Amendment #1227 to H4600

Coverage for Substance Use Disorder Services Rendered by Peer Support Specialists

Ms. Decker of Cambridge moves to amend the bill by adding the following sections:

“SECTION XXXX:

SECTION 1. Chapter 32A of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by adding the following new section:-

Section 31. (a) The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for the provision of behavioral health or substance use disorder services provided by peer support specialists, including but not limited to, peer recovery coaches and recovery support navigators, regardless of the setting these services are provided in. This coverage shall include coverage of peer recovery coaches and recovery support navigators who are employed by health care facilities and who only provide recovery coach or recovery support navigator services for patients while the patient is being treated in an emergency department, acute care hospital, freestanding psychiatric hospital, or substance use disorder facility. The commission shall include reimbursement for the provision of said services via telemedicine, electronic or telephonic consultation. The contractual rate for these services may be no less than the prevailing MassHealth rate for peer recovery coach services or recovery support navigator services. The benefits in this section shall not be subject to any deductible, coinsurance, copayments, or out-of-pocket limits. Peer support specialist services, including peer recovery coach services and recovery support navigator services shall be deemed medically necessary and shall not require prior authorization.

SECTION 2.Chapter 118E of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by adding the following new section:-

Section 83. (a) 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, accountable care organization, or primary care clinician plan shall provide coverage for the provision of behavioral health or substance use disorder services provided by peer support specialists, including but not limited to, peer recovery coaches, and recovery support navigators, regardless of the setting these services are provided in. This coverage shall include coverage of peer recovery coaches and recovery support navigators who are employed by health care facilities and who only provide recovery coach or recovery support navigator services for patients while the patient is being treated in an emergency department, acute care hospital, freestanding psychiatric hospital, or substance use disorder facility. The division and its contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third-party administrators shall include reimbursement for the provision of said services via telemedicine, electronic or telephonic consultation. The benefits in this section shall not be subject to any deductible, coinsurance, copayments, or out-of-pocket limits. Peer support specialist services, including peer recovery coach services and recovery support navigator services shall be deemed medically necessary and shall not require prior authorization.

SECTION 3. Chapter 175 of the General Laws, as so appearing, is hereby amended by inserting after section 4TT the following new section:-

Section 47UU. (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 118M, shall provide coverage for the provision of behavioral health or substance use disorder services provided by peer support specialists, including but not limited to, peer recovery coaches and recovery support navigators, regardless of the setting these services are provided in. This coverage shall include coverage of peer recovery coaches and recovery support navigators who are employed by health care facilities and who only provide recovery coach or recovery support navigator services for patients while the patient is being treated in an emergency department, acute care hospital, freestanding psychiatric hospital, or substance use disorder facility. The policy, contract, agreement, plan or certificate of insurance shall include reimbursement for the provision of said services via telemedicine, electronic or telephonic consultation. The contractual rate for these services may be no less than the prevailing MassHealth rate for peer recovery coach services or recovery support navigator services. The benefits in this section shall not be subject to any deductible, coinsurance, copayments, or out-of-pocket limits. Peer support specialist services, including peer recovery coach services and recovery support navigator services shall be deemed medically necessary and shall not require prior authorization.

SECTION 4. Chapter 176A of the General Laws, as so appearing, is hereby amended by inserting after section 8UU the following new section:-

Section 8VV. (a) Any contract between a subscriber and the corporation under an individual or group hospital service plan that is delivered, issued, or renewed within the commonwealth shall provide coverage for the provision of behavioral health or substance use disorder services provided by peer support specialists, including but not limited to, peer recovery coaches and recovery support navigators, regardless of the setting these services are provided in. This coverage shall include coverage of peer recovery coaches and recovery support navigators who are employed by health care facilities and who only provide recovery coach or recovery support navigator services for patients while the patient is being treated in an emergency department, acute care hospital, freestanding psychiatric hospital, or substance use disorder facility. The contract shall include reimbursement for the provision of said services via telemedicine, electronic or telephonic consultation. The contractual rate for these services may be no less than the prevailing MassHealth rate for peer recovery coach services or recovery support navigator services. The benefits in this section shall not be subject to any deductible, coinsurance, copayments, or out-of-pocket limits. Peer support specialist services, including peer recovery coach services and recovery support navigator services shall be deemed medically necessary and shall not require prior authorization.

SECTION 5. Chapter 176B of the General Laws, as so appearing, is hereby amended by adding the following new section after section 4UU:

Section 4VV. (a) Any subscription certificate under an individual or group medical service agreement delivered, issued, or renewed within the commonwealth shall provide coverage for the provision of behavioral health or substance use disorder services provided by peer support specialists, including but not limited to, peer recovery coaches and recovery support navigators, regardless of the setting these services are provided in. This coverage shall include coverage of peer recovery coaches and recovery support navigators who are employed by health care facilities and who only provide recovery coach or recovery support navigator services for patients while the patient is being treated in an emergency department, acute care hospital, freestanding psychiatric hospital, or substance use disorder facility. The subscription certificate shall include reimbursement for the provision of said services via telemedicine, electronic or telephonic consultation. The contractual rate for these services may be no less than the prevailing MassHealth rate for peer recovery coach services or recovery support navigator services. The benefits in this section shall not be subject to any deductible, coinsurance, copayments, or out-of-pocket limits. Peer support specialist services, including peer recovery coach services and recovery support navigator services shall be deemed medically necessary and shall not require prior authorization.

SECTION 6. Chapter 176G of the General Laws, as so appearing, is hereby amended by inserting after section 4MM the following new section:-

Section 4NN. (a) An individual or group health maintenance contract that is issued or renewed within or without the commonwealth shall provide coverage for the provision of behavioral health or substance use disorder services provided by peer support specialists, including but not limited to, peer recovery coaches and recovery support navigators, regardless of the setting these services are provided in. This coverage shall include coverage of peer recovery coaches and recovery support navigators who are employed by health care facilities and who only provide recovery coach or recovery support navigator services for patients while the patient is being treated in an emergency department, acute care hospital, freestanding psychiatric hospital, or substance use disorder facility. The individual or group health maintenance contract shall include reimbursement for the provision of said services via telemedicine, electronic or telephonic consultation. The contractual rate for these services may be no less than the prevailing MassHealth rate for peer recovery coach services or recovery support navigator services. The benefits in this section shall not be subject to any deductible, coinsurance, copayments, or out-of-pocket limits. Peer support specialist services, including peer recovery coach services and recovery support navigator services shall be deemed medically necessary and shall not require prior authorization.

SECTION 7. Notwithstanding any general or special law to the contrary, the division of insurance, in consultation with the division of medical assistance, shall promulgate regulations or issue sub-regulatory guidance to require carriers reimburse acute care hospitals and clinics licensed under chapter 111 of the General laws, for the provision of behavioral health or substance use disorder services provided by peer support specialists, including but not limited to, peer recovery coaches and recovery support navigators. The regulations or sub-regulatory guidance shall include reimbursement for the provision of said services via telemedicine, electronic or telephonic consultation.

SECTION 8. Notwithstanding any general or special law to the contrary, the bureau of substance addiction services within the department of public health shall conduct a comprehensive report addressing barriers to certification, credentialing, and other employment and practice requirements of peer recovery specialists, including peer recovery coaches and recovery support navigators. The report shall include, but not be limited to, (i) cost barriers for individuals with lived experience, including but not limited to, application and examination fees for initial certification and credentialing, (ii) cost barriers to certification and credentialing renewals, (iii) cost and reimbursement barriers for hospitals and clinics licensed under chapter 111 to hire, train, and retain peer recovery coaches and peer support navigators, (iv) eligibility requirements for certification and credentialing, and (v) access to training programs and resources. The report shall also include recommendations to address said barriers. The department shall submit a copy of the report to the executive office of health and human services, the clerks of the senate and house of representatives, and the joint committee on mental health, substance use, and recovery within 90 days of the effective date of this act.

SECTION 9. Notwithstanding any general or special law to the contrary, the bureau of substance addiction services within the department of public health shall establish or arrange for a comprehensive peer support program to provide mentorship, technical assistance, and support resources for the wellbeing of peer support specialists, including, but not limited to, peer recovery coaches and recovery support navigators. The program shall include, but not be limited to, a network for peer-to-peer trainings, education, mentorship, counseling and support; educational and other clinical support materials; technical assistance for certification, credentialing, and other employment and practice requirements; and billing technical assistance for organizations that employ peer support specialists, including peer recovery coaches and recovery support navigators.

Additional co-sponsor(s) added to Amendment #1227 to H4600

Coverage for Substance Use Disorder Services Rendered by Peer Support Specialists