Massachusetts 2023-2024 Regular Session

Massachusetts Senate Bill S615 Compare Versions

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

Old	New	Differences
1	1	1 of 1
2	2	SENATE DOCKET, NO. 369 FILED ON: 1/13/2023
3	3	SENATE . . . . . . . . . . . . . . No. 615
4	4	The Commonwealth of Massachusetts
5	5	_________________
6	6	PRESENTED BY:
7	7	Julian Cyr
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 :Julian CyrCape and IslandsJoanne M. ComerfordHampshire, Franklin and Worcester2/22/2023Adam GomezHampden2/22/2023Brian W. Murray10th Worcester2/22/2023 1 of 6
16	16	SENATE DOCKET, NO. 369 FILED ON: 1/13/2023
17	17	SENATE . . . . . . . . . . . . . . No. 615
18	18	By Mr. Cyr, a petition (accompanied by bill, Senate, No. 615) of Julian Cyr, Joanne M.
19	19	Comerford, Adam Gomez and Brian W. Murray for legislation relative to ensuring treatment for
20	20	genetic craniofacial conditions. Financial Services.
21	21	[SIMILAR MATTER FILED IN PREVIOUS SESSION
22	22	SEE SENATE, NO. 648 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 ensuring treatment for genetic craniofacial conditions.
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 32A of the General Laws is hereby amended by inserting after
32	32	2section 17Q the following section:-
33	33	3 Section 17R. Any coverage offered by the commission to an active or retired employee of
34	34	4the commonwealth insured under the group insurance commission shall provide coverage for
35	35	5medically necessary functional repair or restoration of craniofacial disorders, with the exception
36	36	6of coverage for cleft lip and cleft palate which is prescribed elsewhere in the General Laws, to
37	37	7improve the function of, or to approximate the normal appearance or any abnormal structures
38	38	8caused by congenital disease of anomaly. Coverage under this section shall include the necessary
39	39	9care and treatment of medically diagnosed congenital disease or anomaly. Including, but not
40	40	10limited to, ectodermal dysplasia, dentinogenesis imperfecta, amelogenesis imperfecta. Coverage 2 of 6
41	41	11shall not include cosmetic surgery or for dental or orthodontic treatment unrelated to congenital
42	42	12disease or anomaly. The benefits in this section shall not be subject to any greater deductible,
43	43	13coinsurance, copayments or out-of-pocket limits than any other benefit provided by the
44	44	14commission.
45	45	15 SECTION 2. Chapter 118E of the General Laws is hereby amended by inserting after
46	46	16section 10L the following section:-
47	47	17 Section 10M. The division shall provide coverage for medically necessary functional
48	48	18repair or restoration of craniofacial disorders; with the exception of coverage for cleft lip and
49	49	19cleft palate which is prescribed elsewhere in the General Laws, to improve the function of, or to
50	50	20approximate the normal appearance of any abnormal structures caused by congenital disease or
51	51	21anomaly. Coverage under this section shall include the necessary care and treatment of medically
52	52	22diagnosed congenital disease or anomaly, including ectodermal dysplasia, dentinogenesis
53	53	23imperfecta, and amelogenesis imperfecta. Coverage shall not include cosmetic surgery or for
54	54	24dental or orthodontic treatment unrelated to congenital disease or anomaly. The benefits in this
55	55	25section shall not be subject to any greater deductible, coinsurance, copayments or out-of-pocket
56	56	26limits than any other benefit provided by the division.
57	57	27 SECTION 3. Chapter 175 of the General Laws is hereby amended by inserting after
58	58	28section 47KK the following section:-
59	59	29 Section 47LL. The following shall provide coverage for medically necessary functional
60	60	30repair or restoration of craniofacial disorders; with the exception of coverage for cleft lip and
61	61	31cleft palate which is prescribed elsewhere in the General Laws, to improve the function of, or to
62	62	32approximate the normal appearance of any abnormal structures caused by congenital disease or 3 of 6
63	63	33anomaly. Coverage under this section shall include the necessary care and treatment of medically
64	64	34diagnosed congenital disease or anomaly, including ectodermal dysplasia, dentinogenesis
65	65	35imperfecta, and amelogenesis imperfecta. Coverage shall not include cosmetic surgery or dental
66	66	36or orthodontic treatment unrelated to congenital disease or anomaly.: (i) any policy of accident
67	67	37and sickness insurance, as described in section 108, which provides hospital expense and
68	68	38surgical expense insurance and which is delivered, issued or subsequently renewed by agreement
69	69	39between the insurer and policyholder in the commonwealth; (ii) any blanket or general policy of
70	70	40insurance described in subdivision (A), (C) or (D) of section 110 which provides hospital
71	71	41expense and surgical expense insurance and which is delivered, issued or subsequently renewed
72	72	42by agreement between the insurer and the policyholder in or outside of the commonwealth; or
73	73	43(iii) any employees’ health and welfare fund which provides hospital expense and surgical
74	74	44expense benefits and which is delivered, issued or renewed to any person or group of persons in
75	75	45the commonwealth. The benefits in this section shall not be subject to any greater deductible,
76	76	46coinsurance, copayments or out-of-pocket limits than any other benefit provided by the insurer.
77	77	47 SECTION 4. Chapter 176A of the General Laws is hereby amended by inserting after
78	78	48section 8MM, the following section:-
79	79	49 Section 8OO. Any contract between a subscriber and the corporation under an individual
80	80	50or group hospital service plan which is delivered, issued or renewed within the commonwealth
81	81	51shall provide coverage for medically necessary functional repair or restoration of craniofacial
82	82	52disorders; with the exception of coverage for cleft lip and cleft palate which is prescribed
83	83	53elsewhere in the General Laws, to improve the function of, or to approximate the normal
84	84	54appearance of any abnormal structures caused by congenital disease or anomaly. Coverage under
85	85	55this section shall include the necessary care and treatment of medically diagnosed congenital 4 of 6
86	86	56disease or anomaly, including, ectodermal dysplasia, dentinogenesis imperfecta, and
87	87	57amelogenesis imperfecta. Coverage shall not include cosmetic surgery or dental or orthodontic
88	88	58treatment unrelated to congenital disease or anomaly. The benefits in this section shall not be
89	89	59subject to any greater deductible, coinsurance, copayments or out-of-pocket limits than any other
90	90	60benefit provided by the insurer.
91	91	61 SECTION 5. Chapter 176B of the General Laws is hereby amended by inserting after
92	92	62section 4MM the following section:-
93	93	63 Section 4OO. Any subscription certificate under an individual or group medical service
94	94	64agreement delivered, issued or renewed within the commonwealth shall provide coverage for
95	95	65medically necessary functional repair or restoration of craniofacial disorders; with the exception
96	96	66of coverage for cleft lip and cleft palate which is prescribed elsewhere in the General Laws, to
97	97	67improve the function of, or to approximate the normal appearance of any abnormal structures
98	98	68caused by disease or anomaly. Coverage under this section shall include the necessary care and
99	99	69treatment of medically diagnosed congenital disease or anomaly, including, ectodermal
100	100	70dysplasia, dentinogenesis imperfecta, and amelogenesis imperfecta. Coverage shall not include
101	101	71cosmetic surgery or dental or orthodontic treatment unrelated to congenital disease or anomaly.
102	102	72The benefits in this section shall not be subject to any greater deductible, coinsurance,
103	103	73copayments or out-of-pocket limits than any other benefit provided by the insurer.
104	104	74 SECTION 6. Chapter 176G of the General Laws is hereby amended by inserting after
105	105	75section 4EE the following section:-
106	106	76 Section 4FF. Any individual or group health maintenance contract shall provide coverage
107	107	77for medically necessary functional repair or restoration of craniofacial disorders; with the 5 of 6
108	108	78exception of coverage for cleft lip and cleft palate which is prescribed elsewhere in the General
109	109	79Laws, to improve the function of, or to approximate the normal appearance of any abnormal
110	110	80structures caused by congenital disease or anomaly. Coverage under this section shall include the
111	111	81necessary care and treatment of medically diagnosed congenital disease or anomaly, including,
112	112	82ectodermal dysplasia, dentinogenesis imperfecta, and amelogenesis imperfecta. Coverage shall
113	113	83not include cosmetic surgery or dental or orthodontic treatment unrelated to congenital disease or
114	114	84anomaly. The benefits in this section shall not be subject to any greater deductible, coinsurance,
115	115	85copayments or out-of-pocket limits than any other benefit provided by the insurer.
116	116	86 SECTION 7. Chapter 176I of the General Laws, as so appearing, is hereby amended by
117	117	87inserting after section 12 the following section:-
118	118	88 Section 13. An organization entering into a preferred provider contract shall provide
119	119	89coverage for medically necessary functional repair or restoration of craniofacial disorders; with
120	120	90the exception of coverage for cleft lip and cleft palate which is prescribed elsewhere in the
121	121	91General Laws, to improve the function of, or to approximate the normal appearance of any
122	122	92abnormal structures caused by congenital disease or anomaly. Coverage under this section shall
123	123	93include the necessary care and treatment of medically diagnosed congenital disease or anomaly,
124	124	94including, ectodermal dysplasia, dentinogenesis imperfecta, and amelogenesis imperfecta.
125	125	95Coverage shall not include cosmetic surgery or dental or orthodontic treatment unrelated to
126	126	96congenital defects, developmental deformities, trauma, tumors, infections or disease. The
127	127	97benefits in this section shall not be subject to any greater deductible, coinsurance, copayments or
128	128	98out-of-pocket limits than any other benefit provided by the insurer. 6 of 6
129	129	99 SECTION 8. This act shall apply to all policies, contracts and certificates of health
130	130	100insurance subject to chapters 32A, 118E, 175, 176A, 176B, 176G and 176I, of the General Laws,
131	131	101as so appearing, issued or renewed, except any entity to the extent it offers a policy, certificate or
132	132	102contract that provides coverage for dental care services or vision care services.