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