SENATE DOCKET, NO. 1921        FILED ON: 1/20/2017

SENATE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 1103

 

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 providing access to full spectrum addiction treatment services.

_______________

PETITION OF:

 

Name:

District/Address:

 

John F. Keenan

Norfolk and Plymouth

 

James M. Cantwell

4th Plymouth

 

Elizabeth A. Malia

11th Suffolk

 

Eric P. Lesser

First Hampden and Hampshire

 

Jason M. Lewis

Fifth Middlesex

 

Jennifer L. Flanagan

Worcester and Middlesex

 

Michael D. Brady

Second Plymouth and Bristol

 

James B. Eldridge

Middlesex and Worcester

 

Tackey Chan

2nd Norfolk

 

Kathleen O'Connor Ives

First Essex

 

Joan B.  Lovely

Second Essex

 

Eileen M. Donoghue

First Middlesex

 

Viriato M. deMacedo

Plymouth and Barnstable

 

James E. Timilty

Bristol and Norfolk

 

Smitty Pignatelli

4th Berkshire

 

Barbara A. L'Italien

Second Essex and Middlesex

 

Walter F. Timilty

Norfolk, Bristol and Plymouth

 

Colleen M. Garry

36th Middlesex

 

Linda Dorcena Forry

First Suffolk

 

Geoff Diehl

7th Plymouth

 

Susannah M. Whipps

2nd Franklin

 

Daniel J. Hunt

13th Suffolk

 

Mark J. Cusack

5th Norfolk

 

Aaron Vega

5th Hampden

 

Mathew Muratore

1st Plymouth

 

Hannah Kane

11th Worcester

 

David F. DeCoste

5th Plymouth

 

Carole A. Fiola

6th Bristol

 

Paul R. Heroux

2nd Bristol

 

Joseph W. McGonagle, Jr.

28th Middlesex

 

Kevin G. Honan

17th Suffolk

 

Claire D. Cronin

11th Plymouth

 

James R. Miceli

19th Middlesex

 

Robert M. Koczera

11th Bristol

 

Julian Cyr

Cape and Islands

 

Adam G. Hinds

Berkshire, Hampshire, Franklin and Hampden

 

Bruce J. Ayers

1st Norfolk

 

Michael J. Rodrigues

First Bristol and Plymouth

 

Michael O. Moore

Second Worcester

 

John W. Scibak

2nd Hampshire

 

Kenneth J. Donnelly

Fourth Middlesex

 

Adrian Madaro

1st Suffolk

 

Carolyn C. Dykema

8th Middlesex

 

José F. Tosado

9th Hampden

1/20/2017

Jennifer E. Benson

37th Middlesex

1/23/2017

Susan Williams Gifford

2nd Plymouth

2/3/2017

David M. Rogers

24th Middlesex

1/24/2017

Thomas M. McGee

Third Essex

1/25/2017

Shawn Dooley

9th Norfolk

1/25/2017

Solomon Goldstein-Rose

3rd Hampshire

1/25/2017

Michael J. Barrett

Third Middlesex

1/26/2017

Tricia Farley-Bouvier

3rd Berkshire

1/26/2017

Louis L. Kafka

8th Norfolk

1/26/2017

Patrick M. O'Connor

Plymouth and Norfolk

1/26/2017

James J. Dwyer

30th Middlesex

1/26/2017

Jack Lewis

7th Middlesex

1/27/2017

Theodore C. Speliotis

13th Essex

1/27/2017

Randy Hunt

5th Barnstable

1/27/2017

William N. Brownsberger

Second Suffolk and Middlesex

1/30/2017

Marjorie C. Decker

25th Middlesex

1/30/2017

Joseph D. McKenna

18th Worcester

1/30/2017

RoseLee Vincent

16th Suffolk

1/31/2017

Mike Connolly

26th Middlesex

1/31/2017

Dylan Fernandes

Barnstable, Dukes and Nantucket

1/31/2017

James J. O'Day

14th Worcester

2/1/2017

Gerard Cassidy

9th Plymouth

2/1/2017

Michael S. Day

31st Middlesex

2/1/2017

Kenneth I. Gordon

21st Middlesex

2/1/2017

Antonio F. D. Cabral

13th Bristol

2/1/2017

Mary S. Keefe

15th Worcester

2/2/2017

Denise Provost

27th Middlesex

2/2/2017

Linda Dean Campbell

15th Essex

2/2/2017

Anne M. Gobi

Worcester, Hampden, Hampshire and Middlesex

2/2/2017

Sal N. DiDomenico

Middlesex and Suffolk

2/2/2017

James M. Murphy

4th Norfolk

2/2/2017

Patricia A. Haddad

5th Bristol

2/2/2017

Juana B. Matias

16th Essex

2/2/2017

John J. Mahoney

13th Worcester

2/2/2017

Natalie Higgins

4th Worcester

2/3/2017

Daniel Cullinane

12th Suffolk

2/3/2017

Carlos González

10th Hampden

2/3/2017

Thomas A. Golden, Jr.

16th Middlesex

2/3/2017

Jonathan Hecht

29th Middlesex

2/3/2017

Mark C. Montigny

Second Bristol and Plymouth

2/3/2017

David T. Vieira

3rd Barnstable

2/3/2017

Thomas M. Stanley

9th Middlesex

2/3/2017

Jay R. Kaufman

15th Middlesex

2/3/2017

Daniel J. Ryan

2nd Suffolk

3/21/2017

Sean Garballey

23rd Middlesex

3/22/2017

William L. Crocker, Jr.

2nd Barnstable

5/10/2017

Cindy F. Friedman

Fourth Middlesex

10/2/2017


SENATE DOCKET, NO. 1921        FILED ON: 1/20/2017

SENATE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 1103

By Mr. Keenan, a petition (accompanied by bill, Senate, No. 1103) of John F. Keenan, James M. Cantwell, Elizabeth A. Malia, Eric P. Lesser and other members of the General Court for legislation to provide access to full spectrum addiction treatment services.  Mental Health, Substance Use and Recovery.

 

[SIMILAR MATTER FILED IN PREVIOUS SESSION
SEE SENATE, NO. 1502 OF 2015-2016.]

 

The Commonwealth of Massachusetts

 

_______________

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

_______________

 

An Act providing access to full spectrum addiction treatment services.

 

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 17N of chapter 32A of the General Laws, as appearing in the 2014 Official Edition, is hereby amended by inserting after the definition of “Clinical stabilization services” the following definition:-

“Transitional support services”, short-term, residential support services, as defined by the department of public health, usually following clinical stabilization services, that provide a safe and structured environment to support adults or adolescents through the addiction recovery process and the transition to outpatient or other step-down addiction recovery care.

SECTION 2. Said section 17N of said chapter 32A, as so appearing, is hereby further amended by striking out the second paragraph and inserting in place thereof the following paragraph:-

The commission shall provide for medically necessary acute treatment services, medically necessary clinical stabilization services and medically necessary transitional support services to an active or retired employee of the commonwealth who is insured under the group insurance commission coverage for up to 30 days and shall not require preauthorization prior to obtaining such acute treatment services, clinical stabilization services or transitional support services. The facility providing such services shall provide the carrier with notification of admission and the initial treatment plan within 48 hours of admission and within a reasonable time thereafter shall provide the carrier with a projected discharge plan for the member. The carrier’s utilization review procedures may be initiated on day 14; provided however that a carrier shall not make any utilization review decisions that impose any restriction or deny any future medically necessary acute treatment, clinical stabilization, or transitional support services unless a patient has received at least 30 consecutive days of said services; and provided further, that the commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for, without preauthorization, substance abuse evaluations ordered pursuant to section 51½ of chapter 111. Upon receipt of notification by the admitting facility and receipt of the discharge plan, the carrier may provide outreach to the treating clinician and member to offer care management and support services.

Medical necessity shall be determined by the treating clinician in consultation with the patient and noted in the patient’s medical record.

SECTION 3. Section 10H of chapter 118E of the General Laws, inserted by section 19 of chapter 258 of the acts of 2014, is hereby repealed.

SECTION 4. Said chapter 118E is hereby further amended by inserting after section 10J the following section:-

Section 10K. For the purposes of this section, the following words shall have the following meanings unless the context clearly requires otherwise:

“Acute treatment services”, 24-hour medically supervised addiction treatment for adults or adolescents provided in a medically managed or medically monitored inpatient facility, as defined by the department of public health, that provides evaluation and withdrawal management and which may include biopsychosocial assessment, individual and group counseling, psychoeducational groups and discharge planning.

“Clinical stabilization services”, 24-hour clinically managed post detoxification treatment for adults or adolescents, as defined by the department of public health, usually following acute treatment services for substance abuse for individuals beginning to engage in recovery from addiction, which may include intensive education and counseling regarding the nature of addiction and its consequences, relapse prevention, outreach to families and significant others and aftercare planning.

“Transitional support services”, short-term, residential support services, as defined by the department of public health, usually following clinical stabilization services, that provide a safe and structured environment to support adults or adolescents through the addiction recovery process and the transition to outpatient or other step-down addiction recovery care.

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 cover the cost of medically necessary acute treatment services and shall not require a preauthorization prior to obtaining treatment.

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 cover the cost of medically necessary clinical stabilization services and medically necessary transitional support services for up to 30 days and shall not require preauthorization prior to obtaining clinical stabilization services or transitional support services. The facility providing such services shall provide the carrier notification of admission and the initial treatment plan within 48 hours of admission and within a reasonable time thereafter shall provide the carrier with a projected discharge plan for the member. The carrier’s utilization review procedures may be initiated on day 14; provided, however, that a carrier shall not make any utilization review decisions that impose any restriction or deny any future medically necessary acute treatment, clinical stabilization, or transitional support services unless a patient has received at least 30 consecutive days of said services; and provided further, that 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 cover, without preauthorization, substance abuse evaluations ordered pursuant to section 51½ of chapter 111. Upon receipt of notification by the admitting facility and receipt of the discharge plan, the carrier may provide outreach to the treating clinician and member to offer care management and support services.

Medical necessity shall be determined by the treating clinician in consultation with the patient and noted in the patient’s medical record.

SECTION 5. Section 47GG of chapter 175 of the General Laws, as appearing in the 2014 Official Edition, is hereby amended by inserting after the definition of “Clinical stabilization services” the following definition:-

“Transitional support services”, short-term, residential support services, as defined by the department of public health, usually following clinical stabilization services, that provide a safe and structured environment to support adults or adolescents through the addiction recovery process and the transition to outpatient or other step-down addiction recovery care.

SECTION 6. Said section 47GG of said chapter 175, as so appearing, is hereby further amended by striking out the second paragraph and inserting in place thereof the following paragraph:-

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 provide coverage for medically necessary acute treatment services, medically necessary clinical stabilization services and medically necessary transitional support services for up to 30 days and shall not require preauthorization prior to obtaining acute treatment services, clinical stabilization services or transitional support services. The facility providing such services shall provide the carrier notification of admission and the initial treatment plan within 48 hours of admission and within a reasonable time thereafter shall provide the carrier with a projected discharge plan for the member. The carrier’s utilization review procedures may be initiated on day 14; provided however that a carrier shall not make any utilization review decisions that impose any restriction or deny any future medically necessary acute treatment, clinical stabilization, or transitional support services unless a patient has received at least 30 consecutive days of said services; provided further, any policy, contract, agreement, plan or certificate of insurance issued, delivered or renewed within the commonwealth, which is considered creditable coverage pursuant to section 1 of chapter 111M, shall cover, without preauthorization, a substance abuse evaluation ordered pursuant to section 51½ of chapter 111. Upon receipt of notification by the admitting facility and receipt of the discharge plan, the carrier may provide outreach to the treating clinician and member to offer care management and support services.

Medical necessity shall be determined by the treating clinician in consultation with the patient and noted in the patient’s medical record.

SECTION 7. Section 8II of chapter 176A of the General Laws, as so appearing, is hereby amended by inserting after the definition of “Clinical stabilization services” the following definition:-

“Transitional support services”, short-term, residential support services, as defined by the department of public health, usually following clinical stabilization services, that provide a safe and structured environment to support adults or adolescents through the addiction recovery process and the transition to outpatient or other step-down addiction recovery care.

SECTION 8. Said section 8II of said chapter 176A, as so appearing, is hereby further amended by striking out the second paragraph and inserting in place thereof the following paragraph:-

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 medically necessary acute treatment services, medically necessary clinical stabilization services and medically necessary transitional support services for up to 30 days and shall not require preauthorization prior to obtaining acute treatment services, clinical stabilization services or transitional support services. The facility providing such services shall provide the carrier notification of admission and the initial treatment plan within 48 hours of admission and within a reasonable time thereafter shall provide the carrier with a projected discharge plan for the member. The carrier’s utilization review procedures may be initiated on day 14; provided however that a carrier shall not make any utilization review decisions that impose any restriction or deny any future medically necessary acute treatment, clinical stabilization, or transitional support services unless a patient has received at least 30 consecutive days of said services; provided further, 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 cover, without preauthorization, a substance abuse evaluation ordered pursuant to section 51½ of chapter 111. Upon receipt of notification by the admitting facility and receipt of the discharge plan, the carrier may provide outreach to the treating clinician and member to offer care management and support services.

Medical necessity shall be determined by the treating clinician in consultation with the patient and noted in the patient’s medical record.

SECTION 9. Section 4II of chapter 176B of the General Laws, as so appearing, is hereby amended by inserting after the definition of “Clinical stabilization services” the following definition:-

“Transitional support services”, short-term, residential support services, as defined by the department of public health, usually following clinical stabilization services, that provide a safe and structured environment to support adults or adolescents through the addiction recovery process and the transition to outpatient or other step-down addiction recovery care.

SECTION 10. Said section 4II of said chapter 176B, as so appearing, is hereby further amended by striking out the second paragraph and inserting in place thereof the following paragraph:-

Any subscription certificate under an individual or group medical service agreement delivered, issued or renewed within the commonwealth shall provide coverage for medically necessary acute treatment services, medically necessary clinical stabilization services and medically necessary transitional support services for up to 30 days and shall not require preauthorization prior to obtaining acute treatment services, clinical stabilization services or transitional support services. The facility providing such services shall provide the carrier notification of admission and the initial treatment plan within 48 hours of admission and within a reasonable time thereafter shall provide the carrier with a projected discharge plan for the member. The carrier’s utilization review procedures may be initiated on day 14; provided however that a carrier shall not make any utilization review decisions that impose any restriction or deny any future medically necessary acute treatment, clinical stabilization, or transitional support services unless a patient has received at least 30 consecutive days of said services; provided further, any subscription certificate under an individual or group medical service agreement delivered, issued or renewed within the commonwealth shall provide coverage for, without preauthorization, a substance abuse evaluation ordered pursuant to section 51½ of chapter 111. Upon receipt of notification by the admitting facility and receipt of the discharge plan, the carrier may provide outreach to the treating clinician and member to offer care management and support services.

Medical necessity shall be determined by the treating clinician in consultation with the patient and noted in the patient’s medical record.

SECTION 11. Section 4AA of chapter 176G of the General Laws, as so appearing, is hereby amended by inserting after the definition of “Clinical stabilization services” the following definition:-

“Transitional support services”, short-term, residential support services, as defined by the department of public health, usually following clinical stabilization services, that provide a safe and structured environment to support adults or adolescents through the addiction recovery process and the transition to outpatient or other step-down addiction recovery care.

SECTION 12. Said section 4AA of said chapter 176G, as so appearing, is hereby further amended by striking out the second paragraph and inserting in place thereof the following paragraph:-

An individual or group health maintenance contract that is issued or renewed shall provide coverage for medically necessary acute treatment services, medically necessary clinical stabilization services and medically necessary transitional support services for up to 30 days and shall not require preauthorization prior to obtaining acute treatment services, clinical stabilization services or transitional support services. The facility providing such services shall provide the carrier notification of admission and the initial treatment plan within 48 hours of admission and within a reasonable time thereafter shall provide the carrier with a projected discharge plan for the member. The carrier’s utilization review procedures may be initiated on day 14; provided however that a carrier shall not make any utilization review decisions that impose any restriction or deny any future medically necessary acute treatment, clinical stabilization, or transitional support services unless a patient has received at least 30 consecutive days of said services; provided further, an individual or group health maintenance contract that is issued or renewed shall provide coverage for, without preauthorization, a substance abuse evaluation ordered pursuant to section 51½ of chapter 111. Upon receipt of notification by the admitting facility and receipt of the discharge plan, the carrier may provide outreach to the treating clinician and member to offer care management and support services.

Medical necessity shall be determined by the treating clinician in consultation with the patient and noted in the patient’s medical record.

SECTION 13. The center for health information and analysis, in consultation with the division of insurance, the department of public health, the office of Medicaid and the health policy commission, shall conduct reviews on the 14 day mandated coverage of acute treatment services, clinical stabilization services and the long-term effects of the increase in covered days from 14 days to 30 days related to the mandated benefits for acute treatment services, clinical stabilization services and transitional support services on the following areas: (i) the continuum of care for substance use disorder treatment; (ii) access to the continuum of care for patients eligible for MassHealth and department of public health programs; (iii) access to the continuum of care for commercially insured patients; and (iv) any changes in costs to MassHealth, the department of public health and health insurance carriers. The center shall provide an initial report not later than October 1, 2017 on the effects of the 14 day mandated coverage of acute treatment services and clinical stabilization services to the areas listed above and a final report not later than October 1, 2019 on the effects of the 30 day mandated coverage of acute treatment services, clinical stabilization services and transitional support services to the areas listed above.

The initial report and final report shall be posted on the center’s website and shall be filed with the clerks of the house of representatives and senate, the house and senate chairs of the committee on financial services, the house and senate chairs of the committee on health care financing, the house and senate chairs of the committee on public health, and the house and senate committees on ways and means not later than October 1, 2017 and October 1, 2019, respectively.

SECTION 14. Sections 1 through 12, inclusive, shall take effect October 1, 2017.