January 14, 2025

On December 23, 2024, Massachusetts House Bill 5142 was signed into law, which intends to increase access to treatment and recovery support for addiction disorder. The provisions, some of which create new business opportunities for provider organizations, establish new treatment options plus mandates for health care coverage for treatment and recovery. To reduce overdose deaths, the legislation expands access to emergency opioid antagonists (EOAs) and non-opioid alternatives for pain treatment. Multiple provisions focus on reducing stigma associated with needing or receiving addiction treatment.

Establish new treatment options: New treatment options include licensure and an insurance coverage mandate for recovery coaches, use of acupuncture as a detoxification treatment, prescriber and consumer education about non-opioid options for non-opioid alternatives for pain, and reforms to involuntary commitment for addiction treatment.

• Recovery coaching: The Department of Public Health (DPH) will establish licensing and oversight for recovery coaches. The Bureau of Substance Abuse Services (BSAS) will report on barriers to certification, credentialing, and other employment and practice requirements for recovery coaches. BSAS will establish a peer support program for recovery coaches and their employers that includes mentorship, technical assistance, and other resources. All health plans will be required to cover recovery coach services without cost-sharing or prior authorization at no less than MassHealth rates, regardless of the setting in which the services are provided.
• Auricular Acupuncture Detoxification (AAD) practice. The bill establishes the practice of—and restrictions on—AAD to expand access to this treatment by increasing the type of providers authorized to practice it.
• Non-opioid alternatives for pain treatment: The provisions address prescriber training, consumer education, and insurance coverage. It expands required prescriber training to include acute and chronic pain treatment, incorporating available and appropriate non-opioid alternatives. It also requires pharmacists dispensing opioids to distribute printed educational materials on non-opioid alternatives to pain treatment as issued by the Department of Public Health (DPH) and it requires DPH to include educational materials on its website related to non-opioid alternatives for the treatment of pain, as well as the risks of and protective measures against unintended overdoses associated with prescription opioids. The bill updates requirements for insurance providers to ensure adequate coverage and access to pain management services without prior authorization, including non-opioid alternatives to pain treatment.
• Reforms to involuntary commitment for addiction treatment. By 2027, the state will develop a plan to close the Massachusetts Alcohol and Substance Abuse Center (MASAC), a court-ordered addiction treatment program for men located inside a correctional facility. MASC will be replaced with beds in programs overseen by DPH or the Department of Mental Health (DMH).

Expand access to EOAs across the health system to prevent overdose deaths. The provisions address insurance coverage, consumer education, and dispensing of naloxone and Narcan¸ Health insurers will be required to cover EOAs to reverse overdose without cost sharing or prior authorization. Hospitals must provide discharge education to people with a history of overdose, opioid use, or opioid use disorder (OUD) about EOAs and to prescribe or dispense at least two doses of EOAs. Addiction treatment facilities must also educate consumers on EOAs and dispense two doses of EOA drugs on discharge. Pharmacies in areas with high incidences of overdoses must maintain a sufficient and consistent supply of EOAs. Pharmacies are required to stock EOAs approved for over-the-counter sale in addition to those requiring a prescription. If a pharmacy is unable to comply due to insufficient supply, the pharmacy must report to the Department of Public Health.

Reduce stigma of needing or receiving an EOA or addiction treatment. The provisions address a variety of contexts including insurer coverage, civil and criminal liability for clinical professionals providing harm reduction, and other issues related to targeted populations receiving treatment.

• Insurer provisions: Health insurers are broadly required to cover EOAs, non-opioid pain management alternatives, and addiction treatment. Life insurance companies are prohibited from limiting or refusing coverage to a person solely because they obtained an EOA for themselves or others.
• Protection from civil or criminal liability: Public health and harm reduction organizations will be protected from civil or criminal liability and professional disciplinary actions if they are providing drug checking services in good faith. Medical malpractice insurers will be prohibited from discriminating against health care practitioners who provide harm reduction services. Individuals seeking drug checking services on substances for personal use will be protected from criminal liability if the check takes place on the premises of a public health or harm reduction organization. DPH will enforce anti-discrimination protections for people with substance use disorder who are covered by public health insurance. It prohibits discrimination against those lawfully possessing or taking prescribed medication for opioid-related addiction treatment.
• Change to Department of Children and Families policies related to substance-exposed newborns: Mandated reporting requirements will be clarified that encountering a substance-exposed newborn is not an automatic referral to DCF if the mother is taking prescribed medications, including medications for OUD (MOUDs). DCF with DPH and the Office of the Child Advocate (OCA) will develop regulations related to the care, treatment, and reporting of substance-exposed newborns for state child abuse or neglect prevention and treatment programs. All births of substance-exposed newborns will be tracked by DPH in consultation with DCF and OCA and reported to DCF.,
• Alternative-to-discipline and rehabilitation program for dental professionals. This bill establishes remediation and outreach programs for dentists and dental hygienists with physical, mental health, or substance use needs that have impaired or may impair their ability to practice their profession safely.

Additionally, the legislation includes provisions for research and reporting to further expand access to treatment and recovery services. BSAS will report its recommendations about additional legislation or regulatory changes needed to reduce the disparate impact of addiction, overdose and overdose deaths, and clinical outcomes for members of historically marginalized communities. BSAS will study treatment outcomes after discharge from addiction treatment facilities, and will report on the potential benefits of allowing pharmacists to prescribe MOUDs outside of hospital or health care institution settings. DPH will report on the safety and recovery of sober home residents. Two new commissions will study ways to address public health and safety concerns related to xylazine and prescribing practices for benzodiazepines and non-benzodiazepine hypnotics.

A link to the full text of “Massachusetts House Bill H.5143: An Act Relative To Treatments & Coverage For Substance Use Disorder & Recovery Coach Licensure” is in the OPEN MINDS Circle Library at https://openminds.com/market-intelligence/resources/121724mahb5143/.