Massachusetts 2023-2024 Regular Session

Massachusetts House Bill H988 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. 2157 FILED ON: 1/19/2023
3	3	HOUSE . . . . . . . . . . . . . . . No. 988
4	4	The Commonwealth of Massachusetts
5	5	_________________
6	6	PRESENTED BY:
7	7	Marjorie C. Decker
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 patient financial protection.
13	13	_______________
14	14	PETITION OF:
15	15	NAME:DISTRICT/ADDRESS :DATE ADDED:Marjorie C. Decker25th Middlesex1/11/2023 1 of 3
16	16	HOUSE DOCKET, NO. 2157 FILED ON: 1/19/2023
17	17	HOUSE . . . . . . . . . . . . . . . No. 988
18	18	By Representative Decker of Cambridge, a petition (accompanied by bill, House, No. 988) of
19	19	Marjorie C. Decker relative to regulating separate out-of-pocket insurance limits for prescription
20	20	drugs, including specialty drugs. Financial Services.
21	21	[SIMILAR MATTER FILED IN PREVIOUS SESSION
22	22	SEE HOUSE, NO. 1059 OF 2021-2022.]
23	23	The Commonwealth of Massachusetts
24	24	_______________
25	25	In the One Hundred and Ninety-Third General Court
26	26	(2023-2024)
27	27	_______________
28	28	An Act relative to patient financial protection.
29	29	Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
30	30	of the same, as follows:
31	31	1 SECTION 1. Chapter 175 of the General Laws, as appearing in the 2020 Official Edition,
32	32	2is hereby amended by inserting after section 47PP the following section:-
33	33	3 Section 47QQ. Any policy, contract, agreement, plan or certificate of insurance issued,
34	34	4delivered or renewed within the commonwealth that provides coverage for prescription drugs
35	35	5shall establish a separate out-of-pocket limit for prescription drugs, which shall include specialty
36	36	6drugs. The out-of-pocket limit shall not exceed the dollar amount set as the minimum annual
37	37	7deductible for a high deductible health plan under section 223 of the federal Internal Revenue
38	38	8Code of 1986, 26 U.S.C. §223 (c)(2)(A)(i), for self-only and family coverage, respectively. For
39	39	9the purposes of this section the term “out-of-pocket limit” shall include expenses that: (1) are a 2 of 3
40	40	10cost-sharing expenditure under section 1302 of the federal Patient Protection and Affordable
41	41	11Care Act, 42 U.S.C. §18022 (c)(3); and (2) relate to prescription drug coverage.
42	42	12 SECTION 2. Chapter 176A of the General Laws, as appearing in the 2020 Official
43	43	13Edition, is hereby amended by inserting after section 8QQ the following section:-
44	44	14 Section 8RR. Any contract between a subscriber and the corporation under an individual
45	45	15or group hospital service plan which is delivered, issued or renewed within the commonwealth
46	46	16that provides coverage for prescription drugs shall establish a separate out-of-pocket limit for
47	47	17prescription drugs, which shall include specialty drugs. The out out-of-pocket limit shall not
48	48	18exceed the dollar amount set as the minimum annual deductible for a high deductible health plan
49	49	19under section 223 of the federal Internal Revenue Code of 1986, 26 U.S.C. §223 (c)(2)(A)(i), for
50	50	20self-only and family coverage, respectively. For the purposes of this section the term “out-of-
51	51	21pocket limit” shall include expenses that: (1) are a cost-sharing expenditure under section 1302
52	52	22of the federal Patient Protection and Affordable Care Act, 42 U.S.C. §18022 (c)(3); and (2) relate
53	53	23to prescription drug coverage.
54	54	24 SECTION 3. Chapter 176B of the General Laws, as appearing in the 2020 Official
55	55	25Edition, is hereby amended by inserting after section 4QQ the following section:-
56	56	26 Section 4RR. Any subscription certificate under an individual or group medical service
57	57	27agreement delivered, issued or renewed within the commonwealth that provides coverage for
58	58	28prescription drugs shall establish a separate out-of-pocket limit for prescription drugs, which
59	59	29shall include specialty drugs. The out-of-pocket limit shall not exceed the dollar amount set as
60	60	30the minimum annual deductible for a high deductible health plan under section 223 of the federal
61	61	31Internal Revenue Code of 1986, 26 U.S.C. §223 (c)(2)(A)(i), for self-only and family coverage, 3 of 3
62	62	32respectively. For the purposes of this section the term “out-of-pocket limit” shall include
63	63	33expenses that: (1) are a cost-sharing expenditure under section 1302 of the federal Patient
64	64	34Protection and Affordable Care Act, 42 U.S.C. §18022 (c)(3); and (2) relate to prescription drug
65	65	35coverage.
66	66	36 SECTION 4. Chapter 176G of the General Laws, as appearing in the 2020 Official
67	67	37Edition, is hereby amended by inserting after section 4GG the following section:-
68	68	38 Section 4HH. Any individual or group health maintenance organization that provides
69	69	39coverage for prescription drugs shall establish a separate out-of-pocket limit for prescription
70	70	40drugs, which shall include specialty drugs. The out-of-pocket limit shall not exceed the dollar
71	71	41amount set as the minimum annual deductible for a high deductible health plan under section
72	72	42223of the federal Internal Revenue Code of 1986, 26 U.S.C. §223 (c)(2)(A)(i), for self-only and
73	73	43family coverage, respectively. For the purposes of this section the term “out-of-pocket limit”
74	74	44shall include expenses that: (1) are a cost-sharing expenditure under section 1302 of the federal
75	75	45Patient Protection and Affordable Care Act, 42 U.S.C. §18022 (c)(3); and (2) relate to
76	76	46prescription drug coverage.
77	77	47 SECTION 5. This act shall apply to all policies, contracts and certificates of health
78	78	48insurance subject to section 47QQ of chapter 175, section 8RR of chapter 176A, section 4RR of
79	79	49chapter 176B and section 4HH of chapter 176G of the General Laws delivered, issued or
80	80	50renewed on or after January 1, 2023.