Amendment #8, as changed to H.4743

Amendment #8, as changed to H4743

Removing barriers to non-opioid pain management

Ms. Decker of Cambridge moves to amend the bill by inserting before section 1 the following section:-

SECTION A1. Chapter 32A of the General Laws is hereby amended by striking out section 17Q and inserting in place thereof the following section:-

Section 17Q. (a) The commission shall develop a plan to provide active or retired employees insured under the group insurance commission adequate coverage and access to a broad spectrum of pain management services, including, but not limited to, non-medication, non-surgical treatment modalities and non-opioid medication treatment options that serve as alternatives to opioid prescribing, in accordance with guidelines developed by the division of insurance.

(b) No such coverage offered by the commission shall, relative to pain management services identified by the commission pursuant to subsection (a), require a member to obtain a preauthorization for non-medication, non-surgical treatment modalities that include restorative therapies, behavioral health approaches or integrative health therapies, including acupuncture, chiropractic treatments, massage and movement therapies.

(c)(1) The plan pursuant to subsection (a) shall be subject to review by the division of insurance. In its review, the division shall consider the adequacy of access to a broad spectrum of pain management services and any policies that may create unduly preferential coverage to prescribing opioids without other pain management modalities.

(2) Any coverage offered by the commission to an active or retired employee of the commonwealth insured under the group insurance commission shall not establish utilization controls, including preauthorization or step therapy requirements, for clinically appropriate non-opioid drugs approved by the federal Food and Drug Administration for the treatment or management of pain that are more restrictive or extensive than the least restrictive or extensive utilization controls applicable to any clinically appropriate opioid drug.

(d) The commission shall annually distribute educational materials to providers within their network and to members about the pain management access plan and shall make information about its plan publicly available on its website.

And further amend the bill in section 1, in line 1, by striking out the words “Chapter 32A of the General Laws is hereby amended” and inserting in place thereof the following:- Said chapter 32A is hereby further amended.

And further amend the bill by inserting after section 13 the following section:-

SECTION 13A. Chapter 175 of the General Laws is hereby amended by striking out section 47KK and inserting in place thereof the following section:-

Section 47KK. (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 a broad spectrum of pain management services, including, but not limited to, non-medication, non-surgical treatment modalities and non-opioid medication treatment options that serve as alternatives to opioid prescribing, in accordance with guidelines developed by the division of insurance.

(b) No such policy, contract, agreement, plan or certificate of insurance shall, relative to pain management services identified by the carrier pursuant to subsection (a), require a member to obtain a preauthorization for non-medication, non-surgical treatment modalities that include restorative therapies, behavioral health approaches or integrative health therapies, including acupuncture, chiropractic treatments, massage and movement therapies.

(c)(1) The plan pursuant to 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 a broad spectrum of pain management services and any carrier policies that may create unduly preferential coverage to prescribing opioids without other pain management modalities.

(2) No policy, contract, agreement, plan or certificate of insurance issued, delivered or renewed within the commonwealth, which is considered creditable coverage under said section 1 of said chapter 111M, shall establish utilization controls, including preauthorization or step therapy requirements, for clinically appropriate non-opioid drugs approved by the federal Food and Drug Administration for the treatment or management of pain, that are more restrictive or extensive than the least restrictive or extensive utilization controls applicable to any clinically appropriate opioid drug.

(d) Carriers shall annually distribute educational materials to providers within their networks and to members about the pain management access plan and shall make information about their plans publicly available on their websites.

And further amend the bill in section 14, in line 451, by striking out the words “Chapter 175 of the General Laws is hereby amended” and inserting in place thereof the following:- Said chapter 175 is hereby further amended.

And further amend the bill by inserting after section 15 the following section:-

SECTION 15A. Chapter 176A of the General Laws is hereby amended by striking out section 8MM and inserting in place thereof the following section:-

Section 8MM. (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 develop a plan to provide adequate coverage and access to a broad spectrum of pain management services, including, but not limited to, non-medication, non-surgical treatment modalities and non-opioid medication treatment options that serve as alternatives to opioid prescribing, in accordance with guidelines developed by the division of insurance.

(b) No such contract shall, relative to pain management services identified by the carrier pursuant to subsection (a), require a member to obtain a preauthorization for non-medication, non-surgical treatment modalities that include restorative therapies, behavioral health approaches or integrative health therapies, including acupuncture, chiropractic treatments, massage, and movement therapies.

(2) No 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 establish utilization controls, including preauthorization or step therapy requirements, for clinically appropriate non-opioid drugs approved by the federal Food and Drug Administration for the treatment or management of pain, that are more restrictive or extensive than the least restrictive or extensive utilization controls applicable to any clinically appropriate opioid drug.

And further amend the bill in section 16, in line 489, by striking out the words “Chapter 176A of the General Laws is hereby amended” and inserting in place thereof the following words:- Said chapter 176A is hereby further amended.

And further amend the bill by inserting after section 16 the following section:-

SECTION 16A. Chapter 176B of the General Laws is hereby amended by striking out section 4MM and inserting in place thereof the following section:-

Section 4MM. (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 a broad spectrum of pain management services, including, but not limited to, non-medication, non-surgical treatment modalities and non-opioid medication treatment options that serve as alternatives to opioid prescribing, in accordance with guidelines developed by the division of insurance.

(b) No such subscription certificate shall, relative to pain management services identified by the carrier pursuant to subsection (a), require a member to obtain a preauthorization for non-medication, non-surgical treatment modalities that include restorative therapies, behavioral health approaches or integrative health therapies, including acupuncture, chiropractic treatments, massage, and movement therapies.

(2) No subscription certificate under an individual or group medical service agreement delivered, issued or renewed within the commonwealth shall establish utilization controls, including preauthorization or step therapy requirements, for clinically appropriate non-opioid drugs approved by the federal Food and Drug Administration for the treatment or management of pain, that are more restrictive or extensive than the least restrictive or extensive utilization controls applicable to any clinically appropriate opioid drug.

And further amend the bill in section 17, in line 515, by striking out the words “Chapter 176B of the General Laws is hereby amended” and inserting in place thereof the following:- Said chapter 176B is hereby further amended.

And further amend the bill by inserting after section 17 the following section:-

SECTION 17A. Chapter 176G of the General Laws is hereby amended by striking out section 4EE and inserting in place thereof the following section:-

SECTION 4EE. (a) Any individual or group health maintenance contract that is issued or renewed within or without the commonwealth shall develop a plan to provide adequate coverage and access to a broad spectrum of pain management services, including, but not limited to, non-medication, non-surgical treatment modalities and non-opioid medication treatment options that serve as alternatives to opioid prescribing, in accordance with guidelines developed by the division of insurance.

(2) No individual or group health maintenance contract that is issued or renewed within or without the commonwealth shall establish utilization controls, including preauthorization or step therapy requirements, for clinically appropriate non-opioid drugs approved by the federal Food and Drug Administration for the treatment or management of pain, that are more restrictive or extensive than the least restrictive or extensive utilization controls applicable to any clinically appropriate opioid drug.

And further amend the bill in section 18, in line 542, by striking out the words “Chapter 176G of the General Laws is hereby amended” and inserting in place thereof the following:- Said chapter 176G is hereby further amended.

Additional co-sponsor(s) added to Amendment #8, as changed to H4743

Removing barriers to non-opioid pain management

Representative:

Adam Scanlon

Kristin E. Kassner

Michelle L. Ciccolo