Massachusetts 2023-2024 Regular Session

Massachusetts Senate Bill S625 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. 2180 FILED ON: 1/20/2023
3	3	SENATE . . . . . . . . . . . . . . No. 625
4	4	The Commonwealth of Massachusetts
5	5	_________________
6	6	PRESENTED BY:
7	7	Sal N. DiDomenico
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 out-of-pocket expenses for covid-19 therapeutics.
13	13	_______________
14	14	PETITION OF:
15	15	NAME:DISTRICT/ADDRESS :Sal N. DiDomenicoMiddlesex and Suffolk 1 of 3
16	16	SENATE DOCKET, NO. 2180 FILED ON: 1/20/2023
17	17	SENATE . . . . . . . . . . . . . . No. 625
18	18	By Mr. DiDomenico, a petition (accompanied by bill, Senate, No. 625) of Sal N. DiDomenico
19	19	for legislation relative to out-of-pocket expenses for covid-19 therapeutics. Financial Services.
20	20	The Commonwealth of Massachusetts
21	21	_______________
22	22	In the One Hundred and Ninety-Third General Court
23	23	(2023-2024)
24	24	_______________
25	25	An Act relative to out-of-pocket expenses for covid-19 therapeutics.
26	26	Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
27	27	of the same, as follows:
28	28	1 SECTION 1. Notwithstanding any other law, Sections 1-8 shall refer to a health care
29	29	2service plan contract issued, amended, or renewed on or after the operative date of this
30	30	3subdivision that covers medical, surgical, and hospital benefits, excluding a specialized health
31	31	4care service plan contract, with respect to therapeutics for COVID-19 covered under the contract,
32	32	5which shall include therapeutics approved or granted emergency use authorization by the federal
33	33	6Food and Drug Administration for treatment of COVID-19 when prescribed or furnished by a
34	34	7licensed health care provider acting within their scope of practice and the standard of care.
35	35	8 (a) A health care service plan contract that covers medical, surgical, and hospital
36	36	9benefits, excluding a specialized health care service plan contract, shall cover, without cost
37	37	10sharing and without prior authorization or other utilization management, the costs of therapeutics
38	38	11for COVID-19 covered under the contract, which shall include therapeutics approved or granted
39	39	12emergency use authorization by the federal Food and Drug Administration for treatment of 2 of 3
40	40	13COVID-19 when prescribed or furnished by a licensed health care provider acting within their
41	41	14scope of practice and the standard of care.
42	42	15 SECTION 2. A health care service plan shall reimburse a provider for the therapeutics
43	43	16described in paragraph (1) at the specifically negotiated rate for those therapeutics, if the plan
44	44	17and provider have negotiated a rate. If the plan does not have a negotiated rate with a provider,
45	45	18the plan may negotiate a rate with the provider.
46	46	19 SECTION 3. For an out-of-network provider with whom a health care service plan does
47	47	20not have a negotiated rate for the therapeutics described in paragraph (1), a health care service
48	48	21plan shall reimburse the provider for the therapeutics in an amount that is reasonable, as
49	49	22determined in comparison to prevailing market rates for the therapeutics in the geographic region
50	50	23in which the therapeutic was delivered. An out-of-network provider shall accept this payment as
51	51	24payment in full, shall not seek additional remuneration from an enrollee, and shall not report
52	52	25adverse information to a consumer credit reporting agency or commence civil action against the
53	53	26enrollee for therapeutics described in this subdivision.
54	54	27 SECTION 4. A health care service plan shall cover COVID-19 therapeutics without cost
55	55	28sharing, regardless of whether the therapeutics are provided by an in-network or out-of-network
56	56	29provider, and without utilization management. If a provider would have been entitled to receive
57	57	30cost sharing but for this section, the health care service plan shall reimburse the provider for the
58	58	31lost cost sharing. A provider shall accept this payment as payment in full, shall not seek
59	59	32additional remuneration from an enrollee, and shall not report adverse information to a consumer
60	60	33credit reporting agency or commence civil action against the enrollee for therapeutics pursuant to
61	61	34this subdivision. 3 of 3
62	62	35 SECTION 5. Beginning six months after the federal public health emergency expires, a
63	63	36health care service plan shall no longer be required to cover the cost sharing for COVID-19
64	64	37therapeutics delivered by an out-of-network provider, unless otherwise required by law.
65	65	38 SECTION 6. For purposes of this section, “health care service plan” includes a health
66	66	39plan service plan offered on the Massachusetts Health Connector that provides coverage for
67	67	40hospital, medical, surgical, or prescription drug benefits, excluding a specialized health insurance
68	68	41policy that provides coverage only for dental or vision benefits.
69	69	42 SECTION 7. For purposes of this section, “health care service plan” includes a
70	70	43MassHealth managed care plan that contracts with Massachusetts Department of Health and
71	71	44Human Services. MassHealth shall seek any federal approvals it deems necessary to implement
72	72	45this section. This section applies to a MassHealth managed care plan contract only to the extent
73	73	46that MassHealth obtains any necessary federal approvals, and federal financial participation
74	74	47under the Medicaid program is available and not otherwise jeopardized.
75	75	48 SECTION 8. This section applies to a disability insurance policy that provides coverage
76	76	49for hospital, medical, surgical, or prescription drug benefits, excluding a specialized health
77	77	50insurance policy that provides coverage only for dental or vision benefits.
78	78	51 (a)A disability insurance policy shall cover, without cost sharing and without prior
79	79	52authorization or other utilization management requirements, the costs of COVID-19 therapeutics
80	80	53approved or granted emergency use authorization by the federal Food and Drug Administration.