The Mass. Legislature has passed final legislation increasing opportunities for long-term substance abuse recovery in the Commonwealth by supporting a continuum of care and removing barriers that stand in the way of effective treatment.
“This legislation is a significant step forward for Massachusetts as we continue to address the rise in substance addition that is so tragically devastating lives across the Commonwealth,” House Speaker Robert A. DeLeo (D-Winthrop) said. “The bill provides a strong foundation for substance abuse treatment services by increasing access to care and changing the way we monitor and respond to unprecedented public health crises like the one we’re currently confronting.”
“Addiction is a chronic disease, and we must remember that it needs to be treated as such,” Senate President Therese Murray (D-Plymouth) said. “While there is no quick fix for addiction, this bill combined with the investments we made in the FY15 budget take several real and responsible steps forward to ensure that individuals are able to get the care they desperately need. I am proud of the Legislature for working together to find the best solution to this difficult problem in order to protect our constituents and the future of the Commonwealth.”
“After this bill is signed into law, every citizen in the Commonwealth will have access to a full spectrum of substance abuse services without unnecessary burdens or hurdles,” said Representative Elizabeth Malia (D-Jamaica Plain), Chair of the Joint Committee on Mental Health and Substance Abuse. “To the recovery community, I say thank you, from the bottom of my heart. Your voices were heard in hearings and meetings all session and now your hard work has paid off. With passage of this bill, Massachusetts has put the power back in the hands of the doctors, in consultation with their patients, to make the appropriate treatment decisions when it comes to substance abuse services. Massachusetts has once again set a standard for the nation.”
To curb the public health risk of Schedule II and III drugs, the bill requires the Drug Formulary Commission to prepare a drug formulary of chemically equivalent substitutions, which must include abuse deterrent properties and must take into consideration cost and accessibility for consumers. Insurance carriers are required to cover abuse deterrent drugs listed on the formulary in the same manner that they cover non-abuse deterrent drugs and cannot impose additional cost burdens on consumers who receive abuse deterrent drugs.
The bill authorizes the Department of Public Health (DPH) to schedule a substance as Schedule I for up to one year if it poses an imminent hazard to public safety and is not already listed in a different schedule.
The bill strengthens the Prescription Monitoring Program by requiring the Chief Medical Examiner to file a report with the FDA's MedWatch Program and the Department of Public Health if a death is caused by a controlled substance and directs DPH to review the Program upon receiving a report.
The bill creates a commission to review prescription painkiller limitations by insurance carriers, including the system implemented by Blue Cross Blue Shield, and report recommendations and proposed legislation to the Legislature.
This bill both increases access to care and improves the standard of care by removing prior authorization for substance abuse treatment if the provider is certified or licensed by DPH and does the following:
- Removes prior authorization for Acute Treatment Services for all MassHealth Managed Care Entities and requires coverage of up to 14 days of Clinical Stabilization Services with utilization review procedures beginning on day seven;
- Removes prior authorization for Acute Treatment Services and Clinical Stabilization Services for commercial insurers and requires coverage for a total of up to 14 days with utilization review procedures beginning on day seven;
- Requires medical necessity of substance abuse treatment to be determined by the treating clinician in consultation with patient; and,
- Requires all insurance carriers to reimburse for substance abuse treatment services delivered by a Licensed Alcohol and Drug Counselor.
In addition, it directs the Center for Health Information and Analysis to review the accessibility of substance abuse treatment and adequacy of insurance coverage and tasks the Health Policy Commission with recommending policies to ensure access and coverage for substance abuse treatment throughout the Commonwealth, as well as review denial rates for substance abuse treatment coverage by commercial insurers.
The bill now goes to the Governor for his final approval.