Massachusetts 2023-2024 Regular Session

Massachusetts House Bill H1015 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	1 of 1
2	2	HOUSE DOCKET, NO. 2573 FILED ON: 1/19/2023
3	3	HOUSE . . . . . . . . . . . . . . . No. 1015
4	4	The Commonwealth of Massachusetts
5	5	_________________
6	6	PRESENTED BY:
7	7	Sean Garballey
8	8	_________________
9	9	To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
10	10	Court assembled:
11	11	The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:
12	12	An Act providing for certain health insurance coverage.
13	13	_______________
14	14	PETITION OF:
15	15	NAME:DISTRICT/ADDRESS :DATE ADDED:Sean Garballey23rd Middlesex1/17/2023 1 of 5
16	16	HOUSE DOCKET, NO. 2573 FILED ON: 1/19/2023
17	17	HOUSE . . . . . . . . . . . . . . . No. 1015
18	18	By Representative Garballey of Arlington, a petition (accompanied by bill, House, No. 1015) of
19	19	Sean Garballey relative to providing certain health insurance coverage. Financial Services.
20	20	[SIMILAR MATTER FILED IN PREVIOUS SESSION
21	21	SEE HOUSE, NO. 1091 OF 2021-2022.]
22	22	The Commonwealth of Massachusetts
23	23	_______________
24	24	In the One Hundred and Ninety-Third General Court
25	25	(2023-2024)
26	26	_______________
27	27	An Act providing for certain health insurance coverage.
28	28	Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
29	29	of the same, as follows:
30	30	1 SECTION 1. Section 17A of chapter 32A of the General Laws, as appearing in the 2018
31	31	2Official Edition, is hereby amended by striking out the first sentence and inserting in place
32	32	3thereof the following 4 sentences:-
33	33	4 The commission shall provide to any active or retired employee of the commonwealth
34	34	5who is insured under the group insurance commission coverage for the cost of enteral formulas
35	35	6for home use, whether administered orally or via tube feeding, for which a physician has issued a
36	36	7written order. Such written order shall state that the enteral formula is clearly medically
37	37	8necessary and has been proven effective as a disease-specific treatment regimen for those
38	38	9individuals who are or will become malnourished or suffer from disorders, which if left
39	39	10untreated, cause chronic physical or intellectual disability or death. Specific diseases for which 2 of 5
40	40	11enteral formulas have been proven effective shall include, but are not limited to, inherited
41	41	12diseases of amino acid or organic acid metabolism; eosinophilic gastrointestinal disorders;
42	42	13Crohn's Disease; gastroesophageal reflux with failure to thrive; disorders of gastrointestinal
43	43	14motility such as chronic intestinal pseudo-obstruction; and multiple, severe food allergies, which
44	44	15if left untreated will cause malnourishment, chronic physical or intellectual disability or death.
45	45	16Enteral formulas which are medically necessary and taken under written order from a physician
46	46	17for the treatment of specific diseases shall be distinguished from nutritional supplements taken
47	47	18electively.
48	48	19 SECTION 2. Section 47I of chapter 175 of the General Laws, as so appearing, is hereby
49	49	20amended by striking out the first sentence and inserting in place thereof the following 4
50	50	21sentences:-
51	51	22 Any individual policy of accident and sickness insurance issued pursuant to section 108,
52	52	23and any group blanket policy of accident and sickness insurance issued pursuant to section 110,
53	53	24shall provide coverage for the cost of enteral formulas for home use, whether administered orally
54	54	25or via tube feeding, for which a physician has issued a written order. Such written order shall
55	55	26state that the enteral formula is clearly medically necessary and has been proven effective as a
56	56	27disease-specific treatment regimen for those individuals who are or will become malnourished or
57	57	28suffer from disorders, which if left untreated, cause chronic physical or intellectual disability or
58	58	29death. Specific diseases for which enteral formulas have been proven effective shall include, but
59	59	30are not limited to, inherited diseases of amino acid or organic acid metabolism; eosinophilic
60	60	31gastrointestinal disorders; Crohn's Disease; gastroesophageal reflux with failure to thrive;
61	61	32disorders of gastrointestinal motility such as chronic intestinal pseudo-obstruction; and multiple,
62	62	33severe food allergies, which if left untreated will cause malnourishment, chronic physical or 3 of 5
63	63	34intellectual disability or death. Enteral formulas which are medically necessary and taken under
64	64	35written order from a physician for the treatment of specific diseases shall be distinguished from
65	65	36nutritional supplements taken electively.
66	66	37 SECTION 3. Section 8L of chapter 176A of the General Laws, as so appearing, is hereby
67	67	38amended by striking out the first sentence and inserting in place thereof the following 4
68	68	39sentences:-
69	69	40 Any contract between a subscriber and the corporation under an individual or group
70	70	41hospital service plan that shall be delivered, issued or renewed in the commonwealth shall
71	71	42provide, as benefits to all individual subscribers and members within the commonwealth,
72	72	43coverage for the cost of enteral formulas for home use, whether administered orally or via tube
73	73	44feeding, for which a physician has issued a written order. Such written order shall state that the
74	74	45enteral formula is clearly medically necessary and has been proven effective as a disease-specific
75	75	46treatment regimen for those individuals who are or will become malnourished or suffer from
76	76	47disorders, which if left untreated, cause chronic physical or intellectual disability or death.
77	77	48Specific diseases for which enteral formulas have been proven effective shall include, but are not
78	78	49limited to, inherited diseases of amino acid or organic acid metabolism; eosinophilic
79	79	50gastrointestinal disorders; Crohn's Disease; gastroesophageal reflux with failure to thrive;
80	80	51disorders of gastrointestinal motility such as chronic intestinal pseudo-obstruction; and multiple,
81	81	52severe food allergies, which if left untreated will cause malnourishment, chronic physical or
82	82	53intellectual disability or death. Enteral formulas which are medically necessary and taken under
83	83	54written order from a physician for the treatment of specific diseases shall be distinguished from
84	84	55nutritional supplements taken electively. 4 of 5
85	85	56 SECTION 4. Section 4K of chapter 176B of the General Laws, as so appearing, is hereby
86	86	57amended by striking out the first sentence and inserting in place thereof the following 4
87	87	58sentences:-
88	88	59 Any subscription certificate under an individual or group medical service agreement that
89	89	60shall be delivered, issued or renewed in the commonwealth shall provide, as benefits to all
90	90	61individual subscribers and members within the commonwealth, all group members having a
91	91	62principal place of employment within the commonwealth and all persons included in section 4C,
92	92	63coverage for the cost of enteral formulas for home use, whether administered orally or via tube
93	93	64feeding, for which a physician has issued a written order. Such written order shall state that the
94	94	65enteral formula is clearly medically necessary and has been proven effective as a disease-specific
95	95	66treatment regimen for those individuals who are or will become malnourished or suffer from
96	96	67disorders, which if left untreated, cause chronic physical or intellectual disability or death.
97	97	68Specific diseases for which enteral formulas have been proven effective shall include, but are not
98	98	69limited to, inherited diseases of amino acid or organic acid metabolism; eosinophilic
99	99	70gastrointestinal disorders; Crohn's Disease; gastroesophageal reflux with failure to thrive;
100	100	71disorders of gastrointestinal motility such as chronic intestinal pseudo-obstruction; and multiple,
101	101	72severe food allergies, which if left untreated will cause malnourishment, chronic physical or
102	102	73intellectual disability or death. Enteral formulas which are medically necessary and taken under
103	103	74written order from a physician for the treatment of specific diseases shall be distinguished from
104	104	75nutritional supplements taken electively.
105	105	76 SECTION 5. Section 4D of chapter 176G of the General Laws, as so appearing, is hereby
106	106	77amended by striking out the first sentence and inserting in place thereof the following 4
107	107	78sentences:- 5 of 5
108	108	79 A group health maintenance contract shall provide coverage for the cost of enteral
109	109	80formulas for home use, whether administered orally or via tube feeding, for which a physician
110	110	81has issued a written order. Such written order shall state that the enteral formula is clearly
111	111	82medically necessary and has been proven effective as a disease-specific treatment regimen for
112	112	83those individuals who are or will become malnourished or suffer from disorders, which if left
113	113	84untreated, cause chronic physical or intellectual disability or death. Specific diseases for which
114	114	85enteral formulas have been proven effective shall include, but are not limited to, inherited
115	115	86diseases of amino acid or organic acid metabolism; eosinophilic gastrointestinal disorders;
116	116	87Crohn's Disease; gastroesophageal reflux with failure to thrive; disorders of gastrointestinal
117	117	88motility such as chronic intestinal pseudo-obstruction; and multiple, severe food allergies, which
118	118	89if left untreated will cause malnourishment, chronic physical or intellectual disability or death.
119	119	90Enteral formulas which are medically necessary and taken under written order from a physician
120	120	91for the treatment of specific diseases shall be distinguished from nutritional supplements taken
121	121	92electively.