Massachusetts 2023-2024 Regular Session

Massachusetts House Bill H964 Compare Versions

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

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1	1	1 of 1
2	2	HOUSE DOCKET, NO. 2576 FILED ON: 1/19/2023
3	3	HOUSE . . . . . . . . . . . . . . . No. 964
4	4	The Commonwealth of Massachusetts
5	5	_________________
6	6	PRESENTED BY:
7	7	Daniel R. Carey
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 relative to ensuring treatment for genetic craniofacial conditions.
13	13	_______________
14	14	PETITION OF:
15	15	NAME:DISTRICT/ADDRESS :DATE ADDED:Daniel R. Carey2nd Hampshire1/19/2023Thomas M. Stanley9th Middlesex1/25/2023Patricia A. Duffy5th Hampden2/17/2023Brian W. Murray10th Worcester2/22/2023David Paul Linsky5th Middlesex2/23/2023Hannah Kane11th Worcester2/24/2023James C. Arena-DeRosa8th Middlesex2/27/2023 1 of 6
16	16	HOUSE DOCKET, NO. 2576 FILED ON: 1/19/2023
17	17	HOUSE . . . . . . . . . . . . . . . No. 964
18	18	By Representative Carey of Easthampton, a petition (accompanied by bill, House, No. 964) of
19	19	Daniel R. Carey and others relative to healthcare coverage for treatment for genetic craniofacial
20	20	conditions. Financial Services.
21	21	The Commonwealth of Massachusetts
22	22	_______________
23	23	In the One Hundred and Ninety-Third General Court
24	24	(2023-2024)
25	25	_______________
26	26	An Act relative to ensuring treatment for genetic craniofacial conditions.
27	27	Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
28	28	of the same, as follows:
29	29	1 Section 1. Chapter 32A of the General Laws is hereby amended by inserting after section
30	30	217N as appearing in the 2014 Official Edition, the following section:-
31	31	3 Section 17O. Any coverage offered by the commission to an active or retired employee
32	32	4of the commonwealth insured under the group insurance commission shall provide coverage for
33	33	5medically necessary functional repair or restoration of craniofacial disorders, with the exception
34	34	6of coverage for cleft lip and cleft palate which is prescribed elsewhere in the General Laws, to
35	35	7improve the function of, or to approximate the normal appearance or any abnormal structures
36	36	8caused by congenital disease of anomaly. Coverage under this section shall include the necessary
37	37	9care and treatment of medically diagnosed congenital disease or anomaly. Including, but not
38	38	10limited to, ectodermal dysplasia, dentinogenesis imperfecta, amelogenesis imperfecta. Coverage
39	39	11shall not include cosmetic surgery or for dental or orthodontic treatment unrelated to congenital
40	40	12disease or anomaly. The benefits in this section shall not be subject to any greater deductible, 2 of 6
41	41	13coinsurance, copayments or out-of-pocket limits than any other benefit provided by the
42	42	14commission.
43	43	15 SECTION 2. Chapter 118E of the General Laws is hereby amended by inserting after
44	44	16section 10I, inserted by section 105 of chapter 46 of the acts of 2015, the following section:-
45	45	17 Section 10J. The division shall provide coverage for medically necessary functional
46	46	18repair or restoration of craniofacial disorders; with the exception of coverage for cleft lip and
47	47	19cleft palate which is prescribed elsewhere in the General Laws, to improve the function of, or to
48	48	20approximate the normal appearance of any abnormal structures caused by congenital disease or
49	49	21anomaly. Coverage under this section shall include the necessary care and treatment of medically
50	50	22diagnosed congenital disease or anomaly, including ectodermal dysplasia, dentinogenesis
51	51	23imperfecta, and amelogenesis imperfecta. Coverage shall not include cosmetic surgery or for
52	52	24dental or orthodontic treatment unrelated to congenital disease or anomaly. The benefits in this
53	53	25section shall not be subject to any greater deductible, coinsurance, copayments or out-of-pocket
54	54	26limits than any other benefit provided by the division.
55	55	27 SECTION 3. Chapter 175 of the General Laws is hereby amended by inserting after
56	56	28section 47GG, as appearing in the 2014 Official Edition, the following section:-
57	57	29 Section 47HH. The following shall provide coverage for medically necessary functional
58	58	30repair or restoration of craniofacial disorders; with the exception of coverage for cleft lip and
59	59	31cleft palate which is prescribed elsewhere in the General Laws, to improve the function of, or to
60	60	32approximate the normal appearance of any abnormal structures caused by congenital disease or
61	61	33anomaly. Coverage under this section shall include the necessary care and treatment of medically
62	62	34diagnosed congenital disease or anomaly, including ectodermal dysplasia, dentinogenesis 3 of 6
63	63	35imperfecta, and amelogenesis imperfecta. Coverage shall not include cosmetic surgery or dental
64	64	36or orthodontic treatment unrelated to congenital disease or anomaly.: (i) any policy of accident
65	65	37and sickness insurance, as described in section 108, which provides hospital expense and
66	66	38surgical expense insurance and which is delivered, issued or subsequently renewed by agreement
67	67	39between the insurer and policyholder in the commonwealth; (ii) any blanket or general policy of
68	68	40insurance described in subdivision (A), (C) or (D) of section 110 which provides hospital
69	69	41expense and surgical expense insurance and which is delivered, issued or subsequently renewed
70	70	42by agreement between the insurer and the policyholder in or outside of the commonwealth; or
71	71	43(iii) any employees’ health and welfare fund which provides hospital expense and surgical
72	72	44expense benefits and which is delivered, issued or renewed to any person or group of persons in
73	73	45the commonwealth. The benefits in this section shall not be subject to any greater deductible,
74	74	46coinsurance, copayments or out-of-pocket limits than any other benefit provided by the insurer.
75	75	47 SECTION 4. Chapter 176A of the General Laws is hereby amended by inserting after
76	76	48section 8II, as so appearing, the following section:-
77	77	49 Section 8JJ. Any contract between a subscriber and the corporation under an individual or
78	78	50group hospital service plan which is delivered, issued or renewed within the commonwealth shall
79	79	51provide coverage for medically necessary functional repair or restoration of craniofacial
80	80	52disorders; with the exception of coverage for cleft lip and cleft palate which is prescribed
81	81	53elsewhere in the General Laws, to improve the function of, or to approximate the normal
82	82	54appearance of any abnormal structures caused by congenital disease or anomaly. Coverage under
83	83	55this section shall include the necessary care and treatment of medically diagnosed congenital
84	84	56disease or anomaly, including, ectodermal dysplasia, dentinogenesis imperfecta, and
85	85	57amelogenesis imperfecta. Coverage shall not include cosmetic surgery or dental or orthodontic 4 of 6
86	86	58treatment unrelated to congenital disease or anomaly. The benefits in this section shall not be
87	87	59subject to any greater deductible, coinsurance, copayments or out-of-pocket limits than any other
88	88	60benefit provided by the insurer.
89	89	61 SECTION 5. Chapter 176B of the General Laws is hereby amended by inserting after
90	90	62section 4II, as so appearing, the following section:-
91	91	63 Section 4JJ. Any subscription certificate under an individual or group medical service
92	92	64agreement delivered, issued or renewed within the commonwealth shall provide coverage for
93	93	65medically necessary functional repair or restoration of craniofacial disorders; with the exception
94	94	66of coverage for cleft lip and cleft palate which is prescribed elsewhere in the General Laws, to
95	95	67improve the function of, or to approximate the normal appearance of any abnormal structures
96	96	68caused by disease or anomaly. Coverage under this section shall include the necessary care and
97	97	69treatment of medically diagnosed congenital disease or anomaly, including, ectodermal
98	98	70dysplasia, dentinogenesis imperfecta, and amelogenesis imperfecta. Coverage shall not include
99	99	71cosmetic surgery or dental or orthodontic treatment unrelated to congenital disease or anomaly.
100	100	72The benefits in this section shall not be subject to any greater deductible, coinsurance,
101	101	73copayments or out-of-pocket limits than any other benefit provided by the insurer.
102	102	74 SECTION 6. Chapter 176G of the General Laws, as so appearing, is hereby amended by
103	103	75inserting after section 4AA, as so appearing, the following section:-
104	104	76 Section 4BB. Any individual or group health maintenance contract shall provide
105	105	77coverage for medically necessary functional repair or restoration of craniofacial disorders; with
106	106	78the exception of coverage for cleft lip and cleft palate which is prescribed elsewhere in the
107	107	79General Laws, to improve the function of, or to approximate the normal appearance of any 5 of 6
108	108	80abnormal structures caused by congenital disease or anomaly. Coverage under this section shall
109	109	81include the necessary care and treatment of medically diagnosed congenital disease or anomaly,
110	110	82including, ectodermal dysplasia, dentinogenesis imperfecta, and amelogenesis imperfecta.
111	111	83Coverage shall not include cosmetic surgery or dental or orthodontic treatment unrelated to
112	112	84congenital disease or anomaly. The benefits in this section shall not be subject to any greater
113	113	85deductible, coinsurance, copayments or out-of-pocket limits than any other benefit provided by
114	114	86the insurer.
115	115	87 SECTION 7. Chapter 176I of the General Laws, as so appearing, is hereby amended by
116	116	88inserting after section,12, as so appearing, the following section:-
117	117	89 Section 13. An organization entering into a preferred provider contract shall provide
118	118	90coverage for medically necessary functional repair or restoration of craniofacial disorders; with
119	119	91the exception of coverage for cleft lip and cleft palate which is prescribed elsewhere in the
120	120	92General Laws, to improve the function of, or to approximate the normal appearance of any
121	121	93abnormal structures caused by congenital disease or anomaly. Coverage under this section shall
122	122	94include the necessary care and treatment of medically diagnosed congenital disease or anomaly,
123	123	95including, ectodermal dysplasia, dentinogenesis imperfecta, and amelogenesis imperfecta.
124	124	96Coverage shall not include cosmetic surgery or dental or orthodontic treatment unrelated to
125	125	97congenital defects, developmental deformities, trauma, tumors, infections or disease. The
126	126	98benefits in this section shall not be subject to any greater deductible, coinsurance, copayments or
127	127	99out-of-pocket limits than any other benefit provided by the insurer.
128	128	100 SECTION 8. This act shall apply to all policies, contracts and certificates of health
129	129	101insurance subject to chapters 32A, 118E, 175, 176A, 176B, 176G and 176I, of the General Laws, 6 of 6
130	130	102as so appearing, issued or renewed, except any entity to the extent it offers a policy, certificate or
131	131	103contract that provides coverage for dental care services or vision care services.