Massachusetts 2025-2026 Regular Session

Massachusetts House Bill H1235 Compare Versions

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

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2	2	HOUSE DOCKET, NO. 4027 FILED ON: 1/17/2025
3	3	HOUSE . . . . . . . . . . . . . . . No. 1235
4	4	The Commonwealth of Massachusetts
5	5	_________________
6	6	PRESENTED BY:
7	7	John J. Lawn, Jr.
8	8	_________________
9	9	To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
10	10	Court assembled:
11	11	The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:
12	12	An Act updating the mandated benefit review process.
13	13	_______________
14	14	PETITION OF:
15	15	NAME:DISTRICT/ADDRESS :DATE ADDED:John J. Lawn, Jr.10th Middlesex1/17/2025Dennis C. Gallagher8th Plymouth1/23/2025 1 of 6
16	16	HOUSE DOCKET, NO. 4027 FILED ON: 1/17/2025
17	17	HOUSE . . . . . . . . . . . . . . . No. 1235
18	18	By Representative Lawn of Watertown, a petition (accompanied by bill, House, No. 1235) of
19	19	John J. Lawn, Jr. and Dennis C. Gallagher relative to the mandated benefit review process.
20	20	Financial Services.
21	21	The Commonwealth of Massachusetts
22	22	_______________
23	23	In the One Hundred and Ninety-Fourth General Court
24	24	(2025-2026)
25	25	_______________
26	26	An Act updating the mandated benefit review process.
27	27	Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
28	28	of the same, as follows:
29	29	1 SECTION 1. Chapter 3 of the General Laws is hereby amended by striking out section
30	30	238C, as so appearing, and inserting in place thereof the following section:-
31	31	3 Section 38C. (a) As used in this section, the following words shall, unless the context
32	32	4clearly requires otherwise, have the following meanings:-
33	33	5 “Center”, the center for health information and analysis established under chapter 12C.
34	34	6 “Mandated health benefit bill”, a bill that mandates health insurance coverage for (i)
35	35	7treatments or services from a particular type of health care provider or health care professional;
36	36	8(ii) screening, diagnosis, or treatment of a particular disease or condition; or (iii) a particular type
37	37	9of treatment or service, or of medical equipment, medical supplies, or drugs used in connection
38	38	10with a treatment or service, provided, that such coverage is offered as part of a policy or policies
39	39	11of group life and accidental death and dismemberment insurance covering persons in the service
40	40	12of the commonwealth, and group general or blanket insurance providing hospital, surgical, 2 of 6
41	41	13medical, dental, and other health insurance benefits covering persons in the service of the
42	42	14commonwealth, and their dependents organized under chapter 32A, individual or group health
43	43	15insurance policies offered by an insurer licensed or otherwise authorized to transact accident or
44	44	16health insurance organized under chapter 175, a nonprofit hospital service corporation organized
45	45	17under chapter 176A, a nonprofit medical service corporation organized under chapter 176B, a
46	46	18health maintenance organization organized under chapter 176G, or an organization entering into
47	47	19a preferred provider arrangement under chapter 176I, any health plan issued, renewed, or
48	48	20delivered within or without the commonwealth to a natural person who is a resident of the
49	49	21commonwealth, including a certificate issued to an eligible natural person which evidences
50	50	22coverage under a policy or contract issued to a trust or association for said natural person and his
51	51	23dependent, including said person's spouse organized under chapter 176M.
52	52	24 (b) The house and senate committees on ways and means when reporting favorably
53	53	25mandated health benefit bill referred to them, shall include a review and evaluation conducted by
54	54	26the center pursuant to this section.
55	55	27 (c) Upon the request of the house committee on ways and means or the senate committee
56	56	28on ways and means, the center shall conduct a review and evaluation of the mandated health
57	57	29benefit bill, in consultation with other relevant state agencies, and shall report to the committee
58	58	30within 180 days of the request, or pursuant to a timeline agreed to by the committee and the
59	59	31center. If the center fails to report to the appropriate committee within the allotted time, said
60	60	32committee may report favorably on the mandated health benefit bill without including a review
61	61	33and evaluation from the center. The center shall post each analysis on a searchable website as
62	62	34defined in section 14C of chapter 7 and make every analysis available to the public upon request. 3 of 6
63	63	35 (d) When reviewing a mandated health benefit bill the center shall prepare a written
64	64	36analysis with relevant data on the following:
65	65	37 (1) Public health impacts, including, but not limited to, the following:
66	66	38 (A) The impact on the health of the community, including the reduction of communicable
67	67	39disease and the benefits of prevention such as those provided by childhood immunizations and
68	68	40prenatal care.
69	69	41 (B) The impact on the health of the community, including diseases and conditions where
70	70	42disparities in outcomes associated with the social determinants of health as well as gender, race,
71	71	43sexual orientation, or gender identity are established in peer-reviewed scientific and medical
72	72	44literature.
73	73	45 (C) The extent to which the benefit or service reduces premature death and the economic
74	74	46loss associated with disease.
75	75	47 (2) Medical impacts, including, but not limited to, the following:
76	76	48 (A) The extent to which the benefit or service is generally recognized by the medical
77	77	49community as being effective in the screening, diagnosis, or treatment of a condition or disease,
78	78	50as demonstrated by a review of scientific and peer-reviewed medical literature.
79	79	51 (B) The extent to which the benefit or service is generally available and utilized by
80	80	52treating physicians.
81	81	53 (C) The contribution of the benefit or service to the health status of the population,
82	82	54including the results of any research demonstrating the efficacy of the benefit or service
83	83	55compared to alternatives, including not providing the benefit or service. 4 of 6
84	84	56 (D) The extent to which mandating the benefits or services would not diminish or
85	85	57eliminate access to currently available health care benefits or services.
86	86	58 (3) Financial impacts, including, but not limited to, the following:
87	87	59 (A) The extent to which the coverage will increase or decrease the benefit or cost of the
88	88	60benefit or service over the next 5 years.
89	89	61 (B) The extent to which the coverage will increase the utilization of the benefit or service,
90	90	62or will be a substitute for, or affect the cost of, alternative benefits or services over the next 5
91	91	63years.
92	92	64 (C) The extent to which the coverage will increase or decrease the administrative
93	93	65expenses of health care service plans and health insurers and the premium and expenses of
94	94	66subscribers, enrollees, and policyholders.
95	95	67 (D) The impact of this coverage on anticipated costs or savings estimated upon
96	96	68implementation for one subsequent calendar year, or, if applicable, two subsequent calendar
97	97	69years through a long-range estimate.
98	98	70 (E) The potential cost or savings to the private sector, including the impact on large and
99	99	71small employers, employees and nongroup purchasers, other retirement systems funded by the
100	100	72state or by a local government, individuals purchasing individual health insurance and publicly
101	101	73funded state health insurance programs, including MassHealth and the Massachusetts Health
102	102	74Connector
103	103	75 (F) The extent to which costs resulting from lack of coverage or are or would be shifted
104	104	76to other payers, including both public and private entities. 5 of 6
105	105	77 (G) The extent to the costs to health care consumers of not mandating the benefit in terms
106	106	78of out-of-pocket costs for treatment or delayed treatment.
107	107	79 (H) The extent to which mandating the proposed benefit or service would not diminish or
108	108	80eliminate access to currently available health care benefits or services over the next 5 years.
109	109	81 (I) The extent to which the benefit or service is generally utilized by a significant portion
110	110	82of the population
111	111	83 (J) The extent to which health care coverage for the benefit or service is already generally
112	112	84available.
113	113	85 (K) The level of public demand for health care coverage for the benefit or service,
114	114	86including the level of interest of collective bargaining agents in negotiating privately for
115	115	87inclusion of this coverage in group contracts, and the extent to which the mandated benefit or
116	116	88service is covered by self-funded employer groups.
117	117	89 (L) The impact of this coverage on the total cost of health care.
118	118	90 (M) In assessing and preparing a written analysis of the financial impact of legislation
119	119	91proposing to mandate a benefit or service pursuant to this paragraph, the center shall use a
120	120	92certified actuary or other person with relevant knowledge and expertise to determine the
121	121	93financial impact.
122	122	94 (4) The impact on essential health benefits, as defined in 956 CMR 5.00 and 42 U.S.C. §
123	123	9518022(b), and the impact on the Massachusetts Health Connector.
124	124	96 (5) Legislative impacts on health insurance benefit design, cost sharing, premiums, and
125	125	97other health insurance topics. 6 of 6
126	126	98 (6) The medical efficacy of mandating the benefit, including the impact of the benefit to
127	127	99the quality of patient care and the health status of the population and the results of any research
128	128	100demonstrating the medical efficacy of the treatment or service compared to alternative treatments
129	129	101or services or not providing the treatment or service.
130	130	102 (7) If the legislation seeks to mandate coverage of an additional class of practitioners, the
131	131	103results of any professionally acceptable research demonstrating the medical results achieved by
132	132	104the additional class of practitioners relative to those already covered and the methods of the
133	133	105appropriate professional organization that assures clinical proficiency.
134	134	106 (e) The center shall issue a comprehensive report at least once every 5 years on the cost
135	135	107and public health impact of all existing mandated benefits. In conjunction with this review, the
136	136	108center shall consult with the department of public health and the University of Massachusetts
137	137	109Medical School in a clinical review of all mandated benefits to ensure that all mandated benefits
138	138	110continue to conform to existing standards of care in terms of clinical appropriateness or
139	139	111evidence-based medicine. The center may file legislation that would amend or repeal existing
140	140	112mandated benefits that no longer meet these standards.