Amendment #147 to H.4617

Amendment #147 to H4617

Pain Management

Representatives Pignatelli of Lenox and Vincent of Revere move to amend the bill by inserting the following sections:

SECTION X. 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 XX. 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, including but not limited to acupuncture, chiropractic therapy, and physical therapy, 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 XXX. 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, including but not limited to acupuncture, chiropractic therapy, and physical therapy, in accordance with guidelines developed by the division of insurance.

SECTION XXXX. 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, including but not limited to acupuncture, chiropractic therapy, and physical therapy, in accordance with guidelines developed by the division of insurance.

SECTION XXXXX. 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, including but not limited to acupuncture, chiropractic therapy, and physical therapy, in accordance with guidelines developed by the division of insurance.

SECTION XXXXXX. 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 XXXXXXX. 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 XXXXXXXX. 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, including but not limited to acupuncture, chiropractic therapy, and physical therapy, 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 XXXXXXXXX. 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.