FILED ON: 6/13/2024
HOUSE . . . . . . . . . . . . . . . No. 4758
House bill No. 4743, as change by the House committee on Bills in the Third Reading, and as
amended and passed to be engrossed by the House. June 13, 2024.
The Commonwealth of Massachusetts
_______________
In the One Hundred and Ninety-Third General Court
(2023-2024)
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An Act relative to treatments and coverage for substance use disorder and recovery coach
licensure.
Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
of the same, as follows:
1 SECTION A1. Chapter 32A of the General Laws is hereby amended by striking out
2 section 17Q and inserting in place thereof the following section:-
3 Section 17Q. (a) The commission shall develop a plan to provide active or retired
4 employees insured under the group insurance commission adequate coverage and access to a
5 broad spectrum of pain management services, including, but not limited to, non-medication, non-
6 surgical treatment modalities and non-opioid medication treatment options that serve as
7 alternatives to opioid prescribing, in accordance with guidelines developed by the division of
8 insurance.
9 (b) No such coverage offered by the commission shall, relative to pain management
10 services identified by the commission pursuant to subsection (a), require a member to obtain a
11 preauthorization for non-medication, non-surgical treatment modalities that include restorative
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12 therapies, behavioral health approaches or integrative health therapies, including acupuncture,
13 chiropractic treatments, massage and movement therapies.
14 (c)(1) The plan pursuant to subsection (a) shall be subject to review by the division of
15 insurance. In its review, the division shall consider the adequacy of access to a broad spectrum of
16 pain management services and any policies that may create unduly preferential coverage to
17 prescribing opioids without other pain management modalities.
18 (2) Any coverage offered by the commission to an active or retired employee of the
19 commonwealth insured under the group insurance commission shall not establish utilization
20 controls, including preauthorization or step therapy requirements, for clinically appropriate non-
21 opioid drugs approved by the federal Food and Drug Administration for the treatment or
22 management of pain that are more restrictive or extensive than the least restrictive or extensive
23 utilization controls applicable to any clinically appropriate opioid drug.
24 (d) The commission shall annually distribute educational materials to providers within
25 their network and to members about the pain management access plan and shall make
26 information about its plan publicly available on its website.
27 SECTION 1. Said chapter 32A is hereby further amended by inserting after section 17S
28 the following 2 sections:-
29 Section 17T. (a) Any coverage offered by the commission to an active or retired
30 employee of the commonwealth insured under the group insurance commission shall provide
31 coverage for prescribed or dispensed opioid antagonists, as defined in section 19B of chapter
32 94C and used in the reversal of overdoses caused by opioids, which shall be deemed medically
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33 necessary and shall not require prior authorization; provided, however, that a prescription from a
34 health care practitioner shall not be required for coverage of opioid antagonists. An opioid
35 antagonist used in the reversal of overdoses caused by opioids shall not be subject to any
36 deductible, coinsurance, copayments or out-of-pocket limits; provided, however, that cost-
37 sharing shall be required if the applicable plan is governed by the federal Internal Revenue Code
38 and would lose its tax-exempt status as a result of the prohibition on cost-sharing for this service.
39 (b) The commission shall provide coverage for an opioid antagonist used in the reversal
40 of overdoses caused by opioids as a medical benefit when dispensed by the health care facility in
41 which the opioid antagonist was prescribed and shall provide coverage as a pharmacy benefit for
42 an opioid antagonist used in the reversal of overdoses caused by opioids dispensed by a
43 pharmacist, including an opioid antagonist dispensed pursuant to section 19B of chapter 94C;
44 provided, however, that the rate to be reimbursed under the medical benefit shall not exceed the
45 commission’s average in-network pharmacy benefit rate and the health care facility shall not
46 balance bill the patient.
47 Section 17U. (a) The commission shall provide to any active or retired employee of the
48 commonwealth who is insured under the group insurance commission coverage for the provision
49 of services by a recovery coach licensed or otherwise authorized to practice pursuant to chapter
50 111J, irrespective of the setting in which the services are provided; provided, that such services
51 shall be within the lawful scope of practice of a recovery coach. The contractual rate for these
52 services shall be not less than the prevailing MassHealth rate for recovery coach services. The
53 benefits in this section shall not be subject to any deductible, coinsurance, copayments or out-of-
54 pocket limits; provided, however, that cost-sharing shall be required if the applicable plan is
55 governed by the federal Internal Revenue Code and would lose its tax-exempt status as a result
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56 of the prohibition on cost-sharing for the service. Recovery coach services shall be deemed
57 medically necessary and shall not require prior authorization.
58 SECTION 2. Chapter 18 of chapter 94C of the General Laws, as appearing in the 2022
59 Official Edition, is hereby amended by striking out subsection (e) and inserting in place thereof
60 the following subsection:-
61 (e) Practitioners who prescribe controlled substances, except veterinarians, shall be
62 required, as a prerequisite to obtaining or renewing their professional licenses, to complete
63 appropriate training relative to: (i) effective pain management including, but not limited to: (A)
64 appropriate, available non-opioid alternatives for the treatment of pain; (B) the advantages and
65 disadvantages of the use of non-opioid treatment alternatives, considering a patient’s risk of
66 substance misuse; and (C) the options for referring or prescribing appropriate non-opioid
67 treatment alternatives based on the practitioner’s clinical judgment and following generally
68 accepted clinical guidelines, taking into consideration the preference and consent of the patient
69 and the educational information described in section 21; (ii) the risks of misuse and addiction
70 associated with opioid medication; (iii) the identification of patients at risk for substance misuse;
71 (iv) counseling patients about the side effects, risks, addictive nature and proper storage and
72 disposal of prescription medications; (v) the appropriate prescription quantities for prescription
73 medications that have an increased risk of misuse and addiction, including a patient’s option to
74 fill a prescription for a schedule II controlled substance in a lesser quantity than indicated on the
75 prescription pursuant to subsection (d¾); and (vi) opioid antagonists, overdose prevention
76 treatments and information to advise patients on both the use of and ways to access opioid
77 antagonists and overdose prevention treatments. The boards of registration for each professional
78 license that require this training shall, in consultation with the department, relevant stakeholders
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79 and experts in the treatment and management of acute and chronic pain, develop the standards
80 for appropriate training programs. For the purposes of this section, non-opioid treatment
81 alternatives shall include, but shall not be limited to, medications, restorative therapies,
82 interventional procedures, behavioral health approaches and complementary and integrative
83 treatments.
84 SECTION 3. Said chapter 94C is hereby further amended by striking out section 19C and
85 inserting in place thereof the following section:-
86 Section 19C. The board of registration in pharmacy shall promulgate regulations
87 requiring pharmacies located in areas with high incidents of opiate overdose, as determined by
88 the board in consultation with the department, to maintain a continuous supply of opioid
89 antagonists, as defined in section 19B; provided, that the continuous supply of opioid antagonists
90 shall include opioid antagonists that are approved by the federal Food and Drug Administration
91 to be sold over the counter without a prescription; provided further, that such pharmacies shall
92 notify the department if the supply or stock of opioid antagonist doses is insufficient to enable
93 compliance with maintaining a continuous supply of opioid antagonists.
94 SECTION 4. Said chapter 94C is hereby further amended by inserting after section 19D
95 the following section:-
96 Section 19D½. (a) For the purposes of this section, the following words shall, unless the
97 context clearly requires otherwise, have the following meanings:
98 “Opioid antagonist”, as defined in section 19B.
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 99 “Substance use disorder treatment facility”, a facility licensed or approved by the
100 department to offer treatment for substance use disorder, including, but not limited to: (i)
101 withdrawal management services; (ii) clinical stabilization services; (iii) transitional support
102 services; (iv) residential support services; (v) community behavioral health center services; (vi)
103 office-based opioid or addiction treatment services; or (vii) outpatient substance use disorder
104 services.
105 (b) Upon discharge of a patient from a substance use disorder treatment facility, the
106 facility shall educate the patient on the use of opioid antagonists and dispense not less than 2
107 doses of an opioid antagonist to the patient or a legal guardian.
108 (c) The commissioner may promulgate rules and regulations necessary to implement this
109 section.
110 SECTION 5. Section 21 of said chapter 94C, as appearing in the 2022 Official Edition, is
111 hereby amended by striking out the third paragraph and inserting in place thereof the following
112 paragraph:-
113 The department, in consultation with relevant stakeholders and experts in the treatment
114 and management of acute and chronic pain, and based in part on the Pain Management Best
115 Practices Inter-Agency Task Force Report issued by the United States Department of Health and
116 Human Services, shall produce and distribute either in written or electronic form to pharmacies,
117 not including institutional pharmacies, pamphlets for consumers relative to narcotic drugs,
118 specifically opiates, that include educational information related to: (i) pain management and the
119 use and availability of non-opioid alternatives for the treatment of acute and chronic pain,
120 including, but not limited to: (A) information on available non-opioid alternatives for the
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121 treatment of pain, including non-opioid medications and non-pharmacological therapies; and (B)
122 the advantages and disadvantages of the use of such non-opioid treatment alternatives; (ii) the
123 consumer’s option to fill a prescription for a schedule II controlled substance in a lesser quantity
124 than indicated on the prescription pursuant to subsection (d¾) of section 18; (iii) misuse and
125 abuse by adults and children; (iv) the risk of dependency and addiction; (v) proper storage and
126 disposal; (vi) addiction support and treatment resources; (vii) the telephone helpline operated by
127 the bureau of substance addiction services established in section 18 of chapter 17; (viii) risks of
128 unintended overdoses associated with prescription opioid use, including, but not limited to: (A)
129 mixing any opioid with respiratory depressants, including, but not limited to, alcohol,
130 benzodiazepines and stimulants; and (B) changes in personal tolerance levels for persons with a
131 history of overdose; and (ix) risk reduction measures to prevent, respond to and reverse an opioid
132 overdose. A pharmacist shall distribute the pamphlet when dispensing a narcotic or controlled
133 substance contained in schedule II or III; provided, however, that pharmacists shall not be
134 required to distribute the pamphlet if: (i) the patient is receiving outpatient palliative care
135 pursuant to section 227 of chapter 111; (ii) the patient is a resident of a long-term care facility; or
136 (iii) the narcotic or controlled substance is prescribed for use in the treatment of substance use
137 disorder or opioid dependence. For the purposes of this section, non-opioid treatment alternatives
138 shall include, but shall not be limited to, medications, restorative therapies, interventional
139 procedures, behavioral health approaches and complementary and integrative treatments.
140 SECTION 6. Said chapter 94C is hereby further amended by inserting after section 34A the
141 following section:-
142 Section 34A½. (a) As used in this section, the following words shall, unless the context
143 clearly requires otherwise, have the following meanings:
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144 “Drug testing services”, the use of testing equipment to identify or analyze the strength,
145 effectiveness or purity of a controlled substance prior to its injection, inhalation or ingestion by
146 another person to determine whether the controlled substance contains chemicals, toxic
147 substances or hazardous compounds.
148 “Testing equipment”, including, but not limited to: fentanyl test strips, colorimetric
149 reagents, high-performance liquid chromatography, gas chromatography and mass spectrometry.
150 (b)(1) A person acting in good faith and within the scope of their role providing or
151 assisting in the provision of harm reduction services as an owner, employee, intern, volunteer or
152 third-party contractor of an entity providing harm reduction services may provide or assist in
153 drug testing services to an individual to ensure that a controlled substance in the possession of
154 the individual and exclusively for that individual’s personal use does not contain dangerous
155 chemicals, toxic substances or hazardous compounds likely to cause an accidental overdose.
156 (2) A person acting in good faith and within the scope of their role providing or assisting
157 in the provision of harm reduction services as an owner, employee, intern, volunteer or third-
158 party contractor of an entity providing harm reduction services who provides or assists in the
159 provision of drug testing services pursuant to this section shall not be charged or prosecuted
160 pursuant to sections 32I, 34 or 40.
161 (3) A person acting in good faith and within the scope of their role providing or assisting
162 in the provision of harm reduction services as an owner, employee, intern, volunteer or third-
163 party contractor of an entity providing harm reduction services who provides or assists in drug
164 testing services pursuant to this section shall: (i) not be held civilly liable for drug testing
165 services unless for gross negligence or willful misconduct in the execution of the drug testing
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166 services; and (ii) not be subject to any criminal or civil liability or any professional disciplinary
167 action; provided, however, that this section shall not apply to acts of gross negligence or willful
168 or wanton misconduct.
169 (c) An individual acting in good faith who seeks drug testing services of a controlled
170 substance in their possession and intended exclusively for their personal use from a person acting
171 in good faith and within the scope of their role providing, or assisting in the provision of, harm
172 reduction services as an owner, employee, intern, volunteer or third-party contractor of an entity
173 providing harm reduction services shall not be charged or prosecuted pursuant to sections 32I, 34
174 or 40 while on the premises where the drug testing services are conducted.
175 SECTION 7. Section 25J½ of chapter 111 of the General Laws, as appearing in the 2022
176 Official Edition, is hereby amended by inserting after the first paragraph the following
177 paragraph:-
178 Upon discharge of a patient from an acute care hospital or satellite emergency facility
179 who has: (i) a history of or is actively using opioids; (ii) been diagnosed with opioid use
180 disorder; or (iii) experienced an opioid-related overdose, the acute care hospital or satellite
181 emergency facility shall educate the patient on the use of opioid antagonists, as defined in section
182 19B of chapter 94C, and prescribe or dispense not less than 2 doses of an opioid antagonist to the
183 patient or a legal guardian and notify the patient’s primary care physician or preferred care
184 provider, if known and in consultation with the patient, of the prescribed or dispensed opioid
185 antagonist.
186 SECTION 8. Said chapter 111, as so appearing, is hereby amended by inserting after
187 section 110C the following section:-
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188 Section 110D. (a) The department shall collect and provide data to the department of
189 child