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SENATE DOCKET, NO. 369 FILED ON: 1/13/2023
SENATE . . . . . . . . . . . . . . No. 615
The Commonwealth of Massachusetts
_________________
PRESENTED BY:
Julian Cyr
_________________
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 :Julian CyrCape and IslandsJoanne M. ComerfordHampshire, Franklin and Worcester2/22/2023Adam GomezHampden2/22/2023Brian W. Murray10th Worcester2/22/2023 1 of 6
SENATE DOCKET, NO. 369 FILED ON: 1/13/2023
SENATE . . . . . . . . . . . . . . No. 615
By Mr. Cyr, a petition (accompanied by bill, Senate, No. 615) of Julian Cyr, Joanne M.
Comerford, Adam Gomez and Brian W. Murray for legislation relative to ensuring treatment for
genetic craniofacial conditions. Financial Services.
[SIMILAR MATTER FILED IN PREVIOUS SESSION
SEE SENATE, NO. 648 OF 2021-2022.]
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
2section 17Q the following section:-
3 Section 17R. Any coverage offered by the commission to an active or retired employee of
4the 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 2 of 6
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,
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 10L the following section:-
17 Section 10M. 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 47KK the following section:-
29 Section 47LL. 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 3 of 6
33anomaly. Coverage under this section shall include the necessary care and treatment of medically
34diagnosed congenital disease or anomaly, including ectodermal dysplasia, dentinogenesis
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 8MM, the following section:-
49 Section 8OO. Any contract between a subscriber and the corporation under an individual
50or group hospital service plan which is delivered, issued or renewed within the commonwealth
51shall provide 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 4 of 6
56disease or anomaly, including, ectodermal dysplasia, dentinogenesis imperfecta, and
57amelogenesis imperfecta. Coverage shall not include cosmetic surgery or dental or orthodontic
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 4MM the following section:-
63 Section 4OO. 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 is hereby amended by inserting after
75section 4EE the following section:-
76 Section 4FF. Any individual or group health maintenance contract shall provide coverage
77for medically necessary functional repair or restoration of craniofacial disorders; with the 5 of 6
78exception of coverage for cleft lip and cleft palate which is prescribed elsewhere in the General
79Laws, to improve the function of, or to approximate the normal appearance of any abnormal
80structures caused by congenital disease or anomaly. Coverage under this section shall include the
81necessary care and treatment of medically diagnosed congenital disease or anomaly, including,
82ectodermal dysplasia, dentinogenesis imperfecta, and amelogenesis imperfecta. Coverage shall
83not include cosmetic surgery or dental or orthodontic treatment unrelated to congenital disease or
84anomaly. The benefits in this section shall not be subject to any greater deductible, coinsurance,
85copayments or out-of-pocket limits than any other benefit provided by the insurer.
86 SECTION 7. Chapter 176I of the General Laws, as so appearing, is hereby amended by
87inserting after section 12 the following section:-
88 Section 13. An organization entering into a preferred provider contract shall provide
89coverage for medically necessary functional repair or restoration of craniofacial disorders; with
90the exception of coverage for cleft lip and cleft palate which is prescribed elsewhere in the
91General Laws, to improve the function of, or to approximate the normal appearance of any
92abnormal structures caused by congenital disease or anomaly. Coverage under this section shall
93include the necessary care and treatment of medically diagnosed congenital disease or anomaly,
94including, ectodermal dysplasia, dentinogenesis imperfecta, and amelogenesis imperfecta.
95Coverage shall not include cosmetic surgery or dental or orthodontic treatment unrelated to
96congenital defects, developmental deformities, trauma, tumors, infections or disease. The
97benefits in this section shall not be subject to any greater deductible, coinsurance, copayments or
98out-of-pocket limits than any other benefit provided by the insurer. 6 of 6
99 SECTION 8. This act shall apply to all policies, contracts and certificates of health
100insurance subject to chapters 32A, 118E, 175, 176A, 176B, 176G and 176I, of the General Laws,
101as so appearing, issued or renewed, except any entity to the extent it offers a policy, certificate or
102contract that provides coverage for dental care services or vision care services.