1 of 1
SENATE DOCKET, NO. 1043 FILED ON: 1/18/2023
SENATE . . . . . . . . . . . . . . No. 678
The Commonwealth of Massachusetts
_________________
PRESENTED BY:
Liz Miranda
_________________
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 to improve sickle cell care.
_______________
PETITION OF:
NAME:DISTRICT/ADDRESS :Liz MirandaSecond SuffolkLydia EdwardsThird Suffolk2/8/2023 1 of 23
SENATE DOCKET, NO. 1043 FILED ON: 1/18/2023
SENATE . . . . . . . . . . . . . . No. 678
By Ms. Miranda, a petition (accompanied by bill, Senate, No. 678) of Liz Miranda and Lydia
Edwards for legislation to improve sickle cell care. Financial Services.
The Commonwealth of Massachusetts
_______________
In the One Hundred and Ninety-Third General Court
(2023-2024)
_______________
An Act to improve sickle cell care.
Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
of the same, as follows:
1 MEDICAID COVERAGE FOR FERTILITY PRESERVATION SERVICES
2 SECTION 1. Chapter 118E of the General Laws is hereby amended by inserting after
3section 10N the following section:
4 Section 10O. (a) For the purposes of this section, the following words shall, unless the
5context clearly requires otherwise, have the following meanings:-
6 (1) "Iatrogenic infertility", in impairment of fertility by surgery, radiation, chemotherapy,
7or other medical treatment affecting reproductive organs or processes, including without
8limitation treatment for sickle cell disease.
9 (2) "Physician", an individual licensed to practice under section 2 of chapter 112.
10 (3) "Qualified enrollee", an individual who:
11 (A) is enrolled in the MassHealth program pursuant to section 9; 2 of 23
12 (B) has been diagnosed with a form of cancer or other disease by a physician;
13 (C) needs treatment for that cancer or other disease that may cause substantial risk of
14sterility or iatrogenic infertility, including surgery, radiation, or chemotherapy; and
15 (D) has a primary illness that has impaired the patient’s fertility and ability to reproduce
16normally.
17 (4) "Standard Fertility Preservation Services", procedures based upon current evidence-
18based standards of care established by the American Society for Reproductive Medicine, the
19American Society of Clinical Oncology, or other national medical associations that follow
20current evidence-based standards of care, and includes the retrieval and storage of two complete
21oocyte cycles and the collection and storage of two sperm samples.
22 (b)(1) Before January 1, 2024, the division of medical assistance shall apply for a
23Medicaid waiver or a state plan amendment with the Centers for Medicare & Medicaid Services
24of the United States Department of Health and Human Services to implement the coverage
25described in subsection (b).
26 (2) If the waiver or state plan amendment described in subsection (a) is approved,
27MassHealth shall provide coverage to a qualified enrollee for standard fertility preservation
28services.
29 (c) Before November 1, 2025, and before November 1 of each third year after 2025, the
30division of medical assistance shall calculate the change in state spending attributable to the
31coverage described in subsection (b)(2), and report this amount to house and senate committees
32on ways and means 3 of 23
33 Commercial Insurance Coverage for Fertility Preservation Services
34 SECTION 2. (a) Notwithstanding any general or special law to the contrary, any policy,
35contract or certificate of health insurance subject to chapters 32A, 175, 176A, 176B, 176G, 176I,
36176J or 176Q of the General Laws must provide coverage for medically necessary expenses for
37standard fertility preservation services when a necessary medical treatment may directly or
38indirectly cause iatrogenic infertility to an enrollee.
39 (b) In determining coverage pursuant to this section, an insurer shall not discriminate
40based on an individual's expected length of life, present or predicted disability, degree of medical
41dependency, quality of life, or other health conditions, nor based on personal characteristics,
42including age, sex, sexual orientation, or marital status.
43 (c) For the purposes of this section, the following words shall, unless the context clearly
44requires otherwise, have the following meanings:-
45 “Iatrogenic infertility”, in impairment of fertility by surgery, radiation, chemotherapy, or
46other medical treatment affecting reproductive organs or processes, including without limitation
47treatment for sickle cell disease.
48 “May directly or indirectly cause”, the likely possibility that treatment will cause a side
49effect of infertility, based upon current evidence-based standards of care established by the
50American Society for Reproductive Medicine, the American Society of Clinical Oncology, or
51other national medical associations that follow current evidence-based standards of care.
52 “Standard fertility preservation services”, procedures based upon current evidence-based
53standards of care established by the American Society for Reproductive Medicine, the American 4 of 23
54Society of Clinical Oncology, or other national medical associations that follow current
55evidence-based standards of care, and includes the retrieval and storage of two complete oocyte
56cycles and the collection and storage of two sperm samples.
57 STATEWIDE SCD STEERING COMMITTEE
58 SECTION 3. (a)(1) Notwithstanding any general or special law to the contrary, there is
59hereby established a Statewide Steering Committee on Sickle Cell Disease within the department
60of public health.
61 (2) The Steering Committee under this section shall consist of:
62 (A) two representatives from the Massachusetts Sickle Cell Disease Association
63including the Executive Director or their designee;
64 (B) three medical professionals from major Sickle Cell Disease treatment centers in the
65commonwealth who shall be appointed by the commissioner;
66 (C) the Executive Director of the Massachusetts Association of Community Health
67Workers or their designee;
68 (D) the President of the Massachusetts Chapter of the National Association of Social
69Workers or their designee;
70 (E) two members who shall be appointed by the commissioner, one of whom shall be an
71expert on the biology of the disease, and one of whom shall be an expert on the psycho-social
72aspect of the disease; 5 of 23
73 (F) two representatives of the department of elementary and secondary education who
74shall be appointed by the commissioner, including one of whom is knowledgeable about the right
75to comparable education, supportive services and accommodations under section 504 of the
76Rehabilitation Act of 1973;
77 (G) one representative of the Black and Latino Caucus who shall be appointed by the
78commissioner;
79 (H) one representative of the Asian Caucus who shall be appointed by the commissioner;
80 (I) two sickle cell disease patients who shall be appointed by the Governor, one of which
81shall be over 25 years in age and the other shall be between 18 and 25 years in age;
82 (J) a parent of a minor child with sickle cell disease who shall be appointed by the
83Governor;
84 (K) a parent of a secondary or post-secondary school age youth with sickle cell disease
85who shall be appointed by the commissioner; and
86 (L) one representative who has a background in racial health disparities who shall be
87appointed by the Governor.
88 The representatives of nongovernmental organizations shall serve staggered 3–year
89terms. Vacancies of unexpired terms shall be filled within 60 days by the appropriate appointing
90authority.
91 (3) The Steering Committee under this section shall: 6 of 23
92 (A) establish institution and community partnerships, including hospitals, and institutions
93of higher education;
94 (B) establish a statewide network of stakeholders, including parents, home health care
95providers, school-based nurses, and the Massachusetts Sickle Cell Disease Association who are
96committed to care for individuals with sickle cell disease collaboratively in an inclusive setting;
97 (C) establish a statewide network of racially and culturally competent stakeholders who
98include general and special education administrators and teachers and paraprofessionals;
99 (D) oversee the development of educational materials for individuals with sickle cell
100disease, the public, and health care providers about the assistance available to such individuals in
101the commonwealth, including local school district responsibilities for care of such individuals;
102 (E) identify funding sources for implementing or supporting the actions, studies, policies
103required by federal and state laws and regulations, or recommended by the Steering Committee,
104including funding from:
105 (i) state, federal, and local government sources; and
106 (ii) private sources;
107 (F) investigate and report on a standard of basic, multidisciplinary care for patients across
108the commonwealth; and
109 (G) establish subcommittees as appropriate.
110 (4) The department may, in consultation with the Statewide Steering Committee, provide
111services relating to sickle cell disease, including: 7 of 23
112 (A) educational programs on sickle cell disease for individuals affected by the disease,
113including:
114 (i) education on the rights of individuals with sickle cell disease, such as, without
115limitation, the right not to be discriminated against and the right to receive appropriate
116educational programming, health related services and accommodations necessary to access such
117programming and services;
118 (ii) expectations, options, and responsibilities of families of individuals with sickle cell
119disease;
120 (iii) challenges and responsibilities of caregivers of individuals with sickle cell disease;
121 (iv) obligations of employees at primary and secondary schools; and
122 (v) challenges and responsibilities of health care providers;
123 (B) social services support to individuals with sickle cell disease, including support from
124social workers and community health workers to provide information on services that may be
125available to the individual;
126 (C) hemoglobin electrophoresis or genetic testing for the presence of sickle cell disease;
127 (D) genetic counseling;
128 (E) assistance with any available reimbursement for medical expenses related to sickle
129cell disease;
130 (F) education and counseling services for parents and other family members and
131caretakers after the receipt of sickle cell trait test results from the Newborn Screening Program as 8 of 23
132required by section 270.006(A)(2)(e) of chapter 105, Code of Massachusetts Regulations,
133provided that, with the consent of parents and other family members and caretakers, such
134services may be provided in whole or in part by the Massachusetts Sickle Cell Disease
135Association; and
136 (G) any other programs or services that are necessary to decrease the use of acute care
137services by individuals who have sickle cell disease.
138 (5) The department shall, in consultation with any other agency of the commonwealth as
139the department determines appropriate, provide the services in paragraph (4) through
140community–based organizations, including specifically, pre-K, elementary and secondary
141schools as well as institutions for higher education for all affected school-age children, youth,
142and older students to the extent practicable.
143 (6) The Steering Committee, in conjunction with the department and other relevant
144stakeholders, shall study and make recommendations on:
145 (A) how to enhance access to services for individuals with sickle cell disease with a focus
146on areas in the commonwealth where there is a statistically high number of individuals with
147sickle cell disease or in areas where there is a lack of providers with expertise in treating sickle
148cell disease;
149 (B) whether to establish a sickle cell disease registry, and if recommended, the process
150and guidelines for establishing a registry and obtaining information consistent with informed
151consent and protecting data privacy; 9 of 23
152 (C) how to enhance the coordination of health care services for individuals with sickle
153cell disease who are transitioning from pediatric to adult health care, including the identification
154of available resources for individuals who are transitioning; and
155 (D) how to engage with community–based health fairs and other community–sponsored
156events in areas with a statistically high number of individuals with sickle cell disease to provide
157outreach and education on living with sickle cell disease and how to access health care services.
158 (b) The department shall, in consultation with the Steering Committee, establish and
159implement a system the provides information on the sickle cell trait to any individual who has
160the sickle cell trait and, if the individual is a minor, to the individual’s family.
161 (c) The department shall include the following in the information provided under
162subsection (b):
163 (1) how the sickle cell trait impacts the health of an individual with the trait;
164 (2) how the sickle cell trait is passed from a parent to a child; and
165 (3) implications for pregnancy.
166 (d) The department shall maintain in a conspicuous location on its website a list of
167resources for health care practitioners to use to improve their understanding and clinical
168treatment of individuals with sickle cell disease or the sickle cell trait, including information on
169the health impacts of carrying the sickle cell trait.
170 (e) For the purposes of this section, the following word shall, unless the context clearly
171requires otherwise, have the following meaning:- 10 of 23
172 “Steering Committee”, the Statewide Steering Committee on Sickle Cell Disease.
173 SICKLE CELL DISEASE DETECTION AND EDUCATION PROGRAM (ADULT
174SCREENING AND EDUCATION- RELATED GRANTS)
175 SECTION 4. (a) Notwithstanding any general or special law to the contrary, there is
176hereby established within the department of public health the sickle cell disease detection and
177education program to: (1) promote screening and detection of sickle cell disease, especially
178among unserved or underserved populations; (2) educate the public regarding sickle cell disease
179and the benefits of early detection; and (3) provide counseling and referral services.
180 (b) The program under this section shall include:
181 (1) establishment of a statewide public education and outreach campaign to publicize
182evidence-based sickle cell disease screening, detection and education services. The campaign
183shall include: general community education, outreach to specific underserved populations,
184evidence based clinical sickle cell disease screening services, and an informational summary that
185shall include an explanation of the importance of clinical examinations and what to expect during
186clinical examinations and sickle cell disease screening services;
187 (2) provision of grants to approved organizations pursuant to subsection (c) and for
188community based organizations pursuant to subsection (d);
189 (3) compilation of data concerning the program and dissemination of such data to the
190public; and
191 (4) development of health care professional education programs including the benefits of
192early detection of sickle cell disease and clinical examinations, the recommended frequency of 11 of 23
193clinical examinations and sickle cell disease screening services, and professionally recognized
194best practices guidelines.
195 (c)(1) Under the program, the commissioner of public health shall make grants in
196amounts appropriated to approved organizations for the provision of services relating to the
197evidence-based screening and detection of sickle cell disease as part of this program. The
198services required to be provided under such grants shall include:
199 (A) promotion and provision of early detection of sickle cell disease, including clinical
200examinations and sickle cell disease screening services;
201 (B) provision of counseling and information on treatment options and referral for
202appropriate medical treatment;
203 (C) dissemination of information to unserved and underserved populations as determined
204by the commissioner, to the general public and to health care professionals concerning sickle cell
205disease, the benefits of early detection and treatment, and the availability of sickle cell disease
206screening services at no cost to such populations;
207 (D) identification of local sickle cell disease screening services within the approved
208organization's region;
209 (E) provision of information, counseling and referral services to individuals diagnosed
210with sickle cell disease; and
211 (F) provision of information regarding the availability of medical assistance, including
212medical assistance for an individual who is eligible for such assistance pursuant to section 9 of 12 of 23
213chapter 118E of the General Laws, to an individual who requires treatment for sickle cell
214disease.
215 (2) The commissioner shall give notice and provide opportunity to submit applications
216for grants under the program. In order to be considered for a grant, an applicant must show
217evidence of the following, relating to the services the applicant proposes to provide:
218 (A) ability to provide and to ensure consistent and quality services under the program;
219 (B) expertise in providing the service;
220 (C) capacity to coordinate services with physicians, hospitals and other appropriate local
221institutions or agencies;
222 (D) ability to provide the service to unserved or underserved populations; and
223 (E) ability to provide the service in accordance with the standards specified in
224subdivision three of this section.
225 Applications shall be made on forms provided by the commissioner.
226 (3) The commissioner shall develop standards for the implementation of grants under the
227program by approved organizations, which shall ensure the following:
228 (A) integration of the approved organization with existing health care providers;
229 (B) maximizing third party reimbursement; and
230 (C) provision of services to unserved or underserved populations. 13 of 23
231 (4) Within the amounts of state or federal funds appropriated for the program, approved
232organizations may be authorized by the department to provide such services for populations
233served under this title. Services may include evidence based screening, patient education,
234counseling, follow-up and referral.
235 (5) Every organization receiving grants under this subsection shall submit to the
236commissioner, on or before October first of each year, a report of such organization's activities,
237including an assessment of the organization's programs and such data as the commissioner deems
238relevant and necessary to accomplish the purposes of the program
239 (d)(1) Under the program, the commissioner shall make grants within amounts
240appropriated for community based organizations to provide post-diagnosis counseling, education
241and outreach programs for persons diagnosed with sickle cell disease based upon criteria to be
242developed by the commissioner.
243 (2) The commissioner shall provide notice and opportunity for community-based
244organizations to submit applications to provide post-diagnosis sickle cell disease counseling,
245education and outreach programs. Such applications shall be on forms established by the
246commissioner.
247 (e) The commissioner shall submit, on or before December first of each year, an annual
248report to the governor and the legislature concerning the operation of the program. The reports
249shall include the experience of the program in providing services under this act. The annual
250report shall include strategies for implementation of the sickle cell disease awareness program
251and for promoting the awareness program to the general public, state and local elected officials,
252and various public and private organizations, associations, businesses, industries, and agencies. 14 of 23
253Organizations receiving grants under this act shall provide data and assessments as the
254commissioner may require for the report. The report shall include any recommendations for
255additional action to respond to the incidence of sickle cell disease in the commonwealth.
256 (f) For the purposes of this section, the following words shall, unless the context clearly
257requires otherwise, have the following meanings:-
258 “Community-based organizations”, free-standing organizations in which sickle cell
259disease survivors hold significant decision-making responsibility, and which offer a broad range
260of sickle cell disease education and support services free of charge.
261 “Program”, sickle cell disease detection and education program.
262 “Unserved or underserved populations", people having inadequate access and financial
263resources to obtain sickle cell disease screening and detection services, including people who
264lack health coverage or whose health coverage is inadequate or who cannot meet the financial
265requirements of their coverage for accessing detection services.
266 SCD REGISTRY AND REPORTS- COMPREHENSIVE DATA COLLECTION ON
267PEOPLE LIVING WITH SCD OR ITS VARIANTS
268 SECTION 5. (a)(1) Notwithstanding any general or special law to the contrary, the
269commissioner of public health or designee shall, in accordance with regulations adopted by the
270department of public health pursuant to subsection (b), and in consultation with the
271Massachusetts Sickle Cell Disease Association, establish and maintain a system for the reporting
272of information on sickle cell disease and its variants. Said system shall include a record of the
273cases of sickle cell disease and its variants which occur in the commonwealth along with such 15 of 23
274information concerning the cases as may be appropriate to form the basis for: (A) conducting
275comprehensive epidemiologic surveys of sickle cell disease and its variants in the
276commonwealth; and (B) evaluating the appropriateness of measures for the treatment of sickle
277cell disease and its variants.
278 (2) Hospitals, medical laboratories, and other facilities that provide screening, diagnostic
279or therapeutic services to patients with respect to sickle cell disease and its variants shall report
280the information prescribed by the regulation promulgated pursuant to subsection (b).
281 (3) Any provider of health care who diagnoses or provides treatment for sickle cell
282disease and its variants, except for cases directly referred to the provider or cases that have been
283previously admitted to a hospital, medical laboratory or other facility described in paragraph (2),
284shall report the information prescribed by the regulation adopted pursuant to subsection (b).
285 (b) The department of public health shall, by regulation:
286 (1) prescribe the form and manner in which information on cases of sickle cell disease
287and its variants must be reported in compliance with any applicable federal privacy law;
288 (2) prescribe the information that must be included in each report, which must include,
289without limitation: (A) the name, address, age and ethnicity of the patient; (B) the variant of
290sickle cell disease with which the person has been diagnosed; (C) the method of treatment; (D)
291any other diseases from which the patient suffers; (E) information concerning the usage of and
292access to health care services by the patient; and (F) if a patient diagnosed with sickle cell
293disease and its variants dies, his or her age at death and cause of death; and 16 of 23
294 (3) establish a protocol for allowing appropriate access to and preserving the
295confidentiality of the records of patients needed for research into sickle cell disease and its
296variants;
297 (4) establish a protocol for allowing information, in accordance with the preceding
298subsections, to be communicated with Statewide Steering Committee on Sickle Cell Disease, the
299sickle cell disease services program, and within the department as determined appropriate by the
300commissioner.
301 (c) The chief administrative officer of each health care facility in the commonwealth shall
302make available to the commissioner or designee the records of the health care facility for each
303case of sickle cell disease and its variants. The department of public health shall abstract from
304the records of a health care facility or shall require a health care facility to abstract from its own
305records such information as is required by regulations promulgated pursuant to subsection (b).
306The department shall compile the information in a timely manner and not later than 6 months
307after receipt of the abstracted information from the health care facility. The department shall by
308regulation adopt a schedule of fees which must be assessed to a health care facility for each case
309from which information is abstracted by the department. Any person who violates this section is
310subject to an administrative penalty established by regulation by the department.
311 (d) The department shall publish reports based upon the information obtained pursuant to
312subsections (a), (b), and (c) and shall make other appropriate uses of the information to report
313and assess trends in the usage of and access to health care services by patients with sickle cell
314disease and its variants in a particular area or population, advance research and education 17 of 23
315concerning sickle cell disease and its variants and improve treatment of sickle cell disease and its
316variants and associated disorders. The reports must include, without limitation:
317 (1) information concerning the locations in which patients diagnosed with sickle cell
318disease and its variants reside, the demographics of such patients and the utilization of health
319care services by such patients;
320 (2) the information described in paragraph (1), specific to patients diagnosed with sickle
321cell disease and its variants who are over 60 years of age or less than 5 years of age; and
322 (3) information on the transition of patients diagnosed with sickle cell disease and its
323variants from pediatric to adult care upon reaching 18 years of age.
324 (e) The department shall provide any qualified researcher whom the department
325determines is conducting valid scientific research with data from the reported information upon
326the researcher’s: (1) compliance with appropriate conditions as established under the regulations
327of the department; and (2) payment of a fee established by the department by regulation to cover
328the cost of providing the data.
329 (f) The commissioner or designee shall analyze the information obtained pursuant to
330subsections (a), (b) and (c) and the reports published pursuant to subsection (d) to determine
331whether any trends exist in the usage of and access to health care services by patients with sickle
332cell disease and its variants in a particular area or population.
333 (g) If the commissioner or designee determines that a trend exists in the usage of and
334access to health care services by patients with sickle cell disease and its variants in a particular
335area or population, the commissioner or designee shall work with appropriate governmental, 18 of 23
336educational and research entities to investigate the trend, advance research in the trend and
337facilitate the treatment of sickle cell disease and its variants and associated disorders.
338 (h) The department shall not reveal the identity of any patient, physician, or health care
339facility which is involved in any reporting required by this section unless the patient, physician
340or health care facility gives prior written consent to such a disclosure. A person or governmental
341entity that provides information to the department pursuant to this section shall not be held liable
342in a civil or criminal action for sharing confidential information unless the person or organization
343has done so in bad faith or with malicious purpose.
344 (i) For the purposes of this section, the following words shall, unless the context clearly
345requires otherwise, have the following meanings:-
346 “Sickle cell disease and its variants”, an inherited disease caused by a mutation in a gene
347for hemoglobin in which red blood cells have an abnormal crescent shape that causes them to
348block small blood cells and die sooner than normal.
349 SCD REGISTRY AND REPORTS- DATA COLLECTION ON SCD TRAIT
350 SECTION 6. (a)(1) Notwithstanding any general or special law to the contrary, if a
351newborn screening for hereditary disorders performed pursuant to section 270.006(A)(2)(e) of
352chapter 105, Code of Massachusetts Regulations detects the presence of sickle cell trait, the
353laboratory performing the screening shall notify the physician responsible for the newborn’s care
354and shall document the patient’s information in the central registry established pursuant to
355paragraph (2) in a manner and on forms prescribed by the department of public health. 19 of 23
356 (2) The physician responsible for such newborn’s care shall provide the patient’s parents
357with information concerning the availability, benefits, and role of genetic counseling performed
358by a genetic counselor licensed pursuant to section 253 of chapter 112 of the General Laws,
359including a document available in multiple languages (as determined by the department) that
360identifies at least 10 genetic counselors and the public health care payers and private health care
361payers which contract with each such genetic counselor. In the case a physician described in the
362preceding sentence is not identified, the laboratory described in paragraph (1) shall provide the
363patient’s parents with such information relating to genetic counseling. Genetic counseling
364concerning a diagnosis of sickle cell trait shall include, but not be limited to, information
365concerning the fact that one or both of the parents carries sickle cell trait and the risk that other
366children born to the parents may carry sickle cell trait or may be born with sickle cell disease.
367 (b)(1) The commissioner of public health shall establish a central registry of patients
368diagnosed with sickle cell trait. The information in the central registry shall be used for the
369purposes of compiling statistical information and assisting the provision of follow-up counseling,
370intervention, and educational services to patients and to the parents of patients who are listed in
371the registry including, but not limited to, information concerning the availability and benefits of
372genetic counseling performed by a genetic counselor licensed pursuant to section 253 of chapter
373112 of the General Laws.
374 (2) The commissioner shall establish a system to notify the parents of patients who are
375listed in the registry that follow-up consultations with a physician are recommended for children
376diagnosed with sickle cell trait. Such notifications shall be provided: at least once when the
377patient is in early adolescence, when the patient may begin to participate in strenuous athletic
378activities that could result in adverse symptoms for a person with sickle cell trait; at least once 20 of 23
379during later adolescence, when the patient should be made aware of the reproductive
380implications of sickle cell trait; and at such other intervals as the commissioner may require.
381 (3) The commissioner shall establish a system under which the department shall make
382reasonable efforts to notify patients listed in the registry who reach the age of 18 years of the
383patient’s inclusion in the registry and of the availability of educational services, genetic
384counseling, and other resources that may be beneficial to the patient.
385 (4) Information on newborn infants and their families compiled pursuant to this section
386may be used by the department and agencies designated by the commissioner of public health for
387the purposes of carrying out this act, but otherwise the information shall not be a public record
388and shall be confidential and not divulged or made public so as to disclose the identity of any
389person to whom it relates, except as exempted or consented in accordance with section 10 of
390chapter 66 or section 70G of chapter 111 of the General Laws, respectively.
391 DEVELOPMENT OF A COMPREHENSIVE SCD DISEASE QUALITY STRATEGY
392IN MEDICAID MANAGED CARE
393 SECTION 7. (a) Notwithstanding any general or special law to the contrary, the division
394of medical assistance shall ensure the availability of accessible, quality health care for
395individuals with sickle cell disease who are enrolled in Medicaid managed care organizations or
396accountable care organizations that have a contract with the division to provide services to
397individuals enrolled under MassHealth pursuant to section 9 of chapter 118E of the General
398Laws. Such health care shall include, but not be limited to the following:
399 (1) comprehensive integrated care management for sickle cell disease, including primary
400care, specialized care, and mental health services; 21 of 23
401 (2) sickle cell trait testing and genetic counseling;
402 (3) social work services as well as education on disease management to patients,
403caregivers, and providers; and
404 (4) support navigating health insurance coverage and support with transportation to
405treatment centers.
406 (b) Not later than the fiscal year 2024 contract year, the division of medical assistance
407shall require Medicaid managed care or accountable care organizations to implement a sickle cell
408disease quality strategy for children and adults with sickle cell disease that includes, but is not
409limited to, the following components:
410 (1) measurable goals to improve the identification of members with sickle cell disease
411within 90 days after enrolling in the contracted health plan;
412 (2) to the extent practicable, adequate provider network capacity to ensure timely access
413to sickle cell disease specialty service providers, including, but not limited to, hematologists;
414 (3) care coordination strategies and supports to help members with sickle cell disease
415access sickle cell disease specialists and other related care supports;
416 (4) delivery of a training curriculum approved by the division of medical assistance to
417educate primary care providers on sickle cell disease, including information on emergency
418warning signs and complications, evidence-based practices and treatment guidelines, and when
419to make referrals to specialty sickle cell disease treatment providers; and
420 (5) in the case of an individual who is diagnosed with sick cell disease, exceptions to
421otherwise applicable prior authorization or dispensing limits for pain medications that are 22 of 23
422designed to reduce barriers for such an individual to be able to obtain the appropriate dosage and
423amount of a pain medication in a timely manner.
424 (c) The division of medical assistance shall also do the following:
425 (1) Not later than the fiscal year 2025 contract year, require each Medicaid managed care
426organization and accountable care organization to report, on a quarterly basis, an unduplicated
427count of children and adults identified as having sickle cell disease enrolled with the contracted
428plan during the quarter. The department shall publish these reports, by contracted plan, on the
429department's website.
430 (2) Not later than January 1, 2025, and in partnership with Medicaid managed care
431organizations and accountable care organizations, identify, document, and share best practices
432regarding sickle cell disease care management and care coordination with Medicaid-enrolled
433primary care and sickle cell disease specialty providers with a goal of improving services for
434members with sickle cell disease and their families.
435 (3) Enter into a contract not later than January 1, 2025, with a publicly funded university
436to develop a sickle cell disease-focused comprehensive assessment tool or a supplement to an
437existing comprehensive assessment tool to screen members identified with sickle cell disease for
438comorbidities, medical history for the treatment of sickle cell disease including disease-
439modifying medications and pain management, psychosocial history, barriers to accessing or
440completing treatments, social supports, other care coordinators working with the member,
441community resources being used or needed, quality of life, and personal preferences for
442engagement with a care coordinator. 23 of 23
443 (4) Not later than the fiscal year 2025 contract year, establish performance measures
444relative to access to care and available therapies, engagement in treatment, and outcomes for
445individuals with sickle cell disease, with the metrics to be reported annually by the
446comprehensive health care program to Medicaid managed care organizations and accountable
447care organizations and with incentive payments attached to the measures.
448 (5) Not later than January 1, 2025, develop a plan for improving the transition from
449pediatric care to adult care for adolescents with sickle cell disease who are aging out of the
450Medicaid program, and a plan for helping qualified beneficiaries maintain Medicaid coverage
451under another eligibility category, in order to maintain continuity of care.
452 (d) The division of medical assistance shall provide an annual sickle cell disease
453management and accountability report to the senate and house committees on ways and means,
454including the status of sickle cell disease-focused access to care, quality of services, health
455outcomes, and disparities in the commonwealth.
456 (e) The division of medical assistance shall incorporate the sickle cell disease
457management and accountability standards into its contracts with managed care plans and
458accountable care organizations, including financial or administrative penalties for lack of
459performance. Contracted plan rates must be adjusted to reflect enhanced care or other provisions
460that are shifted to the contracted plans.