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Substance use disorder recovery services

Many provisions of Chapter 258, a 2014 law addressing access to substance use recovery services are taking effect in 2015.

1. An updated provider bulletin from MassHealth clarifies that pursuant to the new law, effective Oct 2015, neither MassHealth nor its managed care plans can require prior authorization for acute treatment e.g. admission to a detox facility or for clinical stabilization services . The treating clinician's judgment on medical necessity rules at least for acute care and  the 1st 14 days of clinical stabilization.

For the details, Managed Care Bulletin 2, Nov 2015  is posted here

https://www.mass.gov/media/1043271/download

Private insurance plans sold in Massachusetts are subject to the same prior authorization restrictions. DOI Bulletin 2015-05, July 2015

http://www.mass.gov/ocabr/insurance/providers-and-producers/doi-regulatory-info/doi-regulatory-bulletins/2015-doi-bulletins/bulletin-2015-05.html

2. Also pursuant to the new law is an April 2015 report assessing available SUD treatment resources in the Commonwealth. Particularly useful are the Appendices which list different kinds of treatments and available sources of payment for each treatment: commercial insurance, MassHealth or the DPH Bureau of Substance Abuse Services. Note this report precedes the Oct 2015 change in prior authorization restrictions.

http://www.chiamass.gov/assets/Uploads/SUD-REPORT.pdf

3. Also in October 2015, MassHealth began piloting an expedited eligibility process for uninsured individuals receiving  BSAS funded services with the goal of eventually extending the program statewide.