Amendment #78, as changed to H.3944

Amendment #78 to H3944

Ways & Means Corrective Amendment

Mr. Dempsey of Haverhill moves to amend the bill by inserting after section 2 the following 2 sections:-

“SECTION 2A Section 4 of chapter 17 of the General Laws, as appearing in the 2014 Official Edition, is hereby amended by striking out, in line 11, the words ‘with the advice of the advisory council on alcoholism and’.

SECTION 2B. Said section 4 of said chapter 17 is hereby further amended by striking out, in lines 14 and 15, the words ‘with the advice of the drug rehabilitation advisory board and’.”;

and by striking out section 7 and inserting in place thereof the following section:-

“SECTION 7. Section 17N of said chapter 32A, as so appearing, is hereby amended by inserting after the words figure ‘7’, in line 28, the following words:- ; provided further, 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.”;

and by inserting after section 17 the following section:-

“Section 17A. Section 1 of chapter 111E of the General Laws, as appearing in the 2014 Official Edition, is hereby amended by striking out the definition of ‘advisory board’.”;

and by inserting after section 18 the following section:-

“SECTION 18A. Section 4 of said chapter 111E is hereby amended by striking out, in lines 6 and 7, the words ‘the advisory board,’.”;

and by striking out section 20 and inserting in place thereof the following 2 sections:-

“SECTION 20. Section 10H of chapter 118E of the General Laws, inserted by section 19 of chapter 258 of the acts of 2014, is hereby repealed.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 20A. Chapter 118E of the General Laws is hereby amended by inserting after 10H, as added by section 25 of chapter 226 of the acts of 2014, the following section:-

Section 10H1/2. For the purposes of this section, the following terms shall, unless the context clearly requires otherwise, have the following meanings:-

‘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, 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, for individuals beginning to engage in recovery from addiction.

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 for up to 14 days and shall not require preauthorization prior to obtaining clinical stabilization services; provided that the facility shall provide the carrier both notification of admission and the initial treatment plan within 48 hours of admission; provided further, that utilization review procedures may be initiated on day 7; 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 51 ½ of chapter 111.

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

and by inserting after section 21 the following section:-

“SECTION 21A. Section 47GG of said chapter 175, as so appearing, is hereby amended by striking out, in line 21, the word ‘118M’ and inserting in place thereof the following word:- 111M.”;

and by striking out section 24 and inserting in place thereof the following section:-

“SECTION 24. Section 8II of said chapter 176A, as so appearing, is hereby amended by inserting after the figure ‘7’, in line 28, the following words:- ; 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.”;

and by striking out section 26 and inserting in place thereof the following section:-

“SECTION 26. Section 4II of said chapter 176B, as so appearing, is hereby amended by inserting after the words figure ‘7’, in line 28, the following words:- ; 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.”;

and by striking out section 28 and inserting in place thereof the following section:-

“SECTION 28. Section 4AA of said chapter 176G, as so appearing, is hereby amended by inserting after the figure ‘7’, in line 27, the following words:- ; 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.”;

and, in section 36, by striking out the last sentence of subsection (b) and inserting in place thereof the following sentence:-

All members shall serve without compensation in an advisory capacity.