Legislature Approves Substance Abuse Recovery Bill

BOSTON – The Senate and House passed final legislation to increase 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.”

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 Governor signed the bill into law on August 6, 2014.