	183	154member. The carrier’s utilization review procedures may be initiated on day 14; provided,
184	184	155however, that a carrier shall not make any utilization review decisions that impose any restriction
185	185	156or deny any future medically necessary acute treatment, clinical stabilization or transitional
186	186	157support services unless a patient has received at least 30 consecutive days of said services;
187	187	158provided further, any subscription certificate under an individual or group medical service
188	188	159agreement delivered, issued or renewed within the commonwealth shall provide coverage for,
189	189	160without preauthorization, a substance use disorder evaluation ordered pursuant to section 51½ of
190	190	161chapter 111. Upon receipt of notification by the admitting facility and receipt of the discharge
191	191	162plan, the carrier may provide outreach to the treating clinician and member to offer care
192	192	163management and support services. 9 of 11
193	193	164 Medical necessity shall be determined by the treating clinician in consultation
194	194	165with the patient and noted in the patient’s medical record.
195	195	166 SECTION 11. Section 4AA of chapter 176G is hereby amended by inserting after
196	196	167the definition of “Clinical stabilization services” the following definition:-
197	197	168 “Transitional support services”, short-term, residential support services, as
198	198	169defined by the department of public health, usually following clinical stabilization services,
199	199	170which provide a safe and structured environment to support adults or adolescents through the
200	200	171addiction recovery process and the transition to outpatient or other step-down addiction recovery
201	201	172care.
202	202	173 SECTION 12. Said section 4AA is hereby further amended by striking out the
203	203	174fourth paragraph and inserting in place thereof the following paragraph:-
204	204	175 An individual or group health maintenance contract that is issued or renewed shall
205	205	176provide coverage for medically necessary acute treatment services, medically necessary clinical
206	206	177stabilization services and medically necessary transitional support services for up to 30 days and
207	207	178shall not require preauthorization prior to obtaining acute treatment services, clinical stabilization
208	208	179services or transitional support services. The facility providing such services shall provide the
209	209	180carrier notification of admission and the initial treatment plan within 48 hours of admission and
210	210	181within a reasonable time thereafter shall provide the carrier with a projected discharge plan for
211	211	182the member. The carrier’s utilization review procedures may be initiated on day 14; provided,
212	212	183however, that a carrier shall not make any utilization review decisions that impose any restriction
213	213	184or deny any future medically necessary acute treatment, clinical stabilization or transitional
214	214	185support services unless a patient has received at least 30 consecutive days of said services; 10 of 11
215	215	186provided further, an individual or group health maintenance contract that is issued or renewed
216	216	187shall provide coverage for, without preauthorization, a substance abuse evaluation ordered
217	217	188pursuant to section 51½ of chapter 111. Upon receipt of notification by the admitting facility and
218	218	189receipt of the discharge plan, the carrier may provide outreach to the treating clinician and
219	219	190member to offer care management and support services.
220	220	191 Medical necessity shall be determined by the treating clinician in consultation
221	221	192with the patient and noted in the patient’s medical record.
222	222	193 SECTION 13. The center for health information and analysis, in consultation with
223	223	194the division of insurance, the department of public health, the office of Medicaid and the health
224	224	195policy commission, shall conduct reviews on the 14 day mandated coverage of acute treatment
225	225	196services, clinical stabilization services and the long-term effects of the increase in covered days
226	226	197from 14 days to 30 days related to the mandated benefits for acute treatment services, clinical
227	227	198stabilization services and transitional support services on the following areas: (i) the continuum
228	228	199of care for substance use disorder treatment; (ii) access to the continuum of care for patients
229	229	200eligible for MassHealth and department of public health programs; (iii) access to the continuum
230	230	201of care for commercially insured patients; and (iv) any changes in costs to MassHealth, the
231	231	202department of public health and health insurance carriers. The center shall provide an initial
232	232	203report not later than October 1, 2026 on the effects of the 14 day mandated coverage of acute
233	233	204treatment services and clinical stabilization services to the areas listed above and a final report
234	234	205not later than October 1, 2028 on the effects of the 30 day mandated coverage of acute treatment
235	235	206services, clinical stabilization services and transitional support services to the areas listed above. 11 of 11
236	236	207 The initial report and final report shall be posted on the center’s website and shall
237	237	208be filed with the clerks of the house of representatives and senate, the house and senate chairs of
238	238	209the committee on financial services, the house and senate chairs of the committee on health care
239	239	210financing, the house and senate chairs of the committee on public health and the house and
240	240	211senate committees on ways and means not later than October 1, 2026 and October 1, 2028,
241	241	212respectively.
242	242	213 SECTION 14. Sections 1 through 12, inclusive, shall take effect October 1, 2026.