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H 4934

An Act to improve access and care coordination for people with pain

194th Legislature (2025-2026) Introduced by Marjorie Decker and 2 co-sponsors

Expands access to non-opioid pain treatments and ensures equitable coverage while improving coordinated, multidisciplinary chronic pain care for MassHealth enrollees.

Reporting date extended to Thursday, December 31, 2026
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Bill Summary · H 4934

Overview

H 4934, An Act to improve access and care coordination for people with pain, is a Massachusetts bill filed in the 194th General Court (2025-2026). The bill seeks to improve access to non-opioid pain treatments, ensure equitable coverage for non-opioid and opioid therapies, enhance chronic pain care coordination within MassHealth, and establish a statewide data collection and reporting framework on chronic pain.

Main purpose and intent

  • Improve access to non-opioid pain medications and ensure treatment choices are not disadvantaged relative to opioids.
  • Strengthen access to comprehensive, integrated care for individuals with chronic pain enrolled in MassHealth managed care organizations (MCOs) or accountable care organizations (ACOs).
  • Create and implement a chronic pain quality strategy for both children and adults.
  • Develop data collection and reporting on the incidence, prevalence, and treatment of chronic pain to identify gaps and guide policy and program improvements.

Key provisions

1) Coverage for non-opioid pain medications (Section 10AA)

  • Applies to the division (MassHealth) and its contracted insurers, health plans, HMOs, behavioral health management firms, and third-party administrators under contract to Medicaid managed care or primary care clinician plans.
  • Requirement: No non-opioid pain drug should be disadvantaged relative to opioids/narcotics.
  • Prohibited practices include:
    • Designating non-opioid drugs as non-preferred if any opioid is designated as preferred on the MassHealth Drug List.
    • Imposing more restrictive utilization management (e.g., prior authorization, step therapy) on non-opioids than on the least restrictive management for opioids.

2) Chronic pain care access and coordination (Section 10AA, continued; large scope in §3)

  • Mandates accessible, quality health care for Medicaid enrollees with chronic pain within MCOs/ACOs under contract to MassHealth.
  • Required elements of care:
    • Comprehensive integrated care management for chronic pain, including primary care, medical specialties (pain management, neurology, rheumatology), and specialized providers (physical therapy, occupational therapy, chiropractic, acupuncture, psychology, massage, etc.) as per individualized pain treatment plans.
    • Social work services and education on chronic pain management for patients, caregivers, and providers.
    • Support for navigating health coverage and transportation assistance to primary and specialty care.
  • By Jan 1, 2027, implement a chronic pain quality strategy that includes:
    • Measurable goals to identify members with chronic pain within 90 days of enrollment.
    • Adequate provider network capacity to ensure timely access to chronic pain specialists.
    • Care coordination supports to help members access appropriate providers and therapies.
    • A training curriculum approved by the Division of Medical Assistance for primary care providers on comprehensive chronic pain treatment, including assessment, pain rating tools, individualized treatment plans, medication management, crisis management, and multidisciplinary, evidence-based care across restorative therapies, medications, interventional procedures, behavioral therapies, and complementary treatments.
  • By Jan 1, 2026, MA DA (Division of Medical Assistance) must identify, document, and share best practices for chronic pain care management and coordination with Medicaid-enrolled primary and specialty providers, in partnership with MCOs/ACOs.

3) Data collection, reporting, and research (Chapter 12C, new Section 25)

  • Establishes a data collection framework on the incidence and prevalence of chronic pain in the Commonwealth.
  • The Center (likely the Massachusetts Center for Health Information and Analysis or a designated center) will:
    • Use available data to clarify chronic pain incidence/prevalence from injuries, surgeries, diseases, etc.
    • Identify gaps and collect deidentified population data via medical claims and surveys to fill data gaps.
    • Gather information on: demographics, risk factors, diagnosis/progression markers, direct/indirect costs, epidemiology, detection/management/treatment, comorbid conditions (e.g., depression, anxiety, SUD), service utilization, and effectiveness of evidence-based treatments.
  • Reporting timeline:
    • Not later than 2 years after enactment and every two years thereafter, the Center must publish a report addressing the outlined data and analyses, including gap recommendations.

Who would be affected

  • MassHealth enrollees with chronic pain enrolled in Medicaid managed care organizations or accountable care organizations.
  • MassHealth contracted health plans, insurers, HMOs, and third-party administrators responsible for drug coverage and utilization management.
  • Primary care providers, pain specialists, and other clinical professionals involved in chronic pain treatment and management.
  • Health care providers and organizations participating in the standardized pain treatment training curriculum.
  • The Commonwealth’s data and research bodies responsible for chronic pain incidence/prevalence reporting.

Procedural and timeline aspects

  • Effective drafting requires action by MassHealth and contracted plans to align benefits and utilization management with the non-opioid coverage parity requirement.
  • By January 1, 2026: Center to identify best practices for chronic pain care management and coordination (to be shared with providers).
  • By January 1, 2027: MassHealth to implement a chronic pain quality strategy with specified components (identification within 90 days, provider capacity, care coordination, and provider training).
  • Ongoing: Biennial reporting on chronic pain data and policy impact, starting within two years of enactment and every two years thereafter.

Potential impact

  • Improved patient access to non-opioid analgesics without penalty relative to opioids.
  • More comprehensive, coordinated care for chronic pain across primary and specialty services, with emphasis on multidisciplinary approaches.
  • Enhanced patient education and care navigation, potentially improving adherence and outcomes.
  • A structured data framework to quantify chronic pain burden, track trends, and identify care gaps, informing future policy and resource allocation.

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

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