Governor Deval Patrick E nacts a Massachusetts Law Aimed at Combating Substance Abuse

August 26, 201 4

In response to the growing opioid addiction epidemic in Massachusetts, and across New England, Governor Patrick declared a public health emergency on March 27, 201 4. The Governor directed the Department of Public Health (DPH) to take several actions to combat overdoses, stop the opioid epidemic from getting worse, help those already addicted to recover, and map a long-term solution to ending widespread opioid abuse in the Commonwealth.

The Massachusetts Legislature has also taken actions to address the opioid epidemic. To this end, the state legislature passed, with bipartisan support, a law that includes a variety of provisions related to substance abuse. Governor Patrick signed the bill into law on August 6, 201 4.1

Among

other things, the new law requires an appointed commission to prepare a list of drugs that can be substituted for opiates and requires pharmacists to dispense them. The law also authorizes the commissioner of public health to classify a drug as dangerous for up to a year and impose certain restrictions on it, if the drug poses an imminent threat to public safety. The law includes new data reporting requirements related to the state's prescription monitoring program, to drug overdose deaths and to infants born exposed to drugs.

The law also amends and expands the Insurance Department’s coverage mandates within the Commonwealth that affect prescription drug formularies, preauthorization to a treatment facilities and the admission-notification and initial treatment plan-filing for acute treatment services or clinical stabilization services.

1 An Act To Increase Opportunities For Long-Term Substance Abuse Recovery

HEALTH BENEFITS MANDATE EFFECTIVE OCTOBER 1, 2015

Effective Oct. 1 , 201 5, employers that offer a fully-insured group health plan, policy, contract, agreement or certificate of insurance issued, delivered or renewed within the Commonwealth, which is considered creditable coverage under section 1 of chapter 11 8M, to:

• Provide coverage for abuse deterrent opioid drug products listed on the formulary,

compiled pursuant to subsection (b) of section 1 3 of chapter 1 7, on a basis not less favorable than non-abuse deterrent opioid drug products that are covered by such policy, contract, agreement, plan or certificate of insurance.2 An increase in patient cost sharing shall not be allowed to achieve compliance with this section.

• Prohibit an insurance carrier from requiring a member to obtain a preauthorization for

substance abuse treatment if the provider is certified or licensed by the DPH.3 As used here, the term “substance abuse treatment” shall include: early intervention services for substance use disorder treatment; outpatient services including medically assisted therapies; intensive outpatient and partial hospitalization services; residential or inpatient services, not covered under newly established Section 47GG (which provides coverage for medically necessary acute treatment services and medically necessary clinical stabilization services for up to a total of 1 4 days); and medically managed intensive inpatient services, not covered under said section 47GG.

• Provide coverage for medically necessary acute treatment services and medically

necessary clinical stabilization services for up to a total of 1 4 days and shall not require preauthorization prior to obtaining acute treatment services or clinical stabilization services; provided that the facility shall provide the carrier both notification of admission and the initial treatment plan within 48 hours of admission; provided further, that utilization review procedures may be initiated on day 7.4

Insurance companies opposed the requirements on insurers, arguing that they will establish a standard of care giving all patients 1 4 days of inpatient treatment, even where there is no evidence that is the best medical practice.

*Note: All of this is subject to change based on government regulations.

2 Massachusetts General Laws, chapter 1 75, Section 47EE. 3Massachusetts General Laws, chapter 1 75, Section 47FF. 4 Massachusetts General Laws, chapter 1 75, Section 47GG.