Bill H.565

HOUSE DOCKET, NO. 1116 FILED ON: 1/18/2017

HOUSE . . . . . . . . . . . . . . . No. 565

The Commonwealth of Massachusetts

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PRESENTED BY:

Smitty Pignatelli

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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 relative to opioid prescribing practices and access to pain management.

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PETITION OF:

Name:	District/Address:	Date Added:
Smitty Pignatelli	4th Berkshire	1/18/2017
John F. Keenan	Norfolk and Plymouth	1/18/2017
Elizabeth A. Malia	11th Suffolk
Brian M. Ashe	2nd Hampden
Thomas J. Calter	12th Plymouth
Linda Dean Campbell	15th Essex
James M. Cantwell	4th Plymouth
William L. Crocker, Jr.	2nd Barnstable
Josh S. Cutler	6th Plymouth
Marjorie C. Decker	25th Middlesex
Shawn Dooley	9th Norfolk
Susan Williams Gifford	2nd Plymouth
Adam G. Hinds	Berkshire, Hampshire, Franklin and Hampden
Randy Hunt	5th Barnstable
Kay Khan	11th Middlesex
Robert M. Koczera	11th Bristol
Jason M. Lewis	Fifth Middlesex
Barbara A. L'Italien	Second Essex and Middlesex
Juana B. Matias	16th Essex
Denise Provost	27th Middlesex
Bruce J. Ayers	1st Norfolk
Joan B. Lovely	Second Essex
David F. DeCoste	5th Plymouth

HOUSE DOCKET, NO. 1116 FILED ON: 1/18/2017

HOUSE . . . . . . . . . . . . . . . No. 565

By Mr. Pignatelli of Lenox, a petition (accompanied by bill, House, No. 565) of William Smitty Pignatelli and others relative to opioid prescribing practices and health insurance access to pain management. Financial Services.

The Commonwealth of Massachusetts

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

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An Act relative to opioid prescribing practices and access to pain management.

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. Section 15 of chapter 6D of the General Laws, as appearing in the 2014 Official Edition, is hereby amended by inserting after the words “abuse” in line 65 the following:-

“; non-opioid and non-pharmaceutical pain management”

SECTION 2. Said section 15 of said chapter 6D, as so appearing, is hereby further amended by inserting after the word “illnesses” in line 91 the following:- “or chronic pain,”

SECTION 3. Section 21A of chapter 12C of the General Laws, as appearing in the 2014 Official Edition, is hereby amended by inserting at the end thereof the following sentence:-

“Said program shall include, but not be limited to, the development of reasonable standards and procedures by which to assess provider networks and utilization of services for mental health, substance use disorder, and pain management; the purpose of said standards and procedures being to assist the division of insurance network adequacy review process pursuant to section 2A of chapter 176O.”

SECTION 4. Chapter 175 of the General Laws is hereby amended by inserting after section 47II the following section:-

Section 47JJ. (a) Any policy, contract, agreement, plan or certificate of insurance issued, delivered or renewed within the commonwealth, which is considered creditable coverage under section 1 of chapter 111M, shall develop a plan to provide adequate coverage and access to pain management services that serve as alternatives to opioid prescribing, in accordance with guidelines developed by the division of insurance.

(b) The plan described in subsection (a) shall be subject to approval and shall be a component of carrier accreditation by the division of insurance pursuant to section 2 of chapter 176O. In its review, the division shall consider the adequacy of access to pain management services and any carrier policies which may create unduly preferential coverage to prescribing opiates over other pain management modalities.

(c) Each carrier shall distribute educational materials to providers within their networks about the pain management access plan described in subsection (a) and shall post information about said plan on its public website.

SECTION 5. Chapter 176A of the General Laws is hereby amended by inserting after section 8KK the following section:-

Section 8LL. (a) 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 develop a plan to provide adequate coverage and access to pain management services that serve as alternatives to opioid prescribing, in accordance with guidelines developed by the division of insurance.

SECTION 6. Chapter 176B of the General Laws is hereby amended by inserting after section 4KK the following section:-

Section 4LL. (a) Any subscription certificate under an individual or group medical service agreement delivered, issued or renewed within the commonwealth shall develop a plan to provide adequate coverage and access to pain management services that serve as alternatives to opioid prescribing, in accordance with guidelines developed by the division of insurance.

SECTION 7. Chapter 176G of the General Laws is hereby amended by inserting after section 4CC the following section:-

Section 4DD. (a) Any individual or group health maintenance contract that is issued or renewed shall develop a plan to provide adequate coverage and access to pain management services that serve as alternatives to opioid prescribing, in accordance with guidelines developed by the division of insurance.

SECTION 8. Subsection (a) of section 2 of chapter 176O of the General Laws, as appearing in the 2014 Official Edition, is hereby amended by striking out, in lines 8 and 9, the words “and (5)” and inserting in place thereof the following words:-

“(5) access to pain management services, including non-opioid and non-pharmaceutical service options as described in guidelines published by the division; and (6)”

SECTION 9. Subsection (b) of said section 2 of said chapter 176O, as so appearing, is hereby amended by striking the words “center of health care finance and policy” and inserting in place thereof the words:- “center for health information and analysis”

SECTION 10. Said section 2 of said chapter 176O, as so appearing, is hereby further amended by inserting after subsection (b) the following new subsection:-

(b½) For the purposes of accreditation review in the area of pain management, the division shall consult with the health policy commission, established under chapter 6D, for assistance in determining appropriate standards for evidence-based non-opioid pain management products and services, and shall publish guidelines to assist and evaluate carriers’ development and submission of pain management access plans as required under paragraph (5) of subsection (a).

SECTION 11. Chapter 176O, as so appearing, is hereby amended by inserting after section 2 the following new section:-

Section 2A. To the extent that the division requires a submission of plan provider network documents by carriers to assess network adequacy, the division shall forward to the center for health information and analysis, established under chapter 12C, any such documents received that are related to mental health, substance use disorder, or pain management services. The center for health information and analysis may compare said documents to actual claims paid by the carrier, and shall work in conjunction with the division to establish reasonable standards for determining whether a carrier’s provider network documents accurately reflect actual service access and utilization by the carrier’s covered members.