Massachusetts 2025-2026 Regular Session

Massachusetts Senate Bill S772 Compare Versions

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

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2	2	SENATE DOCKET, NO. 971 FILED ON: 1/15/2025
3	3	SENATE . . . . . . . . . . . . . . No. 772
4	4	The Commonwealth of Massachusetts
5	5	_________________
6	6	PRESENTED BY:
7	7	John F. Keenan
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 :John F. KeenanNorfolk and PlymouthJames B. EldridgeMiddlesex and Worcester2/7/2025James K. Hawkins2nd Bristol2/11/2025Michael J. BarrettThird Middlesex2/21/2025Michael O. MooreSecond Worcester3/6/2025 1 of 10
16	16	SENATE DOCKET, NO. 971 FILED ON: 1/15/2025
17	17	SENATE . . . . . . . . . . . . . . No. 772
18	18	By Mr. Keenan, a petition (accompanied by bill, Senate, No. 772) of John F. Keenan, James B.
19	19	Eldridge, James K. Hawkins, Michael J. Barrett and others for legislation to increases mandatory
20	20	coverage for addiction care recovery. 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 related to comprehensive clinical and extended support services.
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. Section 17N of chapter 32A of the General Laws, as appearing in the 2022
30	30	2Official Edition, is hereby amended by inserting after the definition of “Clinical stabilization
31	31	3services” the following definition:-
32	32	4 “Transitional support services”, short-term, residential support services, as defined by the
33	33	5department of public health, usually following clinical stabilization services, which provide a
34	34	6safe and structured environment to support adults or adolescents through the addiction recovery
35	35	7process and the transition to outpatient or other step-down addiction recovery care.
36	36	8 SECTION 2. Section 17N of chapter 32A is further amended by striking out the fourth
37	37	9paragraph and inserting in place thereof the following paragraph:-
38	38	10 The commission shall provide for medically necessary acute treatment services,
39	39	11medically necessary clinical stabilization services and medically necessary transitional support
40	40	12services to an active or retired employee of the commonwealth who is insured under the group 2 of 10
41	41	13insurance commission coverage for up to 30 days and shall not require preauthorization prior to
42	42	14obtaining such acute treatment services, clinical stabilization services or transitional support
43	43	15services. The facility providing such services shall notify the carrier of admission and the initial
44	44	16treatment plan within 48 hours of admission, and within a reasonable time thereafter, shall
45	45	17provide the carrier with a projected discharge plan for the member. The carrier’s utilization
46	46	18review procedures may be initiated on day 14; provided, however, that a carrier shall not make
47	47	19any utilization review decisions that impose any restriction or deny any future medically
48	48	20necessary acute treatment, clinical stabilization or transitional support services unless a patient
49	49	21has received at least 30 consecutive days of said services; and, provided further, that the
50	50	22commission shall provide, without preauthorization, to any active or retired employee of the
51	51	23commonwealth who is insured under the group insurance commission coverage for substance use
52	52	24disorder evaluations ordered pursuant to section 51½ of chapter 111. Upon receipt of notification
53	53	25by the admitting facility and receipt of the discharge plan, the carrier may provide outreach to the
54	54	26treating clinician and member to offer care management and support services.
55	55	27 Medical necessity shall be determined by the treating clinician in consultation with the
56	56	28patient and noted in the patient’s medical record.
57	57	29 SECTION 3. Section 10H of chapter 118E of the General Laws, inserted by section 19 of
58	58	30chapter 258 of the acts of 2014, is hereby repealed.
59	59	31 SECTION 4. Said chapter 118E is hereby further amended by inserting after section 10N
60	60	32the following section:-
61	61	33 Section 10O. For the purposes of this section, the following words shall have the
62	62	34following meanings unless the context clearly requires otherwise: 3 of 10
63	63	35 “Acute treatment services”, 24-hour medically supervised addiction treatment for adults
64	64	36or adolescents provided in a medically managed or medically monitored inpatient facility, as
65	65	37defined by the department of public health, which provides evaluation and withdrawal
66	66	38management and that may include biopsychosocial assessment, individual and group counseling,
67	67	39psychoeducational groups and discharge planning.
68	68	40 “Clinical stabilization services”, 24-hour clinically managed post detoxification treatment
69	69	41for adults or adolescents, as defined by the department of public health, usually following acute
70	70	42treatment services for substance abuse for individuals beginning to engage in recovery from
71	71	43addiction, which may include intensive education and counseling regarding the nature of
72	72	44addiction and its consequences, relapse prevention, outreach to families and significant others
73	73	45and aftercare planning, for individuals beginning to engage in recovery from addiction.
74	74	46 “Transitional support services”, short-term, residential support services, as defined by the
75	75	47department of public health, usually following clinical stabilization services, which provide a
76	76	48safe and structured environment to support adults or adolescents through the addiction recovery
77	77	49process and the transition to outpatient or other step-down addiction recovery care.
78	78	50 The division and its contracted health insurers, health plans, health maintenance
79	79	51organizations, behavioral health management firms and third-party administrators under contract
80	80	52to a Medicaid managed care organization or primary care clinician plan shall cover the cost of
81	81	53medically necessary acute treatment services and shall not require preauthorization prior to
82	82	54obtaining treatment.
83	83	55 The division and its contracted health insurers, health plans, health maintenance
84	84	56organizations, behavioral health management firms and third-party administrators under contract 4 of 10
85	85	57to a Medicaid managed care organization or primary care clinician plan shall cover the cost of
86	86	58medically necessary clinical stabilization services and medically necessary transitional support
87	87	59services for up to 30 days and shall not require preauthorization prior to obtaining clinical
88	88	60stabilization services or transitional support services. The facility providing such services shall
89	89	61notify the carrier of admission and the initial treatment plan within 48 hours of admission and
90	90	62within a reasonable time thereafter shall provide the carrier with a projected discharge plan for
91	91	63the member. The carrier’s utilization review procedures may be initiated on day 14; provided,
92	92	64however, that a carrier shall not make any utilization review decisions that impose any restriction
93	93	65or deny any future medically necessary acute treatment, clinical stabilization or transitional
94	94	66support services unless a patient has received at least 30 consecutive days of said services; and,
95	95	67provided further, that the division and its contracted health insurers, health plans, health
96	96	68maintenance organizations, behavioral health management firms and third party administrators
97	97	69under contract to a Medicaid managed care organization or primary care clinician plan shall
98	98	70cover, without preauthorization, substance use disorder evaluations ordered pursuant to section
99	99	7151½ of chapter 111. Upon receipt of notification by the admitting facility and receipt of the
100	100	72discharge plan, the carrier may provide outreach to the treating clinician and member to offer
101	101	73care management and support services.
102	102	74 Medical necessity shall be determined by the treating clinician in consultation with the
103	103	75patient and noted in the patient’s medical record.
104	104	76 SECTION 5. Section 47GG of chapter 175 is hereby amended by inserting after the
105	105	77definition of “Clinical stabilization services” the following definition:- 5 of 10
106	106	78 “Transitional support services”, short-term, residential support services, as defined by the
107	107	79department of public health, usually following clinical stabilization services, which provide a
108	108	80safe and structured environment to support adults or adolescents through the addiction recovery
109	109	81process and the transition to outpatient or other step-down addiction recovery care.
110	110	82 SECTION 6. Section 47GG of said chapter 175 is hereby further amended by striking out
111	111	83the fourth paragraph and inserting in place thereof the following paragraph:-
112	112	84 Any policy, contract, agreement, plan or certificate of insurance issued, delivered or
113	113	85renewed within the commonwealth, which is considered creditable coverage under section 1 of
114	114	86chapter 111M, shall provide coverage for medically necessary acute treatment services,
115	115	87medically necessary clinical stabilization services and medically necessary transitional support
116	116	88services for up to 30 days and shall not require preauthorization prior to obtaining acute
117	117	89treatment services, clinical stabilization services or transitional support services. The facility
118	118	90providing such services shall provide the carrier notification of admission and the initial
119	119	91treatment plan within 48 hours of admission and within a reasonable time thereafter shall provide
120	120	92the carrier with a projected discharge plan for the member. The carrier’s utilization review
121	121	93procedures may be initiated on day 14; provided, however, that a carrier shall not make any
122	122	94utilization review decisions that impose any restriction or deny any future medically necessary
123	123	95acute treatment, clinical stabilization or transitional support services unless a patient has received
124	124	96at least 30 consecutive days of said services; provided further, any policy, contract, agreement,
125	125	97plan or certificate of insurance issued, delivered or renewed within the commonwealth, which is
126	126	98considered creditable coverage pursuant to section 1 of chapter 111M, shall cover, without
127	127	99preauthorization, a substance use disorder evaluation ordered pursuant to section 51½ of chapter
128	128	100111. Upon receipt of notification by the admitting facility and receipt of the discharge plan, the 6 of 10
129	129	101carrier may provide outreach to the treating clinician and member to offer care management and
130	130	102support services.
131	131	103 Medical necessity shall be determined by the treating clinician in consultation with the
132	132	104patient and noted in the patient’s medical record.
133	133	105 SECTION 7. Section 8II of chapter 176A is hereby amended by inserting after the
134	134	106definition of “Clinical stabilization services” the following definition:-
135	135	107 “Transitional support services”, short-term, residential support services, as defined by the
136	136	108department of public health, usually following clinical stabilization services, which provide a
137	137	109safe and structured environment to support adults or adolescents through the addiction recovery
138	138	110process and the transition to outpatient or other step-down addiction recovery care.
139	139	111 SECTION 8. Section 8II of said chapter 176A is hereby further amended by striking out
140	140	112the fourth paragraph and inserting in place thereof the following paragraph:-
141	141	113 Any contract between a subscriber and the corporation under an individual or group
142	142	114hospital service plan that is delivered, issued or renewed within the commonwealth shall provide
143	143	115coverage for medically necessary acute treatment services, medically necessary clinical
144	144	116stabilization services and medically necessary transitional support services for up to 30 days and
145	145	117shall not require preauthorization prior to obtaining acute treatment services, clinical stabilization
146	146	118services or transitional support services. The facility providing such services shall provide the
147	147	119carrier notification of admission and the initial treatment plan within 48 hours of admission and
148	148	120within a reasonable time thereafter shall provide the carrier with a projected discharge plan for
149	149	121the member. The carrier’s utilization review procedures may be initiated on day 14; provided,
150	150	122however, that a carrier shall not make any utilization review decisions that impose any restriction 7 of 10
151	151	123or deny any future medically necessary acute treatment, clinical stabilization or transitional
152	152	124support services unless a patient has received at least 30 consecutive days of said services;
153	153	125provided further, any contract between a subscriber and the corporation under an individual or
154	154	126group hospital service plan that is delivered, issued or renewed within the commonwealth, shall
155	155	127cover, without preauthorization, a substance use disorder evaluation ordered pursuant to section
156	156	12851½ of chapter 111. Upon receipt of notification by the admitting facility and receipt of the
157	157	129discharge plan, the carrier may provide outreach to the treating clinician and member to offer
158	158	130care management and support services.
159	159	131 Medical necessity shall be determined by the treating clinician in consultation with the
160	160	132patient and noted in the patient’s medical record.
161	161	133 SECTION 9. Section 4II of chapter 176B is hereby amended by inserting after the
162	162	134definition of “Clinical stabilization services” the following definition:-
163	163	135 “Transitional support services”, short-term, residential support services, as defined by the
164	164	136department of public health, usually following clinical stabilization services, which provide a
165	165	137safe and structured environment to support adults or adolescents through the addiction recovery
166	166	138process and the transition to outpatient or other step-down addiction recovery care.
167	167	139 SECTION 10. Section 4II of said chapter 176B is hereby further amended by striking out
168	168	140the fourth paragraph and inserting in place thereof the following paragraph:-
169	169	141 Any subscription certificate under an individual or group medical service agreement
170	170	142delivered, issued or renewed within the commonwealth shall provide coverage for medically
171	171	143necessary acute treatment services, medically necessary clinical stabilization services and
172	172	144medically necessary transitional support services for up to 30 days and shall not require 8 of 10
173	173	145preauthorization prior to obtaining acute treatment services, clinical stabilization services or
174	174	146transitional support services. The facility providing such services shall provide the carrier
175	175	147notification of admission and the initial treatment plan within 48 hours of admission and within a
176	176	148reasonable time thereafter shall provide the carrier with a projected discharge plan for the
177	177	149member. The carrier’s utilization review procedures may be initiated on day 14; provided,
178	178	150however, that a carrier shall not make any utilization review decisions that impose any restriction
179	179	151or deny any future medically necessary acute treatment, clinical stabilization or transitional
180	180	152support services unless a patient has received at least 30 consecutive days of said services;
181	181	153provided further, any subscription certificate under an individual or group medical service
182	182	154agreement delivered, issued or renewed within the commonwealth shall provide coverage for,
183	183	155without preauthorization, a substance use disorder evaluation ordered pursuant to section 51½ of
184	184	156chapter 111. Upon receipt of notification by the admitting facility and receipt of the discharge
185	185	157plan, the carrier may provide outreach to the treating clinician and member to offer care
186	186	158management and support services.
187	187	159 Medical necessity shall be determined by the treating clinician in consultation with the
188	188	160patient and noted in the patient’s medical record.
189	189	161 SECTION 11. Section 4AA of chapter 176G is hereby amended by inserting after the
190	190	162definition of “Clinical stabilization services” the following definition:-
191	191	163 “Transitional support services”, short-term, residential support services, as defined by the
192	192	164department of public health, usually following clinical stabilization services, which provide a
193	193	165safe and structured environment to support adults or adolescents through the addiction recovery
194	194	166process and the transition to outpatient or other step-down addiction recovery care. 9 of 10
195	195	167 SECTION 12. Said section 4AA is hereby further amended by striking out the fourth
196	196	168paragraph and inserting in place thereof the following paragraph:-
197	197	169 An individual or group health maintenance contract that is issued or renewed shall
198	198	170provide coverage for medically necessary acute treatment services, medically necessary clinical
199	199	171stabilization services and medically necessary transitional support services for up to 30 days and
200	200	172shall not require preauthorization prior to obtaining acute treatment services, clinical stabilization
201	201	173services or transitional support services. The facility providing such services shall provide the
202	202	174carrier notification of admission and the initial treatment plan within 48 hours of admission and
203	203	175within a reasonable time thereafter shall provide the carrier with a projected discharge plan for
204	204	176the member. The carrier’s utilization review procedures may be initiated on day 14; provided,
205	205	177however, that a carrier shall not make any utilization review decisions that impose any restriction
206	206	178or deny any future medically necessary acute treatment, clinical stabilization or transitional
207	207	179support services unless a patient has received at least 30 consecutive days of said services;
208	208	180provided further, an individual or group health maintenance contract that is issued or renewed
209	209	181shall provide coverage for, without preauthorization, a substance abuse evaluation ordered
210	210	182pursuant to section 51½ of chapter 111. Upon receipt of notification by the admitting facility and
211	211	183receipt of the discharge plan, the carrier may provide outreach to the treating clinician and
212	212	184member to offer care management and support services.
213	213	185 Medical necessity shall be determined by the treating clinician in consultation with the
214	214	186patient and noted in the patient’s medical record.
215	215	187 SECTION 13. The center for health information and analysis, in consultation with the
216	216	188division of insurance, the department of public health, the office of Medicaid and the health 10 of 10
217	217	189policy commission, shall conduct reviews on the 14 day mandated coverage of acute treatment
218	218	190services, clinical stabilization services and the long-term effects of the increase in covered days
219	219	191from 14 days to 30 days related to the mandated benefits for acute treatment services, clinical
220	220	192stabilization services and transitional support services on the following areas: (i) the continuum
221	221	193of care for substance use disorder treatment; (ii) access to the continuum of care for patients
222	222	194eligible for MassHealth and department of public health programs; (iii) access to the continuum
223	223	195of care for commercially insured patients; and (iv) any changes in costs to MassHealth, the
224	224	196department of public health and health insurance carriers. The center shall provide an initial
225	225	197report not later than October 1, 2026 on the effects of the 14 day mandated coverage of acute
226	226	198treatment services and clinical stabilization services to the areas listed above and a final report
227	227	199not later than October 1, 2026 on the effects of the 30 day mandated coverage of acute treatment
228	228	200services, clinical stabilization services and transitional support services to the areas listed above.
229	229	201 The initial report and final report shall be posted on the center’s website and shall be filed
230	230	202with the clerks of the house of representatives and senate, the house and senate chairs of the
231	231	203committee on financial services, the house and senate chairs of the committee on health care
232	232	204financing, the house and senate chairs of the committee on public health and the house and
233	233	205senate committees on ways and means not later than October 1, 2026 and October 1, 2028,
234	234	206respectively.
235	235	207 SECTION 14. Sections 1 through 12, inclusive, shall take effect October 1, 2026.