Section 4EE: Pain management access plan; non-medication and nonsurgical treatment; review; educational materials
323 words·~1 min read·
/ma/part-i/title-xxii/chapter-176g/4ee·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
[Text of section applicable to all contracts entered into, renewed or amended on or after July 1, 2025. See 2024, 285, Sec. 47.]
Section 4EE.
(a)Any individual or group health maintenance contract that is issued or renewed within or without the commonwealth shall develop a plan to provide adequate coverage and access to a broad spectrum of pain management services, including, but not limited to, non-medication, nonsurgical treatment modalities and non-opioid medication treatment options that serve as alternatives to opioid prescribing, in accordance with guidelines developed by the division of insurance.
(b)No such contract shall, relative to pain management services identified by the carrier pursuant to subsection (a), require a member to obtain prior authorization for non-medication, nonsurgical treatment modalities that include restorative therapies, behavioral health approaches or integrative health therapies, including acupuncture, chiropractic treatments, massage, and movement therapies.
(c)(1) The plan developed pursuant to subsection
(a)shall be subject to approval by the division of insurance and shall be a component of carrier accreditation by the division pursuant to section 2 of chapter 176O. In its review, the division shall consider the adequacy of access to a broad spectrum of pain management services and any carrier policies that may create unduly preferential coverage to prescribing opioids without other pain management modalities.
(2)No individual or group health maintenance contract that is issued or renewed within or without the commonwealth shall establish utilization controls, including prior authorization or step therapy requirements, for clinically appropriate non-opioid drugs approved by the United States Food and Drug Administration for the treatment or management of pain, that are more restrictive or extensive than the least restrictive or extensive utilization controls applicable to any clinically appropriate opioid drug.
(d)Carriers shall annually distribute educational materials to providers within their networks and to members about the pain management access plans developed pursuant to subsection
(a)and shall make information about the plans publicly available on their websites.