HOUSE DOCKET, NO. 4620        FILED ON: 2/27/2018

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 4380

The Commonwealth of Massachusetts

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PRESENTED BY:

James J. O'Day

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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 to improve substance use disorder treatment in the Commonwealth.

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PETITION OF:

HOUSE DOCKET, NO. 4620        FILED ON: 2/27/2018

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 4380

The Commonwealth of Massachusetts

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In the One Hundred and Ninetieth General Court
(2017-2018)

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An Act to improve substance use disorder treatment in the Commonwealth.

Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:
 

SECTION 1. Chapter 17 of the General Laws, as appearing in the 2016 official edition, is hereby amended by inserting after section 19 the following section:

Section 19A.(a) As used in this section, the following words shall have the following meanings unless the context clearly requires otherwise:

“Relapse discharge”, termination of treatment of a patient for substance use disorder as determined by treatment provider staff, despite a lack of maximal clinical improvement in the patient, due to the use of alcohol or drugs, not including the distribution of alcohol or drugs.

“Department”, the department of public health.

“Bureau”, the bureau of substance addiction services as established in chapter 18.

(b) The bureau, in consultation with the department, shall establish standard criteria and methodology for use in making relapse discharge decisions regarding the appropriate level of treatment based on severity of symptoms. 

(c) The department shall promulgate regulations relative to relapse discharge decisions for substance use disorder treatment programs subject to licensure or approval under sections 24 and 24D of chapter 90, sections 6 and 6A of chapter 111B and section 7 of chapter 111E. The regulations shall include, but not be limited to, a requirement that such substance use disorder treatment providers shall:

(1) make all decisions involving the relapse discharge of patients from a licensed substance use disorder treatment program pursuant to said methodology established in subsection (b) of section 19.

(2) prior to the relapse discharge of any patient from a licensed substance use disorder treatment program, connect the patient to the appropriate level of treatment based on the clinical needs of the patient as determined by the treating clinician.

SECTION 2. Chapter 111E, section 18 of the General Laws, as appearing in the 2016 official edition, is hereby amended by inserting the following subsections after subsection (e):

(f) no patient may be discharged from care as the result of a relapse discharge decision without the connection to clinically appropriate level of care as determined by the treating clinician.

SECTION 3. Section 16 of chapter 6D of the General Laws, as appearing in the 2016 official edition, is hereby amended by inserting the following subsections after subsection (c) :

(d) The office of patient protection shall: -- (1) have the authority to administer and enforce the standards and procedures established by section 19A  of chapter 17. The commission shall promulgate such regulations to enforce this section. The regulations authorized by this section shall be consistent with, and not duplicate or overlap with, regulations promulgated by the bureau of substance abuse services established in the department of public health pursuant to said chapter 17.

(2) assist patients with questions or concerns relating to substance use disorder treatment and care;

(3) establish, by regulation, procedures and rules relating to appeals by patients aggrieved by denials of service or disenrollment resulting from any final action of a substance use disorder treatment program, and to conduct hearings and issue rulings on appeals brought by substance use disorder treatment program patients that are not otherwise properly heard by the patient’s treatment program or care provider.

SECTION 4. Title XVI of the General Laws, as appearing in the 2016 official edition, is hereby amended by inserting after chapter 111O the following chapter:

Chapter 111P. Section 1. As used in this section and in sections 2 to 8, inclusive, the following words shall have the following meanings unless the context clearly requires otherwise:

''Approved continuing education'', continuing education approved by the department, including research and training programs, college and university courses, in-service training programs, seminars and conferences designed to maintain and enhance the skills of certified recovery coaches.

''Approved program'', a program approved by the department for the education and training of certified recovery coaches.

''Approved work experience'', supervised work experience, approved by the department, in substance use disorder treatment and recovery.

''Department'', the department of public health.

“Non-clinical”, not including clinical diagnosis and treatment

“Recovery support services”, non-clinical services provided to assist an individual with initiation and engagement to treatment and to maintain recovery from addiction or substance use disorder that draw upon lived substance use disorder experience, and that include motivational support, informational support, and companionship. Similar roles are commonly known as a recovery coach or a peer recovery support specialist.

“Certified Recovery Coach I”, a person certified by the department to conduct an independent practice of recovery support services and to provide supervision to other recovery coaches. A Recovery Coach I shall have completed a supervised practicum, including training on the supervisory role, which meets the requirements established by the department or such equivalent educational credits as may be established by the department, shall have at least three years of approved work experience in recovery support services and shall have passed a certification examination approved by the department.

“Certified Recovery Coach II”, a person certified by the department to practice non-clinical recovery support services under the supervision of a Certified Recovery Coach I. A certified recovery coach II shall have completed an approved program of education, including a supervised practicum which meets the requirements established by the department or such equivalent educational credits as may be established by the department, shall have at least one year of approved relevant experience and shall have passed a certification examination approved by the department.

Section 2. Duties of department: The department shall establish the requirements for the certification of recovery coaches practicing in the commonwealth, evaluate the qualifications of applicants, supervise certification examinations, collect fees established for certification and examination, grant and issue certifications to recovery coaches who satisfy the department's requirements for certification, require and establish continuing education requirements, investigate complaints and take appropriate disciplinary action to protect the public health, safety and welfare.

The department shall establish requirements for certified recovery coaches I and II and may establish other reasonable classifications for recovery coaches as it finds necessary and appropriate, taking into consideration different levels of education, training and work experience.

The department shall approve and issue certificates of approval of programs for the training of recovery coaches. The department shall maintain a list of approved programs as well as a current roster of persons serving as recovery coaches in the commonwealth.

The department shall promulgate such rules and regulations as it deems necessary to implement the provisions of this chapter including rules and regulations establishing the educational and professional requirements for certifying recovery coaches, establishing fees for certifying and examination and governing the practice and employment of certified recovery coaches to promote the public health, safety and welfare.

Section 3: Certifying; proof of qualifications; biennial certification renewal

Section 3. Each applicant for a certification shall furnish the department with proof of satisfactory completion of the educational, training and experience requirements for certification, including completion of an approved program and approved work experience and proof of having passed such certifying examination as approved or administered by the department.

A person serving as a certified recovery coach shall apply for certification renewal biennially to the department. A recovery coach seeking certification renewal shall submit proof of having successfully completed the requirements for such approved continuing education as may be established by regulations.

Applications for certifications and renewals thereof shall be submitted in accordance with procedures established by the department. Each application shall be accompanied by the payment of a fee to be determined by the department.

Section 4: Prohibition of uncertified recovery coaching; fine; injunction

Section 4. Except as otherwise provided for in this chapter or by regulation, a person who is not certified or is otherwise exempt from certification, shall not hold him or herself out as a certified recovery coach and shall not use the title, initials or description of a certified recovery coach or practice or attempt to practice recovery coaching. Whoever engages in any such unauthorized action shall be subject to a fine of not less than $500. In addition, the department may bring a petition in superior court to enjoin such action or any other violation of this chapter or a regulation of the department.

Section 5: Provision of coaching services by noncertified individuals; limitations:

Section 5. Nothing in this section shall be construed to prevent qualified members of other professions, including licensed alcohol & drug counselors, marriage and family counselors, mental health counselors, psychologists, social workers, nurse practitioners, practical nurses, physician assistants, physicians, Christian Science practitioners or members of the clergy, from providing recovery support services consistent with accepted standards of their respective professions; provided, however, that no such person shall use a title stating or implying that such person is a certified recovery coach.

Nothing in this section shall be construed to prevent members of peer groups or self-help groups from performing peer group or self-help activities; provided, however, that no such person shall use a title stating or implying that such person is a certified recovery coach.

Section 6: Consumer complaints; authority of department; discipline of certified recovery coach

Section 6. The department shall establish procedures for consumers to file written complaints regarding a recovery coach who is subject to requirements for certification.

The department shall investigate all complaints relating to the proper practice of a recovery coach holding a certification and all complaints relating to any violation of this chapter or regulation of the department.

The department may conduct an adjudicatory proceeding pursuant to chapter 30A, but shall not have the power to issue, vacate, modify or enforce subpoenas pursuant to section 12 of said chapter 30A. The department may, after a hearing pursuant to said chapter 30A, deny, refuse renewal, revoke, limit or suspend a certification or otherwise discipline a recovery coach certified pursuant to this chapter. Grounds for denial, refusal to renew, revocation, limitation, suspension or other discipline shall include the following:

(1) fraud or misrepresentation in obtaining a certification;

(2) criminal conduct which the department determines to be of such a nature as to render such person unfit to practice as a certified recovery coach as evidenced by criminal proceedings resulting in a conviction, guilty plea or plea of nolo contendere or an admission of sufficient facts;

(3) violation of any rule or regulation of the department governing the practice of recovery coaches;

(4) violation of ethical standards which the department determines to be of such a nature as to render such person unfit to practice as a recovery coach;

(5) other just and sufficient cause which the department may determine would render a person unfit to practice as a recovery coach.

Where denial, refusal to renew, revocation or suspension is based solely on the failure of the certified recovery coach to file timely an application or pay prescribed fees or to maintain insurance coverage as required by law or regulation, the department may act without first granting the applicant or certified recovery coach a hearing.

Section 7: Certification examinations; form; semi-annually; certificate in lieu of examination

Section 7. Examinations for recovery coaches shall be conducted at least twice a year at times and places designated by the department. Examinations shall be written; provided, however, that portions thereof may be conducted orally. A person who has failed an examination may be admitted to the next subsequent examination.

The department may accept, in lieu of its own examination, a current certificate of any recognized certifying body issued on the basis of an examination satisfactory to the department; provided, however, that the standards of such body shall be at least as stringent as those established by the department.

Section 8: Certification without examination; applicant licensed or certified in another state

Section 8. The department may issue a certification without examination to an applicant whose qualifications meet the requirements for certification established by the department if such applicant is licensed or certified in recovery coaching or a comparable field in another state wherein the requirements for certification are deemed by the department to be equivalent to or in excess of the requirements of this chapter.

SECTION 5. Chapter 32A of the General Laws, as appearing in the 2016 official edition, is hereby amended by inserting after section 17O the following section:-

Section 17P. For the purposes of this section the following terms shall have the following meanings:-

“Recovery support services”, non-clinical services provided to assist an individual with initiation and engagement to treatment and to maintain recovery from addiction or substance use disorder that draw upon lived substance use disorder experience, and that include motivational support, informational support, and companionship. Similar roles are commonly known as a recovery coach or a peer recovery support specialist.

“Certified recovery coach”, an individual certified to provide recovery support services.

“Clinician”, any individual who has a master’s degree in one of the following disciplines or a closely related field: clinical psychology, medicine, psychiatric nursing, rehabilitative counseling, clinical social work, advance practice registered nursing

Any coverage offered by the commission to an active or retired employee of the commonwealth insured under the group insurance commission shall provide coverage for recovery support services provided by a certified recovery coach pursuant to chapter 17, section 21 for the initiation and maintenance of recovery from substance use disorder when determined to be medically necessary by a licensed clinician. An increase in patient cost sharing shall not be allowed to achieve compliance with this section.

SECTION 6. Chapter 118E of the General Laws, as appearing in the 2016 official edition, is hereby amended by inserting after section 10J the following section:-

Section 10K. For the purposes of this section the following terms shall have the following meanings:-

“Recovery support services”, non-clinical services provided to assist an individual with initiation and engagement to treatment and to maintain recovery from addiction or substance use disorder that draw upon lived substance use disorder experience, and that include motivational support, informational support, and companionship. Similar roles are commonly known as a recovery coach or a peer recovery support specialist.

“Certified recovery coach”, an individual certified to provide recovery support services.

The division and its contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third-party administrators under contract to a Medicaid managed care organization or primary care clinician plan shall provide coverage for recovery support services provided by a certified recovery coach pursuant to chapter 17, section 21 for the initiation and maintenance of recovery from substance use disorder when determined to be medically necessary by a licensed clinician and shall establish billing codes and rates of payment for the delivery of said recovery support services.

SECTION 7. Chapter 175 of the General Laws, as appearing in the 2016 official edition, is hereby amended by inserting after section 47II the following section:-

Section 47JJ. For the purposes of this section the following terms shall have the following meanings:-

“Recovery support services”, non-clinical services provided to assist an individual with initiation and engagement to treatment and to maintain recovery from addiction or substance use disorder that draw upon lived substance use disorder experience, and that include motivational support, informational support, and companionship. Similar roles are commonly known as a recovery coach or a peer recovery support specialist.

“Certified recovery coach”, an individual certified to provide recovery support services.

Any policy, contract, agreement, plan or certificate of insurance issued, delivered or renewed within the commonwealth that provides medical expense coverage shall provide coverage for recovery support services provided by a certified recovery coach pursuant to chapter 17, section 21 for the treatment of a patient seeking initiation or maintenance of recovery from substance use disorder when determined to be medically necessary by a licensed clinician. An increase in patient cost sharing shall not be allowed to achieve compliance with this section.

SECTION 8. Chapter 176A of the General Laws, as appearing in the 2016 official edition, is hereby amended by inserting after section Section 8KK the following new section:-

Section 8LL. For the purposes of this section the following terms shall have the following meanings:-

“Recovery support services”, non-clinical services provided to assist an individual with initiation and engagement to treatment and to maintain recovery from addiction or substance use disorder that draw upon lived substance use disorder experience, and that include motivational support, informational support, and companionship. Similar roles are commonly known as a recovery coach or a peer recovery support specialist.

“Certified recovery coach”, an individual certified to provide recovery support services.

Any contract between a subscriber and the corporation under an individual or group hospital service plan which is delivered, issued or renewed within the commonwealth shall provide coverage for recovery support services provided by a certified recovery coach pursuant to chapter 17, section 21 for the treatment of a patient seeking initiation or maintenance of recovery from substance use disorder when determined to be medically necessary by a licensed clinician. An increase in patient cost sharing shall not be allowed to achieve compliance with this section.

SECTION 9. Chapter 176B of the General Laws, as appearing in the 2016 official edition, is hereby amended by inserting after section Section 4KK the following new section:-

Section 4LL. For the purposes of this section the following terms shall have the following meanings:-

“Recovery support services”, non-clinical services provided to assist an individual with initiation and engagement to treatment and to maintain recovery from addiction or substance use disorder that draw upon lived substance use disorder experience, and that include motivational support, informational support, and companionship. Similar roles are commonly known as a recovery coach or a peer recovery support specialist.

“Certified recovery coach”, an individual certified to provide recovery support services.

Any subscription certificate under an individual or group medical service agreement delivered, issued or renewed within the commonwealth shall provide coverage for recovery support services provided by a certified recovery coach pursuant to chapter 17, section 21 for the treatment of a patient seeking initiation or maintenance of recovery from substance use disorder when determined to be medically necessary by a licensed clinician. An increase in patient cost sharing shall not be allowed to achieve compliance with this section.

SECTION 10. Chapter 176G of the General Laws, as appearing in the 2016 official edition, is hereby amended by inserting after section Section 4CC the following new section:-

Section 4DD. For the purposes of this section the following terms shall have the following meanings:-

“Recovery support services”, non-clinical services provided to assist an individual with initiation and engagement to treatment and to maintain recovery from addiction or substance use disorder that draw upon lived substance use disorder experience, and that include motivational support, informational support, and companionship. Similar roles are commonly known as a recovery coach or a peer recovery support specialist.

“Certified recovery coach”, an individual certified to provide recovery support services.

Any individual or group health maintenance contract shall provide coverage for recovery support services provided by a certified recovery coach pursuant to chapter 17, section 21 for the treatment of a patient seeking initiation or maintenance of recovery from substance use disorder when determined to be medically necessary by a licensed clinician. An increase in patient cost sharing shall not be allowed to achieve compliance with this section.