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