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2 | 2 | | HOUSE DOCKET, NO. 983 FILED ON: 1/14/2025 |
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3 | 3 | | HOUSE . . . . . . . . . . . . . . . No. 1218 |
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4 | 4 | | The Commonwealth of Massachusetts |
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5 | 5 | | _________________ |
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6 | 6 | | PRESENTED BY: |
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7 | 7 | | Patrick Joseph Kearney |
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8 | 8 | | _________________ |
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9 | 9 | | To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General |
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10 | 10 | | Court assembled: |
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11 | 11 | | The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill: |
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12 | 12 | | An Act relative to access to health care. |
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13 | 13 | | _______________ |
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14 | 14 | | PETITION OF: |
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15 | 15 | | NAME:DISTRICT/ADDRESS :DATE ADDED:Patrick Joseph Kearney4th Plymouth1/14/2025 1 of 16 |
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16 | 16 | | HOUSE DOCKET, NO. 983 FILED ON: 1/14/2025 |
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17 | 17 | | HOUSE . . . . . . . . . . . . . . . No. 1218 |
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18 | 18 | | By Representative Kearney of Scituate, a petition (accompanied by bill, House, No. 1218) of |
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19 | 19 | | Patrick Joseph Kearney relative to insurance coverage for stuttering speech therapy. Financial |
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20 | 20 | | Services. |
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21 | 21 | | The Commonwealth of Massachusetts |
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22 | 22 | | _______________ |
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23 | 23 | | In the One Hundred and Ninety-Fourth General Court |
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24 | 24 | | (2025-2026) |
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25 | 25 | | _______________ |
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26 | 26 | | An Act relative to access to health care. |
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27 | 27 | | Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority |
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28 | 28 | | of the same, as follows: |
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29 | 29 | | 1 SECTION 1. Chapter 32A of the General Laws, as amended by section 1 of chapter 231 |
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30 | 30 | | 2of the acts of 2024, is hereby further amended by adding the following section:- |
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31 | 31 | | 3 Section 35. (a) For the purposes of this section, the following words shall, unless the |
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32 | 32 | | 4context clearly requires otherwise, have the following meanings: |
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33 | 33 | | 5 “Habilitative services”, health care services that help a person keep, learn or improve |
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34 | 34 | | 6skills and functioning for daily living. |
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35 | 35 | | 7 “Habilitative stuttering speech therapy treatment”, speech therapy that helps an individual |
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36 | 36 | | 8to keep, learn or improve skills and functioning for daily living. |
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37 | 37 | | 9 “Rehabilitative services”, health care services that help a person restore or improve skills |
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38 | 38 | | 10and functioning for daily living that have been lost or impaired. 2 of 16 |
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39 | 39 | | 11 “Rehabilitative stuttering speech therapy treatment”, speech therapy that helps an |
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40 | 40 | | 12individual restore or improve skills and functioning of daily life that have been lost or impaired. |
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41 | 41 | | 13 “Stuttering speech therapy”, therapeutic care provided to an individual for the treatment |
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42 | 42 | | 14of stuttering administered by a licensed speech language pathologist. |
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43 | 43 | | 15 “Telehealth”, the application of telecommunication technology to deliver speech therapy |
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44 | 44 | | 16services at a distance for assessment, intervention or consultation. |
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45 | 45 | | 17 “Utilization review”, a set of formal techniques designed to monitor the use of or |
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46 | 46 | | 18evaluate the medical necessity, appropriateness, efficacy or efficiency of health care services, |
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47 | 47 | | 19procedures or settings, including: prior authorization, second opinion, certification, concurrent |
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48 | 48 | | 20review, case management, discharge planning or retrospective review, in order to make a |
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49 | 49 | | 21determination regarding coverage of the service under the terms of a health insurance policy or |
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50 | 50 | | 22an agreement with the department of health and human services. |
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51 | 51 | | 23 (b) Any coverage offered by the commission to an active or retired employee of the |
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52 | 52 | | 24commonwealth insured through the commission shall provide coverage for the cost of: (i) |
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53 | 53 | | 25habilitative services that shall provide coverage for habilitative stuttering speech therapy |
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54 | 54 | | 26treatment as a treatment for stuttering, regardless of whether the stuttering is classified as |
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55 | 55 | | 27developmental; (ii) rehabilitative services that shall provide coverage for rehabilitative stuttering |
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56 | 56 | | 28speech therapy treatment as a treatment for stuttering; or (iii) both habilitative services and |
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57 | 57 | | 29rehabilitative services under clauses (i) and (ii). |
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58 | 58 | | 30 (c) Habilitative services and rehabilitative services coverage required under this section |
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59 | 59 | | 31shall not be: (i) subject to any maximum annual benefit limit, including any limits on the number |
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60 | 60 | | 32of visits an insured may make to a speech language pathologist; (ii) limited based on the type of 3 of 16 |
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61 | 61 | | 33disease, injury, disorder or other medical condition that resulted in the stuttering; or (iii) subject |
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62 | 62 | | 34to utilization review or utilization management requirements, including prior authorization or a |
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63 | 63 | | 35determination that the speech therapy services are medically necessary. |
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64 | 64 | | 36 (d) Habilitative services and rehabilitative services required under this section shall |
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65 | 65 | | 37include coverage for speech therapy provided in person and via telehealth. Telehealth coverage |
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66 | 66 | | 38required under this subsection shall: (i) not be less than the coverage required for health benefit |
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67 | 67 | | 39plans; and (ii) include the use of any communication technology, application or platform to |
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68 | 68 | | 40deliver telehealth services, except coverage may be restricted to technology, applications or |
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69 | 69 | | 41platforms that are compliant with any applicable privacy provisions of the Federal Health |
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70 | 70 | | 42Insurance Portability and Accountability Act of 1996, 42 U.S.C. sec. 1320d et seq. |
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71 | 71 | | 43 (e) Habilitative services and rehabilitative services required under this section shall |
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72 | 72 | | 44include: (i) treatment of speech, language, voice, communication, fluency or auditory processing |
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73 | 73 | | 45disorder for individual service; and (ii) treatment of speech, language, voice, communication or |
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74 | 74 | | 46auditory processing disorder for group service with 2 or more individuals. |
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75 | 75 | | 47 SECTION 2. Chapter 118E of the General Laws is hereby amended by inserting after |
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76 | 76 | | 48section 10W, added by section 2 of said chapter 231, the following section:- |
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77 | 77 | | 49 Section 10X. (a) For the purposes of this section, the following words shall, unless the |
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78 | 78 | | 50context clearly requires otherwise, have the following meanings: |
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79 | 79 | | 51 “Habilitative services”, health care services that help a person keep, learn or improve |
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80 | 80 | | 52skills and functioning for daily living. 4 of 16 |
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81 | 81 | | 53 “Habilitative stuttering speech therapy treatment”, speech therapy that helps an individual |
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82 | 82 | | 54to keep, learn or improve skills and functioning for daily living. |
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83 | 83 | | 55 “Rehabilitative services”, health care services that help a person restore or improve skills |
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84 | 84 | | 56and functioning for daily living that have been lost or impaired. |
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85 | 85 | | 57 “Rehabilitative stuttering speech therapy treatment”, speech therapy that helps an |
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86 | 86 | | 58individual restore or improve skills and functioning of daily life that have been lost or impaired. |
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87 | 87 | | 59 “Stuttering speech therapy”, therapeutic care provided to an individual for the treatment |
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88 | 88 | | 60of stuttering administered by a licensed speech language pathologist. |
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89 | 89 | | 61 “Telehealth”, the application of telecommunication technology to deliver speech therapy |
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90 | 90 | | 62services at a distance for assessment, intervention or consultation. |
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91 | 91 | | 63 “Utilization review”, a set of formal techniques designed to monitor the use of or |
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92 | 92 | | 64evaluate the medical necessity, appropriateness, efficacy or efficiency of health care services, |
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93 | 93 | | 65procedures or settings, including: prior authorization, second opinion, certification, concurrent |
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94 | 94 | | 66review, case management, discharge planning or retrospective review, in order to make a |
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95 | 95 | | 67determination regarding coverage of the service under the terms of a health insurance policy or |
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96 | 96 | | 68an agreement with the department of health and human services. |
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97 | 97 | | 69 (b) The division and its contracted health insurers, health plans, health maintenance |
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98 | 98 | | 70organizations and third-party administrators under contract to a Medicaid managed care |
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99 | 99 | | 71organization, primary care clinician plan or an accountable care organization shall provide |
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100 | 100 | | 72coverage for habilitative stuttering speech therapy treatment as a treatment for stuttering, |
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101 | 101 | | 73regardless of whether the stuttering is classified as developmental; (ii) rehabilitative services that 5 of 16 |
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102 | 102 | | 74shall provide coverage for rehabilitative stuttering speech therapy treatment as a treatment for |
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103 | 103 | | 75stuttering; or (iii) both habilitative services and rehabilitative services under clauses (i) and (ii). |
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104 | 104 | | 76 (c) Habilitative services and rehabilitative services coverage required under this section |
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105 | 105 | | 77shall not be: (i) subject to any maximum annual benefit limit, including any limits on the number |
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106 | 106 | | 78of visits an insured may make to a speech language pathologist; (ii) limited based on the type of |
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107 | 107 | | 79disease, injury, disorder or other medical condition that resulted in the stuttering; or (iii) subject |
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108 | 108 | | 80to utilization review or utilization management requirements, including prior authorization or a |
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109 | 109 | | 81determination that the speech therapy services are medically necessary. |
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110 | 110 | | 82 (d) Habilitative services and rehabilitative services required under this section shall |
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111 | 111 | | 83include coverage for speech therapy provided in person and via telehealth. Telehealth coverage |
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112 | 112 | | 84required under this subsection shall: (i) not be less than the coverage required for health benefit |
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113 | 113 | | 85plans; and (ii) include the use of any communication technology, application or platform to |
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114 | 114 | | 86deliver telehealth services, except coverage may be restricted to technology, applications or |
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115 | 115 | | 87platforms that are compliant with any applicable privacy provisions of the Federal Health |
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116 | 116 | | 88Insurance Portability and Accountability Act of 1996, 42 U.S.C. sec. 1320d et seq. |
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117 | 117 | | 89 (e) Habilitative services and rehabilitative services required under this section shall |
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118 | 118 | | 90include: (i) treatment of speech, language, voice, communication, fluency or auditory processing |
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119 | 119 | | 91disorder for individual service; and (ii) treatment of speech, language, voice, communication or |
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120 | 120 | | 92auditory processing disorder for group service with 2 or more individuals. |
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121 | 121 | | 93 SECTION 3. Chapter 175 of the General Laws is hereby amended by inserting after |
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122 | 122 | | 94section 47ZZ, added by section 3 of said chapter 231, the following section:- 6 of 16 |
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123 | 123 | | 95 Section 47AAA. (a) For the purposes of this section, the following words shall, unless the |
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124 | 124 | | 96context clearly requires otherwise, have the following meanings: |
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125 | 125 | | 97 “Habilitative services”, health care services that help a person keep, learn or improve |
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126 | 126 | | 98skills and functioning for daily living. |
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127 | 127 | | 99 “Habilitative stuttering speech therapy treatment”, speech therapy that helps an individual |
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128 | 128 | | 100to keep, learn or improve skills and functioning for daily living. |
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129 | 129 | | 101 “Rehabilitative services”, health care services that help a person restore or improve skills |
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130 | 130 | | 102and functioning for daily living that have been lost or impaired. |
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131 | 131 | | 103 “Rehabilitative stuttering speech therapy treatment”, speech therapy that helps an |
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132 | 132 | | 104individual restore or improve skills and functioning of daily life that have been lost or impaired. |
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133 | 133 | | 105 “Stuttering speech therapy”, therapeutic care provided to an individual for the treatment |
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134 | 134 | | 106of stuttering administered by a licensed speech language pathologist. |
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135 | 135 | | 107 “Telehealth”, the application of telecommunication technology to deliver speech therapy |
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136 | 136 | | 108services at a distance for assessment, intervention or consultation. |
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137 | 137 | | 109 “Utilization review”, a set of formal techniques designed to monitor the use of or |
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138 | 138 | | 110evaluate the medical necessity, appropriateness, efficacy or efficiency of health care services, |
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139 | 139 | | 111procedures or settings, including: prior authorization, second opinion, certification, concurrent |
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140 | 140 | | 112review, case management, discharge planning or retrospective review, in order to make a |
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141 | 141 | | 113determination regarding coverage of the service under the terms of a health insurance policy or |
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142 | 142 | | 114an agreement with the department of health and human services. 7 of 16 |
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143 | 143 | | 115 (b) An individual policy of accident and sickness insurance issued under section 108 that |
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144 | 144 | | 116provides hospital expense and surgical expense insurance and any group blanket or general |
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145 | 145 | | 117policy of accident and sickness insurance issued under section 110 that provides hospital expense |
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146 | 146 | | 118and surgical expense insurance, which is issued or renewed within or without the |
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147 | 147 | | 119commonwealth, shall provide coverage for the cost of: (i) habilitative services that shall provide |
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148 | 148 | | 120coverage for habilitative stuttering speech therapy treatment as a treatment for stuttering, |
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149 | 149 | | 121regardless of whether the stuttering is classified as developmental; (ii) rehabilitative services that |
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150 | 150 | | 122shall provide coverage for rehabilitative stuttering speech therapy treatment as a treatment for |
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151 | 151 | | 123stuttering; or (iii) both habilitative services and rehabilitative services under clauses (i) and (ii). |
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152 | 152 | | 124 (c) Habilitative services and rehabilitative services coverage required under this section |
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153 | 153 | | 125shall not be: (i) subject to any maximum annual benefit limit, including any limits on the number |
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154 | 154 | | 126of visits an insured may make to a speech language pathologist; (ii) limited based on the type of |
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155 | 155 | | 127disease, injury, disorder or other medical condition that resulted in the stuttering; or (iii) subject |
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156 | 156 | | 128to utilization review or utilization management requirements, including prior authorization or a |
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157 | 157 | | 129determination that the speech therapy services are medically necessary. |
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158 | 158 | | 130 (d) Habilitative services and rehabilitative services required under this section shall |
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159 | 159 | | 131include coverage for speech therapy provided in person and via telehealth. Telehealth coverage |
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160 | 160 | | 132required under this subsection shall: (i) not be less than the coverage required for health benefit |
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161 | 161 | | 133plans; and (ii) include the use of any communication technology, application or platform to |
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162 | 162 | | 134deliver telehealth services, except coverage may be restricted to technology, applications or |
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163 | 163 | | 135platforms that are compliant with any applicable privacy provisions of the Federal Health |
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164 | 164 | | 136Insurance Portability and Accountability Act of 1996, 42 U.S.C. sec. 1320d et seq. 8 of 16 |
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165 | 165 | | 137 (e) Habilitative services and rehabilitative services required under this section shall |
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166 | 166 | | 138include: (i) treatment of speech, language, voice, communication, fluency or auditory processing |
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167 | 167 | | 139disorder for individual service; and (ii) treatment of speech, language, voice, communication or |
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168 | 168 | | 140auditory processing disorder for group service with 2 or more individuals. |
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169 | 169 | | 141 SECTION 4. Chapter 176A of the General Laws is hereby amended by inserting after |
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170 | 170 | | 142section 8AAA, added by section 4 of said chapter 231, the following section:- |
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171 | 171 | | 143 Section 8BBB. (a) For the purposes of this section, the following words shall, unless the |
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172 | 172 | | 144context clearly requires otherwise, have the following meanings: |
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173 | 173 | | 145 “Habilitative services”, health care services that help a person keep, learn or improve |
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174 | 174 | | 146skills and functioning for daily living. |
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175 | 175 | | 147 “Habilitative stuttering speech therapy treatment”, speech therapy that helps an individual |
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176 | 176 | | 148to keep, learn or improve skills and functioning for daily living. |
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177 | 177 | | 149 “Rehabilitative services”, health care services that help a person restore or improve skills |
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178 | 178 | | 150and functioning for daily living that have been lost or impaired. |
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179 | 179 | | 151 “Rehabilitative stuttering speech therapy treatment”, speech therapy that helps an |
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180 | 180 | | 152individual restore or improve skills and functioning of daily life that have been lost or impaired. |
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181 | 181 | | 153 “Stuttering speech therapy”, therapeutic care provided to an individual for the treatment |
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182 | 182 | | 154of stuttering administered by a licensed speech language pathologist. |
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183 | 183 | | 155 “Telehealth”, the application of telecommunication technology to deliver speech therapy |
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184 | 184 | | 156services at a distance for assessment, intervention or consultation. 9 of 16 |
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185 | 185 | | 157 “Utilization review”, a set of formal techniques designed to monitor the use of or |
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186 | 186 | | 158evaluate the medical necessity, appropriateness, efficacy or efficiency of health care services, |
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187 | 187 | | 159procedures or settings, including: prior authorization, second opinion, certification, concurrent |
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188 | 188 | | 160review, case management, discharge planning or retrospective review, in order to make a |
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189 | 189 | | 161determination regarding coverage of the service under the terms of a health insurance policy or |
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190 | 190 | | 162an agreement with the department of health and human services. |
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191 | 191 | | 163 (b) Any contract between a subscriber and a corporation under an individual or group |
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192 | 192 | | 164hospital service plan which is delivered, issued or renewed within the commonwealth shall |
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193 | 193 | | 165provide coverage for habilitative stuttering speech therapy treatment as a treatment for stuttering, |
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194 | 194 | | 166regardless of whether the stuttering is classified as developmental; (ii) rehabilitative services that |
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195 | 195 | | 167shall provide coverage for rehabilitative stuttering speech therapy treatment as a treatment for |
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196 | 196 | | 168stuttering; or (iii) both habilitative services and rehabilitative services under clauses (i) and (ii). |
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197 | 197 | | 169 (c) Habilitative services and rehabilitative services coverage required under this section |
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198 | 198 | | 170shall not be: (i) subject to any maximum annual benefit limit, including any limits on the number |
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199 | 199 | | 171of visits an insured may make to a speech language pathologist; (ii) limited based on the type of |
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200 | 200 | | 172disease, injury, disorder or other medical condition that resulted in the stuttering; or (iii) subject |
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201 | 201 | | 173to utilization review or utilization management requirements, including prior authorization or a |
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202 | 202 | | 174determination that the speech therapy services are medically necessary. |
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203 | 203 | | 175 (d) Habilitative services and rehabilitative services required under this section shall |
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204 | 204 | | 176include coverage for speech therapy provided in person and via telehealth. Telehealth coverage |
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205 | 205 | | 177required under this subsection shall: (i) not be less than the coverage required for health benefit |
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206 | 206 | | 178plans; and (ii) include the use of any communication technology, application or platform to 10 of 16 |
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207 | 207 | | 179deliver telehealth services, except coverage may be restricted to technology, applications or |
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208 | 208 | | 180platforms that are compliant with any applicable privacy provisions of the Federal Health |
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209 | 209 | | 181Insurance Portability and Accountability Act of 1996, 42 U.S.C. sec. 1320d et seq. |
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210 | 210 | | 182 (e) Habilitative services and rehabilitative services required under this section shall |
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211 | 211 | | 183include: (i) treatment of speech, language, voice, communication, fluency or auditory processing |
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212 | 212 | | 184disorder for individual service; and (ii) treatment of speech, language, voice, communication or |
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213 | 213 | | 185auditory processing disorder for group service with 2 or more individuals. |
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214 | 214 | | 186 SECTION 5. Chapter 176B of the General Laws is hereby amended by inserting after |
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215 | 215 | | 187section 4AAA, added by section 5 of said chapter 231, the following section:- |
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216 | 216 | | 188 Section 4BBB. (a) For the purposes of this section, the following words shall, unless the |
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217 | 217 | | 189context clearly requires otherwise, have the following meanings: |
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218 | 218 | | 190 “Habilitative services”, health care services that help a person keep, learn or improve |
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219 | 219 | | 191skills and functioning for daily living. |
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220 | 220 | | 192 “Habilitative stuttering speech therapy treatment”, speech therapy that helps an individual |
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221 | 221 | | 193to keep, learn or improve skills and functioning for daily living. |
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222 | 222 | | 194 “Rehabilitative services”, health care services that help a person restore or improve skills |
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223 | 223 | | 195and functioning for daily living that have been lost or impaired. |
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224 | 224 | | 196 “Rehabilitative stuttering speech therapy treatment”, speech therapy that helps an |
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225 | 225 | | 197individual restore or improve skills and functioning of daily life that have been lost or impaired. |
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226 | 226 | | 198 “Stuttering speech therapy”, therapeutic care provided to an individual for the treatment |
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227 | 227 | | 199of stuttering administered by a licensed speech language pathologist. 11 of 16 |
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228 | 228 | | 200 “Telehealth”, the application of telecommunication technology to deliver speech therapy |
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229 | 229 | | 201services at a distance for assessment, intervention or consultation. |
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230 | 230 | | 202 “Utilization review”, a set of formal techniques designed to monitor the use of or |
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231 | 231 | | 203evaluate the medical necessity, appropriateness, efficacy or efficiency of health care services, |
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232 | 232 | | 204procedures or settings, including: prior authorization, second opinion, certification, concurrent |
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233 | 233 | | 205review, case management, discharge planning or retrospective review, in order to make a |
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234 | 234 | | 206determination regarding coverage of the service under the terms of a health insurance policy or |
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235 | 235 | | 207an agreement with the department of health and human services. |
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236 | 236 | | 208 (b) Any subscription certificate under an individual or group medical service agreement |
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237 | 237 | | 209delivered, issued or renewed within the commonwealth shall provide coverage for habilitative |
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238 | 238 | | 210stuttering speech therapy treatment as a treatment for stuttering, regardless of whether the |
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239 | 239 | | 211stuttering is classified as developmental; (ii) rehabilitative services that shall provide coverage |
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240 | 240 | | 212for rehabilitative stuttering speech therapy treatment as a treatment for stuttering; or (iii) both |
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241 | 241 | | 213habilitative services and rehabilitative services under clauses (i) and (ii). |
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242 | 242 | | 214 (c) Habilitative services and rehabilitative services coverage required under this section |
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243 | 243 | | 215shall not be: (i) subject to any maximum annual benefit limit, including any limits on the number |
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244 | 244 | | 216of visits an insured may make to a speech language pathologist; (ii) limited based on the type of |
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245 | 245 | | 217disease, injury, disorder or other medical condition that resulted in the stuttering; or (iii) subject |
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246 | 246 | | 218to utilization review or utilization management requirements, including prior authorization or a |
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247 | 247 | | 219determination that the speech therapy services are medically necessary. |
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248 | 248 | | 220 (d) Habilitative services and rehabilitative services required under this section shall |
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249 | 249 | | 221include coverage for speech therapy provided in person and via telehealth. Telehealth coverage 12 of 16 |
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250 | 250 | | 222required under this subsection shall: (i) not be less than the coverage required for health benefit |
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251 | 251 | | 223plans; and (ii) include the use of any communication technology, application or platform to |
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252 | 252 | | 224deliver telehealth services, except coverage may be restricted to technology, applications or |
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253 | 253 | | 225platforms that are compliant with any applicable privacy provisions of the Federal Health |
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254 | 254 | | 226Insurance Portability and Accountability Act of 1996, 42 U.S.C. sec. 1320d et seq. |
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255 | 255 | | 227 (e) Habilitative services and rehabilitative services required under this section shall |
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256 | 256 | | 228include: (i) treatment of speech, language, voice, communication, fluency or auditory processing |
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257 | 257 | | 229disorder for individual service; and (ii) treatment of speech, language, voice, communication or |
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258 | 258 | | 230auditory processing disorder for group service with 2 or more individuals. |
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259 | 259 | | 231 SECTION 6. Chapter 176G of the General Laws is hereby amended by inserting after |
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260 | 260 | | 232section 4SS, added by section 6 of said chapter 231, the following section:- |
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261 | 261 | | 233 Section 4TT. (a) For the purposes of this section, the following words shall, unless the |
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262 | 262 | | 234context clearly requires otherwise, have the following meanings: |
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263 | 263 | | 235 “Habilitative services”, health care services that help a person keep, learn or improve |
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264 | 264 | | 236skills and functioning for daily living. |
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265 | 265 | | 237 “Habilitative stuttering speech therapy treatment”, speech therapy that helps an individual |
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266 | 266 | | 238to keep, learn or improve skills and functioning for daily living. |
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267 | 267 | | 239 “Rehabilitative services”, health care services that help a person restore or improve skills |
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268 | 268 | | 240and functioning for daily living that have been lost or impaired. |
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269 | 269 | | 241 “Rehabilitative stuttering speech therapy treatment”, speech therapy that helps an |
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270 | 270 | | 242individual restore or improve skills and functioning of daily life that have been lost or impaired. 13 of 16 |
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271 | 271 | | 243 “Stuttering speech therapy”, therapeutic care provided to an individual for the treatment |
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272 | 272 | | 244of stuttering administered by a licensed speech language pathologist. |
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273 | 273 | | 245 “Telehealth”, the application of telecommunication technology to deliver speech therapy |
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274 | 274 | | 246services at a distance for assessment, intervention or consultation. |
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275 | 275 | | 247 “Utilization review”, a set of formal techniques designed to monitor the use of or |
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276 | 276 | | 248evaluate the medical necessity, appropriateness, efficacy or efficiency of health care services, |
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277 | 277 | | 249procedures or settings, including: prior authorization, second opinion, certification, concurrent |
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278 | 278 | | 250review, case management, discharge planning or retrospective review, in order to make a |
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279 | 279 | | 251determination regarding coverage of the service under the terms of a health insurance policy or |
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280 | 280 | | 252an agreement with the department of health and human services. |
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281 | 281 | | 253 (b) Any individual or group health maintenance contract shall provide coverage for |
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282 | 282 | | 254habilitative stuttering speech therapy treatment as a treatment for stuttering, regardless of |
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283 | 283 | | 255whether the stuttering is classified as developmental; (ii) rehabilitative services that shall provide |
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284 | 284 | | 256coverage for rehabilitative stuttering speech therapy treatment as a treatment for stuttering; or |
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285 | 285 | | 257(iii) both habilitative services and rehabilitative services under clauses (i) and (ii). |
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286 | 286 | | 258 (c) Habilitative services and rehabilitative services coverage required under this section |
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287 | 287 | | 259shall not be: (i) subject to any maximum annual benefit limit, including any limits on the number |
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288 | 288 | | 260of visits an insured may make to a speech language pathologist; (ii) limited based on the type of |
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289 | 289 | | 261disease, injury, disorder or other medical condition that resulted in the stuttering; or (iii) subject |
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290 | 290 | | 262to utilization review or utilization management requirements, including prior authorization or a |
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291 | 291 | | 263determination that the speech therapy services are medically necessary. 14 of 16 |
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292 | 292 | | 264 (d) Habilitative services and rehabilitative services required under this section shall |
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293 | 293 | | 265include coverage for speech therapy provided in person and via telehealth. Telehealth coverage |
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294 | 294 | | 266required under this subsection shall: (i) not be less than the coverage required for health benefit |
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295 | 295 | | 267plans; and (ii) include the use of any communication technology, application or platform to |
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296 | 296 | | 268deliver telehealth services, except coverage may be restricted to technology, applications or |
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297 | 297 | | 269platforms that are compliant with any applicable privacy provisions of the Federal Health |
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298 | 298 | | 270Insurance Portability and Accountability Act of 1996, 42 U.S.C. sec. 1320d et seq. |
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299 | 299 | | 271 (e) Habilitative services and rehabilitative services required under this section shall |
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300 | 300 | | 272include: (i) treatment of speech, language, voice, communication, fluency or auditory processing |
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301 | 301 | | 273disorder for individual service; and (ii) treatment of speech, language, voice, communication or |
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302 | 302 | | 274auditory processing disorder for group service with 2 or more individuals. |
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303 | 303 | | 275 SECTION 7. Chapter 176I of the General Laws is hereby amended by adding the |
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304 | 304 | | 276following section:- |
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305 | 305 | | 277 Section 14. (a) For the purposes of this section, the following words shall, unless the |
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306 | 306 | | 278context clearly requires otherwise, have the following meanings: |
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307 | 307 | | 279 “Habilitative services”, health care services that help a person keep, learn or improve |
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308 | 308 | | 280skills and functioning for daily living. |
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309 | 309 | | 281 “Habilitative stuttering speech therapy treatment”, speech therapy that helps an individual |
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310 | 310 | | 282to keep, learn or improve skills and functioning for daily living. |
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311 | 311 | | 283 “Rehabilitative services”, health care services that help a person restore or improve skills |
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312 | 312 | | 284and functioning for daily living that have been lost or impaired. 15 of 16 |
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313 | 313 | | 285 “Rehabilitative stuttering speech therapy treatment”, speech therapy that helps an |
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314 | 314 | | 286individual restore or improve skills and functioning of daily life that have been lost or impaired. |
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315 | 315 | | 287 “Stuttering speech therapy”, therapeutic care provided to an individual for the treatment |
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316 | 316 | | 288of stuttering administered by a licensed speech language pathologist. |
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317 | 317 | | 289 “Telehealth”, the application of telecommunication technology to deliver speech therapy |
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318 | 318 | | 290services at a distance for assessment, intervention or consultation. |
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319 | 319 | | 291 “Utilization review”, a set of formal techniques designed to monitor the use of or |
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320 | 320 | | 292evaluate the medical necessity, appropriateness, efficacy or efficiency of health care services, |
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321 | 321 | | 293procedures or settings, including: prior authorization, second opinion, certification, concurrent |
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322 | 322 | | 294review, case management, discharge planning or retrospective review, in order to make a |
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323 | 323 | | 295determination regarding coverage of the service under the terms of a health insurance policy or |
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324 | 324 | | 296an agreement with the department of health and human services. |
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325 | 325 | | 297 (b) An organization entering into a preferred provider contract shall provide coverage for |
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326 | 326 | | 298habilitative stuttering speech therapy treatment as a treatment for stuttering, regardless of |
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327 | 327 | | 299whether the stuttering is classified as developmental; (ii) rehabilitative services that shall provide |
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328 | 328 | | 300coverage for rehabilitative stuttering speech therapy treatment as a treatment for stuttering; or |
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329 | 329 | | 301(iii) both habilitative services and rehabilitative services under clauses (i) and (ii). |
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330 | 330 | | 302 (c) Habilitative services and rehabilitative services coverage required under this section |
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331 | 331 | | 303shall not be: (i) subject to any maximum annual benefit limit, including any limits on the number |
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332 | 332 | | 304of visits an insured may make to a speech language pathologist; (ii) limited based on the type of |
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333 | 333 | | 305disease, injury, disorder or other medical condition that resulted in the stuttering; or (iii) subject 16 of 16 |
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334 | 334 | | 306to utilization review or utilization management requirements, including prior authorization or a |
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335 | 335 | | 307determination that the speech therapy services are medically necessary. |
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336 | 336 | | 308 (d) Habilitative services and rehabilitative services required under this section shall |
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337 | 337 | | 309include coverage for speech therapy provided in person and via telehealth. Telehealth coverage |
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338 | 338 | | 310required under this subsection shall: (i) not be less than the coverage required for health benefit |
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339 | 339 | | 311plans; and (ii) include the use of any communication technology, application or platform to |
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340 | 340 | | 312deliver telehealth services, except coverage may be restricted to technology, applications or |
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341 | 341 | | 313platforms that are compliant with any applicable privacy provisions of the Federal Health |
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342 | 342 | | 314Insurance Portability and Accountability Act of 1996, 42 U.S.C. sec. 1320d et seq. |
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343 | 343 | | 315 (e) Habilitative services and rehabilitative services required under this section shall |
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344 | 344 | | 316include: (i) treatment of speech, language, voice, communication, fluency or auditory processing |
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345 | 345 | | 317disorder for individual service; and (ii) treatment of speech, language, voice, communication or |
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346 | 346 | | 318auditory processing disorder for group service with 2 or more individuals. |
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347 | 347 | | 319 SECTION 8. This act shall apply to all contracts entered into, renewed or amended on or |
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348 | 348 | | 320after January 1, 2026. |
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