Amendment #39 to H4725

Coding & Coverage for Opioid Agonist Treatment Initiated in Hospital Emergency Departments

Ms. Fiola of Fall River moves to amend the bill by adding the following section:

SECTION XXX. "Notwithstanding any other general or special law to the contrary, the commissioner of the division of insurance and the office of Medicaid shall develop regulations which identify the specific coding classification to allow for coverage by health insurers, health plans, health maintenance organizations, behavioral health management firms and third party administrators under contract to a Carrier, Medicaid managed care organization, accountable care organization, or a MassHealth primary care clinician plan for opioid agonist treatment of opioid use disorders provided within an acute care hospital emergency department or satellite emergency facility as well as continuity of care provided through outpatient services within either a community -based treatment facility, an outpatient clinic, or an office based treatment clinic following discharge from the ED.  Said coverage shall be provided without a prior authorization and shall ensure that existing pharmaceutical formularies allow for such services within hospital and community -based treatment locations, as determined by the treating healthcare provider in the hospital and community-based treatment facility."