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Addiction treatment bill mandating automatic insurance coverage signed by Gov. Patrick

Spurred by the ongoing heroin and opioid painkiller problem in the state, a wide-ranging emergency bill intended to increase access to addiction treatment by removing insurers from the early decision-making process, among other measures, cleared the Legislature Friday and was signed into law Wednesday.

The bill, S.2142, passed both houses of the Legislature and arrived on the governor’s desk last week for his signature or veto.

“Families can’t do it on their own,” Patrick said during a bill signing ceremony Wednesday. “Clinics and hospitals can’t do it on their own. Government can’t do it on its own. But all of us working together, we can. And what we can do is break this scourge of addiction to narcotic painkillers and the increase in use of heroin and all of the calamity that that creates in households all over the Commonwealth.”

The governor’s office has reportedly received a flood of protest from insurers and proponents of drug-assisted treatments such as Suboxone and Methadone over in-patient treatment in recent weeks, but supporters were confident of the bill’s passage.

Among other provisions, the bill requires health insurers to automatically cover inpatient detox and two-weeks of post-detox stabilization, commonly known as rehab, and moves the question of whether treatment is medically necessary from insurers to the doctors dealing directly with addicted patients. An existing state parity law requires insurers to cover all medically necessary mental health and addiction treatment as they would any other medical treatment, but the definition of medical necessity has been left up to insurance companies and their medical directors.

The version of the bill passed on to the governor requires insurers to cover a minimum of 14 days of inpatient detox and rehab treatment. The State House News Service reported the number was a compromise between versions of the bill backed by the House and Senate, with the House version calling for a minimum of 10 days and the Senate 21.

The Senate approved the bill 40-0 early Friday morning.

John Merrigan, a Franklin County court official and co-founder of the two-county Opioid Education and Awareness Task Force supported the increased access to treatment and was optimistic about the bill’s future before its passage.

“Now people can walk in without a referral, that’s what we need, clearly,” Merrigan said. The bill should take trying to figure out what their insurance will and will not cover out of the equation for would-be patients, he said.

Fellow task-force co-founder and Franklin County Sheriff Christopher Donelan had a similar take, calling the bill progress, no matter what changes might have been made from its inception to the signing.

“However it lands, it’s definitely progress. A great source of frustration was when hardworking blue-collar families needed services they were basically told by their insurers ‘sign up for MassHealth,’ and that’s just absurd. Insurance companies should be covering treatment,” Donelan said. “What ended up happening was you had to be either very poor or very rich to get treatment, and everyone in between was stuck.”

The legislation also requires all insurance carriers to reimburse individuals for substance abuse treatment services delivered by a licensed alcohol and drug counselor.

According to advocates, the bill’s passage makes Massachusetts the second state in the nation to remove prior authorization for inpatient services.

The insurance provisions would take effect in fall of 2015, according to advocates.

Other provisions of the bill require the Department of Public Health to make monthly reports to the Legislature on the use of the state’s online Prescription Monitoring Program and the data collected, strengthens licensing requirements for large opioid treatment programs employing opioid replacement drugs and requires hospitals to report the number of overdoses treated and babies born exposed to drugs each month.

Insurance lobby Massachusetts Association of Health Plans has raised concerns about the legislation driving up health care costs.

In an Aug. 1 letter to the governor asking him to amend the bill, MAHP president Lora Pellegrini acknowledged the opioid addiction crisis but said the legislation abolishes the ability of health plans to “conduct medical necessity determinations that ensure treatment in the appropriate setting.”

“Even in crisis … we should not endorse arbitrary treatment guidelines that are not evidence-based and we should not prohibit tools that work to ensure that the right care is delivered at the right time and in the right setting,” she added.

Patrick pushed back about the claims when asked by a reporter. “First of all, it is evidence-based and it’s based on evidence developed between a doctor and his or her patient,” Patrick said, drawing applause from the crowd.

Lawmakers earmarked $20 million in the fiscal year 2015 state budget to ensure the availability of detox beds, said Jennifer Flanagan, D-Leominster, who was among the sponsors of the bill. She said there will be endless talk about costs associated with the bill, but argued the cost of not doing something is greater.

You can reach Chris Curtis at: ccurtis@recorder.com or 413-772-0261, ext. 257

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