Amendment 1

SENATE . . . . . . . . . . . . . . No. 2921

July 30, 2024 -- Text of the Senate amendment to the House Bill relative to accessing harm reduction initiatives (House, No. 4758) (being the text of Senate, No. 2898, printed as amended)

The Commonwealth of Massachusetts

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In the One Hundred and Ninety-Third General Court
(2023-2024)

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SECTION 1. Chapter 32A of the General Laws is hereby amended by inserting after section 17S the following 2 sections:-

Section 17T. (a) Coverage offered by the commission to an active or retired employee of the commonwealth insured under the group insurance commission shall provide coverage for prescribed or dispensed opioid antagonists, as defined in section 19B of chapter 94C and used in the reversal of overdoses caused by opioids, which shall not require prior authorization; provided, however, that a prescription from a health care practitioner shall not be required for coverage of opioid antagonists. An opioid antagonist used in the reversal of overdoses caused by opioids shall not be subject to any deductible, coinsurance, copayments or out-of-pocket limits; provided, however, that cost-sharing shall be required if the applicable plan is governed by the Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on cost-sharing for this service.

(b) The commission shall provide coverage for an opioid antagonist used in the reversal of overdoses caused by opioids as a medical benefit when dispensed by the health care facility in which the opioid antagonist was prescribed and shall provide coverage as a pharmacy benefit for an opioid antagonist used in the reversal of overdoses caused by opioids dispensed by a pharmacist, including an opioid antagonist dispensed pursuant to section 19B of chapter 94C; provided, however, that the rate to be reimbursed under the medical benefit shall not exceed the commission’s average in-network pharmacy benefit rate and the health care facility shall not balance bill the patient.

Section 17U. 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 services by a recovery coach licensed or otherwise authorized to practice pursuant to chapter 111J, irrespective of the setting in which the services are provided; provided, however, that such services shall be within the lawful scope of practice of a recovery coach. The contractual rate for these services shall be not less than the prevailing MassHealth rate for recovery coach services. The benefits in this section shall not be subject to any deductible, coinsurance, copayments or out-of-pocket limits; provided, however, that cost-sharing shall be required if the applicable plan is governed by the Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on cost-sharing for the service. Recovery coach services shall not require prior authorization.

SECTION 2. Chapter 94C of the General Laws is hereby amended by striking out section 19C, as appearing in the 2022 Official Edition, and inserting in place thereof the following section:-

Section 19C. The board of registration in pharmacy shall promulgate regulations requiring pharmacies located in areas with high incidents of opiate overdose, as determined by the board in consultation with the department, to maintain a continuous supply of opioid antagonists, as defined in section 19B; provided, however, that the continuous supply of opioid antagonists shall include opioid antagonists that are approved by the United States Food and Drug Administration to be sold over the counter without a prescription; provided further, that such pharmacies shall notify the department if the supply or stock of opioid antagonist doses is insufficient to enable compliance with maintaining a continuous supply of opioid antagonists.

SECTION 3. Said chapter 94C is hereby further amended by inserting after section 19D the following section:-

Section 19D½. (a) For the purposes of this section, the following words shall have the following meanings unless the context clearly requires otherwise:

“Opioid antagonist”, as defined in section 19B.

“Substance use disorder treatment facility”, a facility licensed or approved by the department to offer treatment for substance use disorder, including, but not limited to: (i) withdrawal management services; (ii) clinical stabilization services; (iii) transitional support services; (iv) residential support services; (v) community behavioral health center services; (vi) office-based opioid or addiction treatment services; or (vii) outpatient substance use disorder services.

(b) Upon discharge of a patient with an opioid use disorder from a substance use disorder treatment facility, the facility shall educate the patient on the use of opioid antagonists and dispense not less than 2 doses of an opioid antagonist to the patient or a legal guardian of the patient.

SECTION 4. Section 25J½ of chapter 111 of the General Laws, as appearing in the 2022 Official Edition, is hereby amended by inserting after the first paragraph the following paragraph:-

Upon discharge of a patient from an acute care hospital, satellite emergency facility or a freestanding psychiatric hospital who has: (i) a history of or is actively using opioids; (ii) been diagnosed with opioid use disorder; or (iii) experienced an opioid-related overdose, the acute care hospital or satellite emergency facility shall educate the patient on the use of opioid antagonists, as defined in section 19B of chapter 94C, and prescribe or dispense not less than 2 doses of an opioid antagonist to the patient or a legal guardian of the patient.

SECTION 5. Said chapter 111 is hereby further amended by inserting after section 215 the following section:-

Section 215A. (a) For the purposes of the section, the following words shall have the following meanings unless the context clearly requires otherwise:

“Drug testing services”, the use of testing equipment for the surveillance or identification of, or to analyze the strength, effectiveness or purity of, a controlled substance related to its injection, inhalation or ingestion by a person to determine whether the controlled substance contains chemicals, toxic substances or hazardous compounds.”

“Harm reduction program”, a department approved program or service that reduces the adverse consequences of substance use, including use-related mortality, stabilizes and improves the health of people who use substances and advances public health; provided, however, that programs or services may include harm reduction services, including, but not be limited to: (i) needle exchange programs pursuant to section 215; (ii) primary care, including disease prevention and health screenings; (iii) access or referral to evidence-based treatment options; (iv) drug testing services; (v) overdose reversal care; (vi) supervision of persons who consume pre-obtained substances; and (vii) other social support services deemed permissible by the department.

“Harm reduction program operators”, individuals directly involved in the operation, administration or staffing of a harm reduction program, including directors, board members, consultants, health care providers, service providers, staff and volunteers.

(b) Prior to the establishment of a harm reduction program that provides overdose reversal care and supervision of persons who consume pre-obtained substances, the board of health of the city or town in which the program is located shall vote to approve or deny such program. If the board approves such program the municipal legislative body shall vote to approve or deny such program in the manner provided for in section 4 of chapter 4not later than 3 months following the approval by the board of health. If such program is approved by each body, the city or town shall provide notice of such approval to the department, in a manner determined by the department, and upon such notice, the department shall review the proposed program and make a determination of whether to authorize such program; provided, however, that in making the determination, the department shall take into consideration the program’s proposed location, including, but not limited to, the location’s proximity to schools; provided, further that the department shall provide the determination in writing not later than 3 months after receiving notice of approval from the city or town and, if applicable, shall provide an explanation for rejecting a proposed program; and provided further, that the department shall submit any such program to the attorney general to ensure compliance with state and federal law.

Not later than 1 year after the implementation of a harm reduction program under this subsection, the department shall report the results of authorized programs pursuant to this section and any recommendations by filing the report with the clerks of the senate and house of representatives, the joint committee on mental health, substance use and recovery, the joint committee on public health and the senate and house committees on ways and means; provided, however, that the report shall include, but not be limited to, site-specific information on the: (i) number of participant visits; (ii) types of drugs consumed and tested; (iii) number of overdoses reversed; (iv) types of drugs involved in overdoses; (v) staffing levels and staff experiences; (vi) operating costs; (vii) number of referrals to addiction treatment; (viii) number of hypodermic needles and syringes collected and distributed; (ix) medical emergency and 911 calls; and (x) in consultation with local law enforcement, report on changes to the prevalence of crimes in the vicinity of the program.

(c) Notwithstanding any general or special law to the contrary, harm reduction program operators, individuals who access harm reduction program services, owners, lessors and sub-lessors of property used for harm reduction programs and state, county and municipal employees involved in approving or operating harm reduction programs shall, for actions related to the approval or operation of, or participation in, a harm reduction program, be immune from: (i) arrest, charge or prosecution, including for attempting, aiding and abetting or conspiracy to commit a violation, pursuant to sections 32, 32A, 32B, 32C, 32D, 32E, 32I, 34, 40, 43 and 47 of chapter 94C and chapter 271A; (ii) seizure or forfeiture of data, records, assets or property under state law; (iii) civil suit, liability or damages alleged to have been sustained by an act or omission by a harm reduction program operator in the course of providing harm reduction services; and (iv) for health care providers, disciplinary action by a professional licensing board, credentialing restriction, contractual liability, adverse employment action or denial of any professional privilege; provided, however, that the immunity described in this subsection shall apply only if the harm reduction program operates in good faith in accordance with this section and regulatory requirements issued by the department. Entering or exiting a harm reduction program cannot serve as the basis for, or a fact contributing to the existence of, reasonable suspicion or probable cause to conduct a search or seizure.

(d) The immunity provided under subsection (c) shall not apply: (i) if the damage was caused by an act or omission constituting gross negligence or recklessness, conduct with an intent to harm, discrimination based on race, ethnicity, national origin, religion, disability, sexual orientation or gender identity or conduct outside the scope of responsibility of a harm reduction program employee or volunteer, as determined by the department; (ii) to consumer protection actions brought by the attorney general; (iii) to false claims actions brought by or on behalf of the commonwealth; or (iv) privacy violations.

(e) Notwithstanding any general law or special law to the contrary, a person or entity providing harm reduction services under this section and approved by the department shall not be required to register their activities pursuant to section 7 of chapter 94C.

(f) The department shall promulgate regulations to implement this section.

SECTION 6. Said chapter 111 is hereby further amended by adding the following section:-

Section 245. (a) As used in this section, the following words shall have the following meanings unless the context clearly requires otherwise:

“Acupuncture detoxification specialist”, a qualified health care professional who is registered with the department to engage in the practice of auricular acupuncture detoxification pursuant to this section.

“Auricular acupuncture detoxification”, treatment by means of the subcutaneous insertion of sterile, disposable acupuncture needles in consistent, predetermined bilateral locations on the ear in accordance with the standardized auricular acupuncture detoxification protocol developed by National Acupuncture Detoxification Association, Inc.

“General supervision”, supervision by phone or other electronic means during business hours with in-person site visits as deemed necessary by a licensed acupuncturist.

“Licensed acupuncturist”, an individual who is licensed under sections 148 to 162, inclusive, of chapter 112 to practice as a licensed acupuncturist.

“National Acupuncture Detoxification Association training”, the standardized auricular acupuncture detoxification protocol training developed by National Acupuncture Detoxification Association, Inc., effective as of January 1, 2019.

“Qualified health care professional”, a qualified individual who: (i) is a licensed physician, licensed psychologist, licensed independent clinical social worker, licensed clinical social worker, licensed mental health counselor, licensed psychiatric clinical nurse specialist, certified addictions registered nurse, licensed alcohol and drug counselor I or licensed alcohol and drug counselor II as defined in section 1 of chapter 111J, certified alcohol and drug abuse counselor or certified alcohol and drug abuse counselor II as certified by the Massachusetts Board of Substance Abuse Counselor Certification or an equivalent certifying body or a registered nurse or nurse practitioner certified by the board of registration in nursing pursuant to chapter 112; and (ii) has received training and a certificate of completion from National Acupuncture Detoxification Association, Inc. or from a state-recognized organization or agency that meets or exceeds National Acupuncture Detoxification Association, Inc. training standards to engage in the practice of auricular acupuncture detoxification protocol for the treatment of addictions, mental and behavioral health, trauma as a result of a disaster and other emotional trauma.

(b) An individual who is not a licensed acupuncturist shall not engage in the practice of the auricular acupuncture detoxification or represent themself as an acupuncture detoxification specialist unless the individual: (i) has been issued: (A) an approved registration by the department to practice auricular acupuncture detoxification in accordance with this section; or (B) a license or certificate in another state with requirements that are at least equivalent to the requirements of this section, as determined by the commissioner; and (ii) has been trained in the standardized auricular acupuncture detoxification protocol in accordance with National Acupuncture Detoxification Association, Inc. training or an equivalent training certificate by a state-recognized organization.

To engage in the practice of auricular acupuncture detoxification within the individual’s designated lawful scope of practice, a qualified health care professional shall file an application to register as an acupuncture detoxification specialist with the department, in a form determined by the department. Each application may be accompanied by the payment of a fee to be determined by the department.

The applicant seeking to practice auricular acupuncture detoxification shall, at a minimum, furnish proof of: (i) relevant licensure or certification as a qualified health care professional; and (ii) completion of National Acupuncture Detoxification Association, Inc. training or an equivalent training certificate by a state-recognized organization. An applicant who is registered or certified in another state with requirements that are at least equivalent to the requirements of this section, as determined by the commissioner, shall be allowed to practice auricular acupuncture detoxification in accordance with this section. A registration issued under this section shall be valid for 2 years and subject to renewal as determined by the department.

(c) Auricular acupuncture detoxification shall only be performed by a licensed acupuncturist or a qualified health care professional within their designated lawful scope of practice for the purpose of providing integrated health care delivery interventions in substance abuse treatment and wellness promotion including, but not limited to, treating mental and emotional health, post and acute trauma, addiction or chemical dependency.

(d) A qualified health care professional registered in accordance with this section shall only practice under the general supervision of a licensed acupuncturist; provided, however, that no such individual shall use the title “acupuncturist” or otherwise represent themself or imply that they are a licensed acupuncturist and shall not perform or practice acupuncture outside of the scope of the auricular acupuncture detoxification as defined in this section.

(e) Nothing in this chapter or sections 149 to 162, inclusive, of chapter 112 shall prohibit, limit, interfere with or prevent a qualified health care professional from practicing or performing auricular acupuncture detoxification if the individual is acting within the lawful scope of practice in accordance with the individual’s license and the auricular acupuncture detoxification is performed in: (i) a private, freestanding facility licensed by the department that provides care or treatment for individuals with substance use disorders or other addictive disorders; (ii) a facility under the direction and supervision of the department of mental health; (iii) a setting approved or licensed by the department of mental health; or (iv) any other setting where auricular acupuncture detoxification is an appropriate adjunct therapy to a substance use disorder or behavioral health treatment program; provided, however, that individual or 1-on-1 appointments with a health care provider not within a setting pursuant to this subsection shall not be an appropriate setting in accordance with this section.

(f) The commissioner may promulgate regulations to implement this section.

SECTION 7. Chapter 111J of the General Laws is hereby amended by striking out sections 1 to 8, inclusive, as appearing in the 2022 Official Edition, and inserting in place thereof the following 9 sections:-

Section 1. As used in this chapter, the following words shall have the following meanings unless the context clearly requires otherwise:

“Applicant”, an individual seeking licensure under this chapter.

“Approved continuing education”, continuing education approved by the department, including research and training programs, college and university courses, in-service training programs, seminars and conferences, designed to maintain and enhance the skills of licensees.

“Approved program”, a program approved by the department for the education and training of licensees.

“Approved recovery coach supervisor”, a licensed recovery coach that has completed recovery coach supervision training that has been approved by the department for the supervision of recovery coaches.

“Approved work experience”, supervised work experience, approved by the department, in the practice area for which an applicant seeks licensure.

“Department”, the department of public health.

“Licensee”, an individual who is licensed under this chapter.

“Licensed alcohol and drug counselor I”, a person licensed by the department to conduct an independent practice of alcohol and drug counseling and provide supervision to other alcohol and drug counselors; provided, however, that a “licensed alcohol and drug counselor I” shall have: (i) received a master’s or doctoral degree in behavioral sciences, which included a supervised counseling practicum that meets the requirements established by the department, or such equivalent educational credits as may be established by the department; (ii) not less than 3 years of approved work experience; and (iii) passed a licensing examination approved by the department.

“Licensed alcohol and drug counselor II”, a person licensed by the department to practice alcohol and drug counseling under clinical supervision; provided, however, that a “licensed alcohol and drug counselor II” shall have: (i) completed an approved program of education, which included a supervised counseling practicum that meets the requirements established by the department or such equivalent educational credits as may be established by the department; (ii) not less than 3 years of approved work experience; and (iii) passed a licensing examination approved by the department.

“Licensed recovery coach”, a person with lived experience who is licensed by the department to practice recovery coaching using shared understanding, respect and mutual empowerment to help others become and stay engaged in the process of recovery from a substance use disorder; provided, however, that a “licensed recovery coach” shall: (i) have completed an approved program of education, including approved work experience that meets the requirements established by the department; (ii) demonstrate not less than 2 years of sustained recovery; and (iii) have met all education, training and experience requirements and qualifications as established by the department.

“Lived experience”, the experience of addiction and recovery from a substance use disorder.

Section 2. (a) The department shall establish and administer a program for the licensure of alcohol and drug counselors I, alcohol and drug counselors II and recovery coaches. The department shall: (i) establish the licensure requirements for licensed alcohol and drug counselors practicing in the commonwealth; (ii) establish the licensure requirements for licensed recovery coaches practicing in the commonwealth; (iii) evaluate the qualifications of applicants for licensure; (iv) supervise licensing examinations, where applicable; (v) establish and collect fees for licensing and examination, where applicable; (vi) grant and issue licenses to applicants who satisfy the department’s requirements for licensure; (vii) establish continuing education requirements for licensees; (viii) investigate complaints; (ix) take appropriate disciplinary action to protect the public health, safety and welfare; and (x) perform other functions and duties as may be necessary to carry out this chapter.

(b) The department shall establish requirements for licensed alcohol and drug counselors I and licensed alcohol and drug counselors II and may establish other reasonable classifications for alcohol and drug counselors as it finds necessary and appropriate, including, but not limited to, counselors specializing in youth recovery counseling, taking into consideration different levels of education, training and work experience.

(c) The department shall establish requirements for licensed recovery coaches, including, but not limited to, establishing an ethical code of conduct for recovery coaches, and may establish other reasonable classifications for recovery coaches as it finds necessary and appropriate, taking into consideration different levels of education, training and work experience.

(d) The department shall approve and issue certificates of approval of programs for the training of alcohol and drug counselors. The department shall maintain a list of approved programs and a current roster of persons serving as licensed alcohol and drug counselors in the commonwealth.

(e) The department shall approve and issue certificates of approval of programs for the training of recovery coaches. The department shall maintain a list of approved programs and a current roster of persons serving as licensed recovery coaches in the commonwealth.

(f) The department shall promulgate rules and regulations to implement this chapter, including, but not limited to, rules and regulations establishing the educational and professional requirements for licensing individuals under this chapter, establishing fees for licensing and examination, where applicable, and governing the practice and employment of licensees to promote the public health, safety and welfare.

Section 3. (a) Each applicant shall furnish the department with proof of satisfactory completion of the educational, training and experience requirements for licensure, including completion of an approved program and approved work experience and proof of having passed any licensing examinations required by the department; provided, however, that the department may establish additional requirements for licensure and exemptions by regulation.

(b) A license for alcohol and drug counselor I, alcohol and drug counselor II or recovery coaches shall be valid for a 2-year period and licensees may apply for renewal of a license for a like term. A licensee seeking renewal of a license shall submit proof of having successfully completed the requirements for approved continuing education as may be established by the department.

(c) Applications for licenses and renewals shall be submitted in accordance with procedures established by the department. The department may establish fees for license applications and renewals.

Section 4. (a) Except as otherwise provided in this chapter or by regulation, a person not licensed or otherwise exempt from licensing shall not hold themself out as a licensed recovery coach and shall not use the title, initials, abbreviations, insignia or description of a licensed recovery coach or practice or attempt to practice recovery coaching unless otherwise authorized by law or rule or regulation of the department. Whoever engages in any such unauthorized action shall be subject to a fine of not less than $500. The department may bring a petition in superior court to enjoin such unauthorized action or any other violation of this chapter or regulation hereunder.

(b) Individuals working under an approved recovery coach supervisor and receiving approved work experience may practice without a license in order to obtain the requisite hours of supervised experience needed to obtain a recovery coach license.

(c) Nothing in this section shall prevent members of peer groups or self-help groups from performing peer support or self-help activities that may be included within the practice recovery coaching; provided, however, that no members of peer groups or self-help groups who are not so credentialed shall use a title stating or implying that such person is a licensed recovery coach.

Section 5. (a) Except as otherwise provided in this chapter or by regulation, a person who is not licensed or is otherwise exempt from licensing shall not hold themself out as a licensed alcohol and drug counselor and shall not use the title, initials or description of a licensed alcohol and drug counselor or practice or attempt to practice alcohol and drug counseling. Whoever engages in any such unauthorized action shall be subject to a fine of not less than $500. The department may bring a petition in superior court to enjoin such unauthorized action or any other violation of this chapter or regulation hereunder.

(b) The following individuals shall be exempt from the licensing requirements for alcohol and drug counseling under this chapter:

(i) an educational psychologist, marriage and family therapist, mental health counselor, nurse practitioner, occupational therapist, physician, physician assistant, practical nurse, psychologist, registered nurse, rehabilitation counselor or social worker;

(ii) an employee or other agent of a recognized academic institution or employee assistance program, a federal, state, county or local government institution, program, agency or facility or school committee, school district, school board or board of regents while performing alcohol and drug counseling duties solely for the respective entity or under the jurisdiction of such entity; provided, however, that a license pursuant to this chapter shall not be a requirement for employment in any state, county or municipal agency; and

(iii) an employee of a treatment program or facility licensed or approved by the department pursuant to chapters 111B and 111E; provided, however, that such individual shall perform alcohol and drug counseling solely within or under the jurisdiction of such program or facility.

(c) Nothing in this section shall prevent qualified members of other professions, including attorneys, Christian Science practitioners or members of the clergy, from providing alcohol or drug counseling consistent with accepted standards of their respective professions; provided, however, that no such person shall use a title stating or implying that such person is a licensed alcohol and drug counselor.

(d) Nothing in this section shall prevent members of peer groups or self-help groups from performing peer group or self-help activities; provided, however, that no such person shall use a title stating or implying that such person is a licensed alcohol and drug counselor.

Section 6. (a) The department shall establish procedures for consumers to file written complaints regarding an individual licensed under this chapter. The department shall investigate all complaints relating to the practice of a person holding a license under this chapter and all complaints relating to any violation of this chapter or regulation promulgated hereunder.

(b) The department may conduct an adjudicatory proceeding pursuant to chapter 30A but shall not issue, vacate, modify or enforce subpoenas pursuant to section 12 of said chapter 30A. The department may, after a hearing pursuant to said chapter 30A, deny, refuse renewal, revoke, limit or suspend a license or otherwise discipline a licensee; provided, however, that the department may suspend the license of a licensee who poses an imminent danger to the public without a hearing; provided further, that the licensee shall be afforded a hearing within 7 business days of receipt of a notice of such denial, refusal to renew, revocation, limitation, suspension or other disciplinary action; and provided further, that the department shall conduct its proceedings in accordance with this chapter and said chapter 30A. Grounds for denial, refusal to renew, revocation, limitation, suspension or other disciplinary action shall include: (i) fraud or misrepresentation in obtaining a license; (ii) criminal conduct which the department determines to be of such a nature as to render such person unfit to practice as evidenced by criminal proceedings resulting in a conviction, guilty plea or plea of nolo contendere or an admission of sufficient facts; (iii) a violation of any law or rule or regulation of the department governing the practice of the licensee under this chapter; (iv) a violation of ethical standards which the department determines to be of such a nature as to render such person unfit to practice as a licensee; or (v) other just and sufficient cause that the department determines would render a person unfit to practice as a licensee.

(c) Where denial, refusal to renew, revocation or suspension is based solely on the failure of the licensee to timely file an application or pay prescribed fees or to maintain insurance coverage as required by applicable law or regulation, the department may act without first granting the applicant or licensee a hearing.

Section 7. Examinations for licensure, where applicable, shall be conducted not less than twice per year at times and places and in formats designated by the department. Examinations for licensure, where applicable, shall be written; provided, however, that portions thereof may be conducted orally at the department’s discretion; and provided further, that a person who fails an examination may be admitted to the next available examination.

Section 8. (a) The department may issue a license without examination to an applicant who meets the requirements for licensure; provided, however, that requirements for licensure in another state shall be determined by the department to be equivalent to or in excess of the requirements of this chapter; and provided further, that such applicant is: (i) licensed or certified in alcohol and drug counseling or a comparable field in another state; or (ii) licensed or certified in recovery coaching or a comparable field in another state.

(b) The department shall promulgate rules and regulations as may be necessary to implement this section.

Section 9. The bureau of substance addiction services shall establish a comprehensive peer support program to provide mentorship, technical assistance and resources to support the skill-building and credentialing of peers working in substance addition recovery services, including, but not limited to, peer workers and recovery coaches. The program shall include, but not be limited to: (i) a network for peer-to-peer trainings, education, mentorship, counseling and support; (ii) educational and other support materials; (iii) technical assistance for licensure, certification, credentialing and other employment and practice requirements; and (iv) billing technical assistance for organizations that employ recovery coaches. The bureau shall consult peers working in substance addition recovery services in the establishment of such comprehensive peer support program.

SECTION 8. Chapter 112 of the General Laws is hereby amended by inserting after section 155 the following section:-

Section 155A. Nothing in this chapter shall prohibit, limit, interfere with or prevent a licensed physician or acupuncturist from practicing or performing auricular acupuncture detoxification, as defined in section 245 of chapter 111, if the licensed physician or acupuncturist is acting within the lawful scope of practice in accordance with their license.

SECTION 9. Chapter 118E of the General Laws is hereby amended by inserting after section 10Q the following 2 sections:-

Section 10R. (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 prescribed or dispensed opioid antagonists, as defined in section 19B of chapter 94C and used in the reversal of overdoses caused by opioids, which shall not require prior authorization; provided, however, that a prescription from a health care practitioner shall not be required for coverage of opioid antagonists. An opioid antagonist used in the reversal of overdoses caused by opioids shall not be subject to any deductible, coinsurance, copayments or out-of-pocket limits; provided, however, that cost-sharing shall be required if the applicable plan is governed by the Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on cost-sharing for this service.

(b) 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 an opioid antagonist used in the reversal of overdoses caused by opioids as a medical benefit when dispensed by the health care facility in which the opioid antagonist was prescribed and shall provide coverage as a pharmacy benefit for an opioid antagonist used in the reversal of overdoses caused by opioids dispensed by a pharmacist, including an opioid antagonist dispensed pursuant to section 19B of chapter 94C; provided, however, that the rate to be reimbursed under the medical benefit shall not exceed the carrier’s average in-network pharmacy benefit rate and the health care facility shall not balance bill the patient.

Section 10S. 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 services by a recovery coach licensed or otherwise authorized to practice pursuant to chapter 111J, irrespective of the setting in which these services are provided; provided, however, that such services shall be within the lawful scope of practice of a recovery coach. The benefits in this section shall not be subject to any deductible, coinsurance, copayments or out-of-pocket limits; and provided further, that recovery coach services shall not require prior authorization.

SECTION 10. Chapter 175 of the General Laws is hereby amended by inserting after section 47UU the following 2 sections:-

Section 47VV. (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 provide coverage for prescribed or dispensed opioid antagonists, as defined in section 19B of chapter 94C and used in the reversal of overdoses caused by opioids, which shall not require prior authorization; provided, however, that a prescription from a health care practitioner shall not be required for coverage of opioid antagonists. An opioid antagonist used in the reversal of overdoses caused by opioids shall not be subject to any deductible, coinsurance, copayments or out-of-pocket limits; provided, however, that cost-sharing shall be required if the applicable plan is governed by the Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on cost-sharing for this service.

(b) The policy, contract, agreement, plan or certificate of insurance shall provide coverage for an opioid antagonist used in the reversal of overdoses caused by opioids as a medical benefit when dispensed by the health care facility in which the opioid antagonist was prescribed and shall provide coverage as a pharmacy benefit for an opioid antagonist used in the reversal of overdoses caused by opioids dispensed by a pharmacist, including an opioid antagonist dispensed pursuant to section 19B of chapter 94C; provided, however, that the rate to be reimbursed under the medical benefit shall not exceed the carrier’s average in-network pharmacy benefit rate and the health care facility shall not balance bill the patient.

Section 47WW. 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 provide coverage for the provision of services by a recovery coach licensed or otherwise authorized to practice under chapter 111J, irrespective of the setting in which these services are provided; provided, however, that such services shall be within the lawful scope of practice of a recovery coach. The contractual rate for these services shall be not less than the prevailing MassHealth rate for recovery coach services. The benefits in this section shall not be subject to any deductible, coinsurance, copayments or out-of-pocket limits; provided, however, that cost-sharing shall be required if the applicable plan is governed by the Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on cost-sharing for this service; and provided further, that recovery coach services shall not require prior authorization.

SECTION 11. Said chapter 175 is hereby further amended by inserting after section 122A the following section:-

Section 122B. (a) No insurer authorized to issue policies on the lives of persons in the commonwealth shall make a distinction or otherwise discriminate between persons, reject an applicant, cancel a policy or demand or require a higher rate of premium for reasons based solely upon the fact that an applicant or insured has or had a prescription for, purchased or otherwise possessed an opioid antagonist, as defined in section 19B of chapter 94C.

(b) A violation of this section shall constitute an unfair method of competition or unfair and deceptive act or practice pursuant to chapters 93A and 176D.

SECTION 12. Section 193U of said chapter 175, as appearing in the 2022 Official Edition, is hereby amended by striking out, in lines 21 to 26, inclusive, the words “or (iii) abusive litigation against a provider concerning reproductive health care services or gender-affirming health care services resulted in a judgment against the provider, if such health care services would be lawful and consistent with good medical practice as provided if they occurred entirely in the commonwealth” and inserting in place thereof the following words:- (iii) abusive litigation against a provider concerning reproductive health care services or gender-affirming health care services resulted in a judgment against the provider, if such health care services would be lawful and consistent with good medical practice as provided if they occurred entirely in the commonwealth; or (iv) the health care provider provides services at a harm reduction program.

SECTION 13. Chapter 176A of the General Laws is hereby amended by inserting after section 8VV the following 2 sections:-

Section 8WW. (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 prescribed or dispensed opioid antagonists, as defined in section 19B of chapter 94C and used in the reversal of overdoses caused by opioids, which shall not require prior authorization; provided, however, that a prescription from a health care practitioner shall not be required for coverage of opioid antagonists. An opioid antagonist used in the reversal of overdoses caused by opioids shall not be subject to any deductible, coinsurance, copayments or out-of-pocket limits; provided, however, that cost-sharing shall be required if the applicable plan is governed by the Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on cost-sharing for this service.

(b) Such contracts shall provide coverage for an opioid antagonist used in the reversal of overdoses caused by opioids as a medical benefit when dispensed by the health care facility in which the opioid antagonist was prescribed and shall provide coverage as a pharmacy benefit for an opioid antagonist used in the reversal of overdoses caused by opioids dispensed by a pharmacist, including an opioid antagonist dispensed pursuant to section 19B of chapter 94C; provided, however, that the rate to be reimbursed under the medical benefit shall not exceed the carrier’s average in-network pharmacy benefit rate and the health care facility shall not balance bill the patient.

Section 8XX. 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 services by a recovery coach licensed or otherwise authorized to practice under chapter 111J, irrespective of the setting in which these services are provided; provided, however, that such services shall be within the lawful scope of practice of a recovery coach. The contractual rate for these services shall be not less than the prevailing MassHealth rate for recovery coach services. The benefits in this section shall not be subject to any deductible, coinsurance, copayments or out-of-pocket limits; provided, however, that cost-sharing shall be required if the applicable plan is governed by the Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on cost-sharing for this service. Recovery coach services shall not require prior authorization.

SECTION 14. Chapter 176B of the General Laws is hereby amended by inserting after section 4VV the following 2 sections:-

Section 4WW. (a) Any subscription certificate under an individual or group medical service agreement delivered, issued or renewed within the commonwealth, shall provide coverage for prescribed or dispensed opioid antagonists, as defined in section 19B of chapter 94C and used in the reversal of overdoses caused by opioids, which shall not require prior authorization; provided, however, that a prescription from a health care practitioner shall not be required for coverage of opioid antagonists. An opioid antagonist used in the reversal of overdoses caused by opioids shall not be subject to any deductible, coinsurance, copayments or out-of-pocket limits; provided, however, that cost-sharing shall be required if the applicable plan is governed by the Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on cost-sharing for this service.

Section 4XX. 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 services by a recovery coach licensed or otherwise authorized to practice under chapter 111J, irrespective of the setting in which these services are provided; provided, however, that such services shall be within the lawful scope of practice of a recovery coach. The contractual rate for these services shall be not less than the prevailing MassHealth rate for recovery coach services. The benefits in this section shall not be subject to any deductible, coinsurance, copayments or out-of-pocket limits; provided, however, that cost-sharing shall be required if the applicable plan is governed by the Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on cost-sharing for this service. Recovery coach services shall not require prior authorization.

SECTION 15. Chapter 176G of the General Laws is hereby amended by inserting after section 4NN the following 2 sections:-

Section 4OO. (a) An individual or group health maintenance contract that is issued or renewed within or without the commonwealth shall provide coverage for prescribed or dispensed opioid antagonists, as defined in section 19B of chapter 94C and used in the reversal of overdoses caused by opioids, which shall not require prior authorization; provided, however, that a prescription from a health care practitioner shall not be required for coverage of opioid antagonists. An opioid antagonist used in the reversal of overdoses caused by opioids shall not be subject to any deductible, coinsurance, copayments or out-of-pocket limits; provided, however, that cost-sharing shall be required if the applicable plan is governed by the Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on cost-sharing for this service.

(b) The individual or group health maintenance contract shall provide coverage for an opioid antagonist used in the reversal of overdoses caused by opioids as a medical benefit when dispensed by the health care facility in which the opioid antagonist was prescribed and shall provide coverage as a pharmacy benefit for an opioid antagonist used in the reversal of overdoses caused by opioids dispensed by a pharmacist, including an opioid antagonist dispensed pursuant to section 19B of chapter 94C; provided, however, that the rate to be reimbursed under the medical benefit shall not exceed the carrier’s average in-network pharmacy benefit rate and the health care facility shall not balance bill the patient.

Section 4PP. An individual or group health maintenance contract that is issued or renewed within or without the commonwealth shall provide coverage for the provision of services by a recovery coach licensed or otherwise authorized to practice under chapter 111J, irrespective of the setting in which these services are provided; provided, however, that such services shall be within the lawful scope of practice of a recovery coach. The contractual rate for these services shall be not less than the prevailing MassHealth rate for recovery coach services. The benefits in this section shall not be subject to any deductible, coinsurance, copayments or out-of-pocket limits; provided, however, that cost-sharing shall be required if the applicable plan is governed by the Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on cost-sharing for this service. Recovery coach services shall not require prior authorization.

SECTION 16. A “Certified Addictions Recovery Coach (CARC)” certification issued by the Massachusetts Board of Substance Abuse Counselor Certification or other comparable certifying body shall serve as satisfactory proof for recovery coach application requirements, including test exemptions, for a limited period following the effective date of this act as determined by the department of public health; provided, however, that the department shall waive the lived experience requirement for a recovery coach license pursuant to section 1 of chapter 111J of the General Laws for an applicant who was credentialed by the Massachusetts Board of Substance Abuse Counselor Certification prior to the effective date of this act. The eligible applicants shall meet all other qualifications and requirements for licensure as determined by the department. The department shall promulgate rules and regulations for the implementation of this section.

SECTION 17. (a) The department of public health shall study sober homes in the commonwealth, including the safety and recovery of sober home residents. The study shall include, but not be limited to: (i) appropriate training for operators and staff of sober homes and whether such training should be required; (ii) evidence-based methods to creating safe and health recovery environments; (iii) current oversight and additional oversight needed for sober homes; (iv) barriers to sober home facility improvements, including, but not limited to, fiscal constraints; and (v) different aspects, if any, between certified and noncertified sober homes. The department shall hold at least 1 public hearing as part of its study under this section.

(b) The department shall submit a report detailing the results of the study, along with recommendations and any proposed legislation necessary to carry out its recommendations, to the clerks of the senate and house of representatives, the joint committee on health care financing, the joint committee on public health, the joint committee on mental health, substance use and recovery and the senate and house committees on ways and means not later than July 31, 2025.

SECTION 18. (a) There shall be a special commission to study prescribing practices for benzodiazepines and non-benzodiazepine hypnotics.

(b) The commission shall meet not less than 4 times and shall invite the public and medical experts in the field to offer testimony. The commission shall study and make recommendations on topics including, but not limited to: (i) current and best prescribing practices for benzodiazepines and non-benzodiazepine hypnotics; (ii) proper labeling of benzodiazepines and non-benzodiazepine hypnotics; and (iii) protocols to safely discontinue the use of benzodiazepines and non-benzodiazepine hypnotics and minimize the patient’s symptoms of withdrawal.

(c) The commission shall consist of: the commissioner of public health or a designee, who shall serve as chair; the secretary of health and human services or a designee; 4 members to be appointed by the governor, 1 of whom shall be a psychiatrist licensed to practice in the commonwealth, 1 of whom shall be a representative from the bureau of substance abuse services, 1 of whom shall be a representative from the Center for Addiction Medicine at Massachusetts General Hospital and 1 of whom shall be an advocate from the addiction treatment community.

(d) The commission shall report its findings and recommendations, including any proposed legislation, to the clerks of the senate and the house of representatives, the joint committee on mental health, substance use and recovery and the senate and house committees on ways and means not later than 1 year after the commission’s first meeting.

SECTION 19. (a) The bureau of substance use addiction services shall conduct a study on the potential benefits of expanding collaborative practice agreements between physicians and pharmacists to allow for the prescription of schedule II to VI, inclusive, controlled substances by pharmacists outside of the hospital or health care institution setting to treat patients with substance use disorders.

(b) The bureau shall study and report on: (i) collaborative practice agreements between physicians and pharmacists for the prescription of substances in collaborative practice agreements in other states; and (ii) the positive and negative impacts of allowing a collaborative practice agreement for schedule II to VI, inclusive, controlled substances.

(c) The department shall submit a report detailing the results of the study, along with recommendations and any proposed legislation necessary to carry out its recommendations, to the clerks of the senate and house of representatives, the joint committee on mental health, substance use and recovery, the joint committee on public health and the senate and house committees on ways and means not later than January 1, 2025.

SECTION 20. The department of public health shall issue regulations pursuant to section 7 not later than 6 months after the effective date of this act.

SECTION 21. Sections 1, 9, 10, 13, 14 and 15 shall take effect 6 months after the effective date of this act.

SECTION 22. No person shall be found to have violated section 4 of chapter 111J of the General Laws until 6 months after the department of public health first establishes a recovery coach license pursuant to section 2 of said chapter 111J.