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H 4958

An Act relative to opioid use disorder treatment and rehabilitation coverage

194th Legislature (2025-2026) Introduced by Kate Donaghue and 1 co-sponsor

The bill expands insurance coverage for opioid use disorder treatment and recovery services to improve access, affordability, and care coordination.

Reporting date extended to Thursday, December 31, 2026
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Bill Summary · H 4958

Summary of H 4958 (194th Legislature, Massachusetts)

Purpose and intent

  • The bill, titled An Act relative to opioid use disorder treatment and rehabilitation coverage, aims to enhance insurance coverage and access for individuals with opioid use disorder (OUD) by broadening the scope of treatment and rehabilitation services that are required or encouraged to be covered by health plans.
  • It seeks to improve affordability and availability of evidence-based treatment and recovery supports for OUD, with particular emphasis on treatment access, coverage parity, and streamlined administrative processes.

Key provisions and changes (proposed)

  • Treatment coverage expansion

    • Requires health insurance plans to cover a broader set of treatments for opioid use disorder, aligning with evidence-based practices.
    • May include coverage for medically supervised withdrawal management, pharmacotherapies (such as buprenorphine, methadone, and naltrexone), and comprehensive behavioral health services.
    • Potentially strengthens parity between OUD treatment and other chronic conditions in terms of coverage limits and cost-sharing.

  • Rehabilitation and recovery services

    • Encourages or mandates coverage for rehabilitation and recovery support services that assist individuals in sustaining long-term recovery.
    • Could include inpatient and outpatient rehab services, sober living supports, peer recovery coaching, and case management.

  • Access and affordability provisions

    • Aims to reduce financial barriers by limiting copays, coinsurance, and annual or lifetime limits for OUD treatment services.
    • May address prior authorization processes to reduce delays in obtaining needed treatment.

  • Care coordination and integration

    • Promotes coordination between primary care, addiction treatment providers, and behavioral health services to ensure seamless care.
    • Encourages use of care plans and integrated treatment approaches for individuals with co-occurring mental health disorders and OUD.

  • Data, reporting, and oversight

    • May require reporting on access to OUD services, utilization, and outcomes to monitor impact and ensure compliance.
    • Could establish or involve state oversight to ensure plans meet the new coverage standards.

Who is affected

  • Individuals with opioid use disorder and those seeking treatment: Potentially improved access to a wider range of covered services and reduced cost barriers.
  • Health insurers and managed care organizations: Subject to new coverage requirements and potential changes to benefits design, prior authorization, and parity standards.
  • Healthcare providers: Encouraged to coordinate care and may see streamlined processes for referring patients to covered OUD treatments.
  • State Medicaid program (MassHealth) and private plans: Depending on the bill’s scope, both public and private payers may need to align benefits with the new requirements.

Procedural and timeline aspects

  • Committee process and reporting
    • The bill has progressed through the Massachusetts legislative process, with a reported favorable disposition from the Financial Services Committee and referral to the Health Care Financing Committee as of January 28, 2026.
    • A new draft (H1337) was circulated alongside the committee report.
  • Extended reporting date
    • The reporting date has been extended to Thursday, December 31, 2026, indicating continued consideration and potential amendments during the session.
  • Sponsorship
    • Co-sponsors include Andy Vargas and Kate Donaghue, signaling bicameral or cross-party support within the legislative process.

Practical considerations

  • The bill emphasizes expansion of coverage for OUD treatment and rehabilitation, aiming to reduce barriers and improve outcomes for individuals affected by opioid use disorder.
  • If enacted, enforcement and implementation would involve coordination between state agencies, insurers, and healthcare providers to ensure compliance and measurement of impact.
  • Stakeholders may monitor for changes in cost-sharing, service scope, and access metrics to assess effectiveness over time.

Compiled from official sources — confirm details with the bill’s official record.

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