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