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Massachusetts House Bill H4918

Massachusetts 2023-2024 Regular Session

Massachusetts House Bill H4918 Compare Versions

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11 HOUSE . . . . . . . No. 4918
22 The Commonwealth of Massachusetts
33 ______________________________________
44 HOUSE OF REPRESENTATIVES, July 25, 2024.
55 The committee on Ways and Means, to whom was referred the Bill
66 relative to breast cancer equity and early detection (House, No. 4410),
77 reports recommending that the same ought to pass with an amendment
88 substituting therefor the accompanying bill (House, No. 4918).
99 For the committee,
1010 AARON MICHLEWITZ. 1 of 11
1111 FILED ON: 7/25/2024
1212 HOUSE . . . . . . . . . . . . . . . No. 4918
1313 The Commonwealth of Massachusetts
1414 _______________
1515 In the One Hundred and Ninety-Third General Court
1616 (2023-2024)
1717 _______________
1818 An Act relative to medically necessary breast screenings and exams for equity and early
1919 detection.
2020 Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
2121 of the same, as follows:
2222 1 SECTION 1. Chapter 32A of the General Laws is hereby amended by adding the
2323 2following section:-
2424 3 Section 34. (a) As used in this section, the following words shall, unless the context
2525 4clearly requires otherwise, have the following meanings:
2626 5 “Cost sharing”, a deductible, coinsurance, copayment and any maximum limitation on the
2727 6application of such a deductible, coinsurance, copayment or similar out-of-pocket expense.
2828 7 “Diagnostic examinations for breast cancer”, a medically necessary and appropriate
2929 8examination for breast cancer to evaluate an abnormality in the breast that is seen or suspected
3030 9from a screening examination for breast cancer, detected by another means of examination or
3131 10suspected based on the medical history or family medical history of the individual. 2 of 11
3232 11 “Examination for breast cancer”, an examination used to evaluate an abnormality in a
3333 12breast using diagnostic mammography, digital breast tomosynthesis, breast magnetic resonance
3434 13imaging or breast ultrasound.
3535 14 “HSA-qualified health insurance policy”, a policy of individual or group health insurance
3636 15coverage that satisfies the criteria for a high-deductible health plan under 26 U.S.C. 223, as
3737 16implemented and interpreted by the United States Department of the Treasury in the regulations
3838 17and guidance in effect at the time the policy is issued.
3939 18 (b) Any coverage offered by the commission to an active or retired employee of the
4040 19commonwealth insured through the commission that provides medical expense coverage for
4141 20screening mammograms shall provide coverage for diagnostic examinations for breast cancer,
4242 21digital breast tomosynthesis screening and medically necessary and appropriate screening with
4343 22breast magnetic resonance imaging or screening breast ultrasound on a basis not less favorable
4444 23than screening mammograms that are covered as medical benefits. There shall be no increase in
4545 24patient cost sharing for: (i) screening mammograms; (ii) digital breast tomosynthesis; (iii)
4646 25screening breast magnetic resonance imaging; (iv) screening breast ultrasound; or (v) diagnostic
4747 26examinations for breast cancer.
4848 27 (c)(1) Except as provided in paragraph (2), an HSA-qualified health insurance policy
4949 28shall be exempt from any prohibition on cost-sharing requirements for a covered benefit required
5050 29under any general or special law to the extent that the exemption is necessary to allow the policy
5151 30to be an HSA-qualified health insurance policy.
5252 31 (2) The exemption provided in paragraph (1) shall not apply to any coverage required
5353 32under any general or special law pertaining to preventive care, as described in 26 U.S.C. 223, 3 of 11
5454 33with respect to any HSA-qualified health insurance policy issued, delivered, amended or
5555 34renewed while such regulation or guidance is effective.
5656 35 SECTION 2. Chapter 118E of the General Laws is hereby amended by inserting after
5757 36section 10Q the following section:-
5858 37 Section 10R. (a) As used in this section, the following words shall, unless the context
5959 38clearly requires otherwise, have the following meanings:
6060 39 “Cost sharing”, a deductible, coinsurance, copayment and any maximum limitation on the
6161 40application of such a deductible, coinsurance, copayment or similar out-of-pocket expense.
6262 41 “Diagnostic examinations for breast cancer”, a medically necessary and appropriate
6363 42examination for breast cancer to evaluate an abnormality in the breast that is seen or suspected
6464 43from a screening examination for breast cancer, detected by another means of examination or
6565 44suspected based on the medical history or family medical history of the individual.
6666 45 “Examination for breast cancer”, an examination used to evaluate an abnormality in a
6767 46breast using diagnostic mammography, digital breast tomosynthesis, breast magnetic resonance
6868 47imaging or breast ultrasound.
6969 48 “HSA-qualified health insurance policy”, a policy of individual or group health insurance
7070 49coverage that satisfies the criteria for a high-deductible health plan under 26 U.S.C. 223, as
7171 50implemented and interpreted by the United States Department of the Treasury in the regulations
7272 51and guidance in effect at the time the policy is issued.
7373 52 (b) The division and its contracted health insurers, health plans, health maintenance
7474 53organizations and third-party administrators under contract to a Medicaid managed care 4 of 11
7575 54organization, primary care clinician plan or an accountable care organization shall provide
7676 55coverage for diagnostic examinations for breast cancer, digital breast tomosynthesis screening
7777 56and medically necessary and appropriate screening with breast magnetic resonance imaging or
7878 57screening breast ultrasound on a basis not less favorable than screening mammograms that are
7979 58covered as medical benefits. There shall be no increase in patient cost sharing for: (i) screening
8080 59mammograms; (ii) digital breast tomosynthesis; (iii) screening breast magnetic resonance
8181 60imaging; (iv) screening breast ultrasound; or (v) diagnostic examinations for breast cancer.
8282 61 (c)(1) Except as provided in paragraph (2), an HSA-qualified health insurance policy
8383 62shall be exempt from any prohibition on cost-sharing requirements for a covered benefit required
8484 63under any general or special law to the extent that the exemption is necessary to allow the policy
8585 64to be an HSA-qualified health insurance policy.
8686 65 (2) The exemption provided in paragraph (1) shall not apply to any coverage required
8787 66under any general or special law pertaining to preventive care, as described in 26 U.S.C. 223,
8888 67with respect to any HSA-qualified health insurance policy issued, delivered, amended or
8989 68renewed while such regulation or guidance is effective.
9090 69 SECTION 3. Chapter 175 of the General Laws is hereby amended by inserting after
9191 70section 47UU the following section:-
9292 71 Section 47VV. (a) As used in this section, the following words shall, unless the context
9393 72clearly requires otherwise, have the following meanings:
9494 73 “Cost sharing”, a deductible, coinsurance, copayment and any maximum limitation on the
9595 74application of such a deductible, coinsurance, copayment or similar out-of-pocket expense. 5 of 11
9696 75 “Diagnostic examinations for breast cancer”, a medically necessary and appropriate
9797 76examination for breast cancer to evaluate an abnormality in the breast that is seen or suspected
9898 77from a screening examination for breast cancer, detected by another means of examination or
9999 78suspected based on the medical history or family medical history of the individual.
100100 79 “Examination for breast cancer”, an examination used to evaluate an abnormality in a
101101 80breast using diagnostic mammography, digital breast tomosynthesis, breast magnetic resonance
102102 81imaging or breast ultrasound.
103103 82 “HSA-qualified health insurance policy”, a policy of individual or group health insurance
104104 83coverage that satisfies the criteria for a high-deductible health plan under 26 U.S.C. 223, as
105105 84implemented and interpreted by the United States Department of the Treasury in the regulations
106106 85and guidance in effect at the time the policy is issued.
107107 86 (b) Any policy, contract, agreement, plan or certificate of insurance issued, delivered or
108108 87renewed within the commonwealth, that provides medical expense coverage for screening
109109 88mammograms shall provide coverage for diagnostic examinations for breast cancer, digital breast
110110 89tomosynthesis screening and medically necessary and appropriate screening with breast magnetic
111111 90resonance imaging or screening breast ultrasound on a basis not less favorable than screening
112112 91mammograms that are covered as medical benefits. There shall be no increase in patient cost
113113 92sharing for: (i) screening mammograms; (ii) digital breast tomosynthesis; (iii) screening breast
114114 93magnetic resonance imaging; (iv) screening breast ultrasound; or (v) diagnostic examinations for
115115 94breast cancer.
116116 95 (c)(1) Except as provided in paragraph (2), an HSA-qualified health insurance policy
117117 96shall be exempt from any prohibition on cost-sharing requirements for a covered benefit required 6 of 11
118118 97under any general or special law to the extent that the exemption is necessary to allow the policy
119119 98to be an HSA-qualified health insurance policy.
120120 99 (2) The exemption provided in paragraph (1) shall not apply to any coverage required
121121 100under any general or special law pertaining to preventive care, as described in 26 U.S.C. 223,
122122 101with respect to any HSA-qualified health insurance policy issued, delivered, amended or
123123 102renewed while such regulation or guidance is effective.
124124 103 SECTION 4. Chapter 176A of the General Laws is hereby amended by inserting after
125125 104section 8VV the following section:-
126126 105 Section 8WW. (a) As used in this section, the following words shall, unless the context
127127 106clearly requires otherwise, have the following meanings:
128128 107 “Cost sharing”, a deductible, coinsurance, copayment and any maximum limitation on the
129129 108application of such a deductible, coinsurance, copayment or similar out-of-pocket expense.
130130 109 “Diagnostic examinations for breast cancer”, a medically necessary and appropriate
131131 110examination for breast cancer to evaluate an abnormality in the breast that is seen or suspected
132132 111from a screening examination for breast cancer, detected by another means of examination or
133133 112suspected based on the medical history or family medical history of the individual.
134134 113 “Examination for breast cancer”, an examination used to evaluate an abnormality in a
135135 114breast using diagnostic mammography, digital breast tomosynthesis, breast magnetic resonance
136136 115imaging or breast ultrasound.
137137 116 “HSA-qualified health insurance policy”, a policy of individual or group health insurance
138138 117coverage that satisfies the criteria for a high-deductible health plan under 26 U.S.C. 223, as 7 of 11
139139 118implemented and interpreted by the United States Department of the Treasury in the regulations
140140 119and guidance in effect at the time the policy is issued.
141141 120 (b) Any contract between a subscriber and a corporation under an individual or group
142142 121hospital service plan which is delivered, issued or renewed within the commonwealth that
143143 122provides coverage for screening mammograms shall provide coverage for diagnostic
144144 123examinations for breast cancer, digital breast tomosynthesis screening and medically necessary
145145 124and appropriate screening with breast magnetic resonance imaging or screening breast ultrasound
146146 125on a basis not less favorable than screening mammograms that are covered as medical benefits.
147147 126There shall be no increase in patient cost sharing for: (i) screening mammograms; (ii) digital
148148 127breast tomosynthesis; (iii) screening breast magnetic resonance imaging; (iv) screening breast
149149 128ultrasound; or (v) diagnostic examinations for breast cancer.
150150 129 (c)(1) Except as provided in paragraph (2), an HSA-qualified health insurance policy
151151 130shall be exempt from any prohibition on cost-sharing requirements for a covered benefit required
152152 131under any general or special law to the extent that the exemption is necessary to allow the policy
153153 132to be an HSA-qualified health insurance policy.
154154 133 (2) The exemption provided in paragraph (1) shall not apply to any coverage required
155155 134under any general or special law pertaining to preventive care, as described in 26 U.S.C. 223,
156156 135with respect to any HSA-qualified health insurance policy issued, delivered, amended or
157157 136renewed while such regulation or guidance is effective.
158158 137 SECTION 5. Chapter 176B of the General Laws is hereby amended by inserting after
159159 138section 4VV the following section:- 8 of 11
160160 139 Section 4WW. (a) As used in this section, the following words shall, unless the context
161161 140clearly requires otherwise, have the following meanings:
162162 141 “Cost sharing”, a deductible, coinsurance, copayment and any maximum limitation on the
163163 142application of such a deductible, coinsurance, copayment or similar out-of-pocket expense.
164164 143 “Diagnostic examinations for breast cancer”, a medically necessary and appropriate
165165 144examination for breast cancer to evaluate an abnormality in the breast that is seen or suspected
166166 145from a screening examination for breast cancer, detected by another means of examination or
167167 146suspected based on the medical history or family medical history of the individual.
168168 147 “Examination for breast cancer”, an examination used to evaluate an abnormality in a
169169 148breast using diagnostic mammography, digital breast tomosynthesis, breast magnetic resonance
170170 149imaging or breast ultrasound.
171171 150 “HSA-qualified health insurance policy”, a policy of individual or group health insurance
172172 151coverage that satisfies the criteria for a high-deductible health plan under 26 U.S.C. 223, as
173173 152implemented and interpreted by the United States Department of the Treasury in the regulations
174174 153and guidance in effect at the time the policy is issued.
175175 154 (b) Any subscription certificate under an individual or group medical service agreement
176176 155delivered, issued or renewed within the commonwealth that provides coverage for screening
177177 156mammograms shall provide coverage for diagnostic examinations for breast cancer, digital breast
178178 157tomosynthesis screening and medically necessary and appropriate screening with breast magnetic
179179 158resonance imaging or screening breast ultrasound on a basis not less favorable than screening
180180 159mammograms that are covered as medical benefits. There shall be no increase in patient cost
181181 160sharing for: (i) screening mammograms; (ii) digital breast tomosynthesis; (iii) screening breast 9 of 11
182182 161magnetic resonance imaging; (iv) screening breast ultrasound; or (v) diagnostic examinations for
183183 162breast cancer.
184184 163 (c)(1) Except as provided in paragraph (2), an HSA-qualified health insurance policy
185185 164shall be exempt from any prohibition on cost-sharing requirements for a covered benefit required
186186 165under any general or special law to the extent that the exemption is necessary to allow the policy
187187 166to be an HSA-qualified health insurance policy.
188188 167 (2) The exemption provided in paragraph (1) shall not apply to any coverage required
189189 168under any general or special law pertaining to preventive care, as described in 26 U.S.C. 223,
190190 169with respect to any HSA-qualified health insurance policy issued, delivered, amended or
191191 170renewed while such regulation or guidance is effective.
192192 171 SECTION 6. Chapter 176G of the General Laws is hereby amended by inserting after
193193 172section 4NN the following section:-
194194 173 Section 4OO. (a) As used in this section, the following words shall, unless the context
195195 174clearly requires otherwise, have the following meanings:
196196 175 “Cost sharing”, a deductible, coinsurance, copayment and any maximum limitation on the
197197 176application of such a deductible, coinsurance, copayment or similar out-of-pocket expense.
198198 177 “Diagnostic examinations for breast cancer”, a medically necessary and appropriate
199199 178examination for breast cancer to evaluate an abnormality in the breast that is seen or suspected
200200 179from a screening examination for breast cancer, detected by another means of examination or
201201 180suspected based on the medical history or family medical history of the individual. 10 of 11
202202 181 “Examination for breast cancer”, an examination used to evaluate an abnormality in a
203203 182breast using diagnostic mammography, digital breast tomosynthesis, breast magnetic resonance
204204 183imaging or breast ultrasound.
205205 184 “HSA-qualified health insurance policy”, a policy of individual or group health insurance
206206 185coverage that satisfies the criteria for a high-deductible health plan under 26 U.S.C. 223, as
207207 186implemented and interpreted by the United States Department of the Treasury in the regulations
208208 187and guidance in effect at the time the policy is issued.
209209 188 (b) Any individual or group health maintenance contract that provides coverage for
210210 189screening mammograms shall provide coverage for diagnostic examinations for breast cancer,
211211 190digital breast tomosynthesis screening and medically necessary and appropriate screening with
212212 191breast magnetic resonance imaging or screening breast ultrasound on a basis not less favorable
213213 192than screening mammograms that are covered as medical benefits. There shall be no increase in
214214 193patient cost sharing for: (i) screening mammograms; (ii) digital breast tomosynthesis; (iii)
215215 194screening breast magnetic resonance imaging; (iv) screening breast ultrasound; or (v) diagnostic
216216 195examinations for breast cancer.
217217 196 (c)(1) Except as provided in paragraph (2), an HSA-qualified health insurance policy
218218 197shall be exempt from any prohibition on cost-sharing requirements for a covered benefit required
219219 198under any general or special law to the extent that the exemption is necessary to allow the policy
220220 199to be an HSA-qualified health insurance policy.
221221 200 (2) The exemption provided in paragraph (1) shall not apply to any coverage required
222222 201under any general or special law pertaining to preventive care, as described in 26 U.S.C. 223, 11 of 11
223223 202with respect to any HSA-qualified health insurance policy issued, delivered, amended or
224224 203renewed while such regulation or guidance is effective.
225225 204 SECTION 7. This act shall be effective for all contracts entered into, renewed or
226226 205amended on or after January 1, 2025.