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