BOSTON — Sen. Jennifer L. Flanagan (D-Leominster) has announced the successful passage of 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.
The bill was crafted in response to the growing opioid addiction crisis and a statewide listening tour lead by Flanagan in her capacity as chair of the Senate Special Committee on Drug Abuse and Treatment Options.
“Access to treatment at all levels of care is the theme we heard repeatedly as we crafted this bill,” said Flanagan (D-Leominster). “This legislation allows patients and their clinicians, who are working close together, to devise what the best plan of care is for the individual and asks that their insurance to cover that care. This is the beginning of a long-term conversation about treating addiction as a disease, getting people the help they need, and letting families know they are not alone in this battle.”
This bill, which is now before Governor Deval Patrick for final approval, 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 the Department of Public Health.
The substance abuse bill:
* 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.
“This bill comes from months of input from families, patients, doctors, addicts, treatment providers, substance abuse counselors, insurance companies, and anyone who has seen the terrible impact drug addiction can have on a community,” said Senator Flanagan. “It does not advocate for any one type of treatment – but rather it opens up access to a variety of treatments.
to be covered so that a person can work out a care plan that will help them cope without drugs, work toward long term sobriety, and live a long and healthy life.”
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.
“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.”
The bill authorizes the Department of Public Health 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 legislation also 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.
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.