The Massachusetts Senate Approved a Substance Abuse Bill: Here is What You Need to Know

mass-state-houseA substance abuse bill that will help the state’s efforts to control a growing dependency problem won unanimous approval Tuesday in the Massachusetts Senate. The measure will toughen the state’s prescription drug monitoring program and require pharmacists to dispense an interchangeable abuse deterrent unless a physician has indicated that substitution could not be made. It would also mandate insurers reimburse for substance abuse treatment services delivered by licensed drug and alcohol counselors.

The substance abuse bill strengthens the Prescription Monitoring Program by requiring physicians to receive training on the Program before renewing their licenses. It also requires them to consult with the Program before writing a prescription on an annual basis for patients who receive ongoing treatment of a controlled substance and before writing a new or replacement prescription.

In the event that a death is caused by a controlled substance, the Chief Medical Examiner is required to file a report with the FDA’s MedWatch Program and the Department of Public Health 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.

It also does a lot more than that. 

  • Removes prior authorization for Acute Treatment Services for all MassHealth Managed Care Entities and requires coverage of up to 15 days of Clinical Stabilization Services;
  • Removes prior authorization for Acute Treatment Services and Clinical Stabilization Services  for commercial insurers and requires coverage for a total of up to 21 days before engaging in utilization management activities;
  • Directs the Health Policy Commission, in consultation with the Department of Public Health, to determine standards for evidence-based, effective substance abuse treatment with high quality outcomes and create a certification process for providers, and once certified, insurance carriers are prohibited from requiring prior authorization for services offered by a certified provider; 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.

 

What are your thoughts? This is huge. The bill will now move to the house for voting before landing on the governor’s desk.