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S 863

Increases access to substance abuse programming for incarcerated individuals whose first language is not English

2025 Regular Session Introduced by Jamaal Bailey and 2 co-sponsors

Expands MassHealth coverage for FDA-approved non-opioid pain meds to parity with opioids and strengthens multidisciplinary chronic pain care and data collection.

REPORTED AND COMMITTED TO FINANCE
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Bill Summary · S 863

Summary — S.863 (2025): An Act relative to non-opioid options for chronic pain

Note: The bill text provided here is titled “An Act relative to non-opioid options for chronic pain” (Senate Docket No. 1822, presented by Sen. Dylan A. Fernandes). Some metadata supplied with the request (alternate title, sponsor list) appears inconsistent with the bill text; this summary follows the bill language.

Main purpose

To expand and equalize coverage of FDA‑approved non‑opioid pain medications and strengthen comprehensive, multidisciplinary care and data collection for people with chronic pain enrolled in MassHealth (Medicaid) managed care and accountable care organizations (ACOs).

Key provisions

  1. Coverage parity for non‑opioid drugs (new G.L. c.118E, §10R)

    • Defines “non‑opioid drug” as any FDA‑approved non‑opioid medication for pain.
    • Prohibits MassHealth and contracted insurers/TPAs from disadvantaging non‑opioid drugs compared with opioids — e.g., may not label a non‑opioid as non‑preferred if an opioid is preferred, nor impose more restrictive utilization management (prior authorization, step therapy) on non‑opioids than on opioids.

  2. Enhanced chronic pain care in MassHealth MCOs/ACOs (amendment to division of medical assistance requirements)

    • Requires availability of integrated care management, including primary care, specialists (pain management, neurology, rheumatology), and non‑pharmacologic providers (PT, OT, chiropractic, acupuncture, psychology, massage) as specified in individualized treatment plans.
    • Requires social work, patient/caregiver/provider education, insurance navigation, and transportation assistance.
    • By FY2026 contract year, MCOs/ACOs must adopt a “chronic pain quality strategy” with measurable goals (identify members with chronic pain within 90 days of enrollment), network adequacy, care coordination, and a division‑approved training curriculum for primary care providers covering comprehensive, multidisciplinary pain care.

  3. Best practices and data collection (new G.L. c.12C, §25)

    • The state health data center will compile federal/state and claims/survey data to clarify incidence/prevalence of chronic pain, identify research gaps, and collect de‑identified data.
    • Required analyses include prevalence, demographics, risk factors, diagnostic/progression markers, direct and indirect costs, epidemiology, treatment/utilization, and co‑occurring conditions (full list in text).

Who is affected

  • MassHealth enrollees with chronic pain (adults and children)
  • Medicaid managed care organizations, ACOs, contracted insurers, health plans, and TPAs
  • Primary care and specialty providers, allied health practitioners, and pharmacists
  • State agencies responsible for MassHealth policy and health data collection

Timeline and procedural status

  • Bill text filed Jan 16, 2025 (Senate Docket No. 1822); presented by Sen. Dylan A. Fernandes.
  • Key dates in the bill: requirements tied to the fiscal year 2026 contract year; best‑practice sharing required by Jan 1, 2026.
  • Legislative status (per metadata): REPORTED AND COMMITTED TO FINANCE; hearing scheduled 06/18/2025. Verify current docket/status with the legislative clerk for updates.

Potential impact

  • Likely increases access to non‑opioid medications and encourages multidisciplinary, evidence‑based chronic pain care for Medicaid enrollees.
  • Could alter utilization management and formulary practices, and increase demand for specialty and non‑pharmacologic services — with budgetary and network capacity implications for MCOs/ACOs and the state.
  • Improved data collection may inform future policy and resource allocation for chronic pain care.

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

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