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HOUSE DOCKET, NO. 1173 FILED ON: 1/14/2025
HOUSE . . . . . . . . . . . . . . . No. 1257
The Commonwealth of Massachusetts
_________________
PRESENTED BY:
Paul McMurtry and Brian W. Murray
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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 relative to ensuring treatment for genetic craniofacial conditions.
_______________
PETITION OF:
NAME:DISTRICT/ADDRESS :DATE ADDED:Paul McMurtry11th Norfolk1/14/2025Steven Owens29th Middlesex1/21/2025David Paul Linsky5th Middlesex1/21/2025Lindsay N. Sabadosa1st Hampshire1/22/2025Hannah Kane11th Worcester1/22/2025Joanne M. ComerfordHampshire, Franklin and Worcester1/22/2025Natalie M. Blais1st Franklin1/23/2025Aaron L. Saunders7th Hampden1/27/2025Sean Garballey23rd Middlesex1/29/2025Homar Gómez2nd Hampshire2/3/2025Thomas M. Stanley9th Middlesex2/3/2025Jacob R. OliveiraHampden, Hampshire and Worcester2/6/2025James B. EldridgeMiddlesex and Worcester2/10/2025Mindy Domb3rd Hampshire2/18/2025Joseph D. McKenna18th Worcester2/23/2025James C. Arena-DeRosa8th Middlesex3/3/2025David Henry Argosky LeBoeuf17th Worcester3/4/2025Thomas W. MoakleyBarnstable, Dukes and Nantucket3/10/2025 2 of 2
Jay D. Livingstone8th Suffolk3/10/2025 1 of 5
HOUSE DOCKET, NO. 1173 FILED ON: 1/14/2025
HOUSE . . . . . . . . . . . . . . . No. 1257
By Representatives McMurtry of Dedham and Murray of Milford, a petition (accompanied by
bill, House, No. 1257) of Paul McMurtry, Steven Owens and others relative to health insurance
coverage for treatment for genetic craniofacial conditions. Financial Services.
The Commonwealth of Massachusetts
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In the One Hundred and Ninety-Fourth General Court
(2025-2026)
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An Act relative to ensuring treatment for genetic craniofacial conditions.
Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
of the same, as follows:
1 SECTION 1. Chapter 32A of the General Laws is hereby amended by inserting after
2section 17S the following section:-
3 Section 17T. Any coverage offered by the commission to an active or retired employee of
4the commonwealth insured under the group insurance commission shall provide coverage for
5medically necessary functional repair or restoration of craniofacial disorders, with the exception
6of coverage for cleft lip and cleft palate which is prescribed under section 17J , to improve the
7function of, or to approximate the normal appearance or any abnormal structures caused by
8congenital disease of anomaly. Coverage under this section shall include the necessary care and
9treatment of ectodermal dysplasia, dentinogenesis imperfecta and amelogenesis imperfecta.
10Coverage under this section shall not include cosmetic surgery or for dental or orthodontic
11treatment unrelated to said congenital disease or anomaly. The benefits in this section shall not 2 of 5
12be subject to any greater deductible, coinsurance, copayments or out-of-pocket limits than any
13other benefit provided by the commission.
14 SECTION 2. Chapter 118E of the General Laws is hereby amended by inserting after
15section 10Q the following section:-
16 Section 10R. The division shall provide coverage for medically necessary functional
17repair or restoration of craniofacial disorders; with the exception of coverage for cleft lip and
18cleft palate which is prescribed pursuant to section 10G, to improve the function of, or to
19approximate the normal appearance of any abnormal structures caused by congenital disease or
20anomaly. Coverage under this section shall include the necessary care and treatment of
21ectodermal dysplasia, dentinogenesis imperfecta and amelogenesis imperfecta. Coverage under
22this section shall not include cosmetic surgery or for dental or orthodontic treatment unrelated to
23said congenital disease or anomaly. The benefits in this section shall not be subject to any greater
24deductible, coinsurance, copayments or out-of-pocket limits than any other benefit provided by
25the division.
26 SECTION 3. Chapter 175 of the General Laws is hereby amended by inserting after
27section 47UU the following section:-
28 Section 47VV. Any blanket or general policy of insurance under section 110 that
29provides hospital expense and surgical expense insurance and which is delivered, issued or
30subsequently renewed by agreement between the insurer and the policyholder in or outside of the
31commonwealth and any employees’ health and welfare fund that provides hospital expense and
32surgical expense benefits and which is delivered, issued or renewed to any person or group of
33persons in the commonwealth shall provide coverage for medically necessary functional repair 3 of 5
34or restoration of craniofacial disorders; with the exception of coverage for cleft lip and cleft
35palate which is prescribed under section 47BB, to improve the function of, or to approximate the
36normal appearance of any abnormal structures caused by congenital disease or anomaly.
37Coverage under this section shall include the necessary care and treatment of ectodermal
38dysplasia, dentinogenesis imperfecta and amelogenesis imperfecta. Coverage under this section
39shall not include cosmetic surgery or dental or orthodontic treatment unrelated to said congenital
40disease or anomaly. The benefits in this section shall not be subject to any greater deductible,
41coinsurance, copayments or out-of-pocket limits than any other benefit provided by the insurer.
42 SECTION 4. Chapter 176A of the General Laws is hereby amended by inserting after
43section 8VV, the following section:-
44 Section 8WW. Any contract between a subscriber and the corporation under an
45individual or group hospital service plan which is delivered, issued or renewed within the
46commonwealth shall provide coverage for medically necessary functional repair or restoration of
47craniofacial disorders; with the exception of coverage for cleft lip and cleft palate which is
48prescribed pursuant to section 8EE of this section, to improve the function of, or to approximate
49the normal appearance of any abnormal structures caused by congenital disease or anomaly.
50Coverage under this section shall include the necessary care and treatment of ectodermal
51dysplasia, dentinogenesis imperfecta and amelogenesis imperfecta. Coverage under this section
52shall not include cosmetic surgery or dental or orthodontic treatment unrelated to said congenital
53disease or anomaly. The benefits in this section shall not be subject to any greater deductible,
54coinsurance, copayments or out-of-pocket limits than any other benefit provided by the insurer. 4 of 5
55 SECTION 5. Chapter 176B of the General Laws is hereby amended by inserting after
56section 4VV the following section:-
57 Section 4WW. Any subscription certificate under an individual or group medical service
58agreement delivered, issued or renewed within the commonwealth shall provide coverage for
59medically necessary functional repair or restoration of craniofacial disorders; with the exception
60of coverage for cleft lip and cleft palate, to improve the function of, or to approximate the normal
61appearance of any abnormal structures caused by congenital disease or anomaly. Coverage under
62this section shall include the necessary care and treatment of ectodermal dysplasia,
63dentinogenesis imperfecta and amelogenesis imperfecta. Coverage under this section shall not
64include cosmetic surgery or dental or orthodontic treatment unrelated to said congenital disease
65or anomaly. The benefits in this section shall not be subject to any greater deductible,
66coinsurance, copayments or out-of-pocket limits than any other benefit provided by the insurer.
67 SECTION 6. Chapter 176G of the General Laws is hereby amended by inserting after
68section 4NN the following section:-
69 Section 4OO. Any individual or group health maintenance contract shall provide
70coverage for medically necessary functional repair or restoration of craniofacial disorders; with
71the exception of coverage for cleft lip and cleft palate which is prescribed under section 4W of
72this chapter, to improve the function of, or to approximate the normal appearance of any
73abnormal structures caused by congenital disease or anomaly. Coverage under this section shall
74include the necessary care and treatment of ectodermal dysplasia, dentinogenesis imperfecta and
75amelogenesis imperfecta. Coverage under this section shall not include cosmetic surgery or
76dental or orthodontic treatment unrelated to said congenital disease or anomaly. The benefits in 5 of 5
77this section shall not be subject to any greater deductible, coinsurance, copayments or out-of-
78pocket limits than any other benefit provided by the insurer.
79 SECTION 7. Chapter 176I of the General Laws, as so appearing, is hereby amended by
80inserting after section 13 the following section:-
81 Section 14 An organization entering into a preferred provider contract shall provide
82coverage for medically necessary functional repair or restoration of craniofacial disorders; with
83the exception of coverage for cleft lip and cleft palate which is prescribed under section 12 of
84this chapter, to improve the function of, or to approximate the normal appearance of any
85abnormal structures caused by congenital disease or anomaly. Coverage under this section shall
86include the necessary care and treatment of medically diagnosed congenital disease or anomaly,
87including, ectodermal dysplasia, dentinogenesis imperfecta, and amelogenesis imperfecta.
88Coverage under this section shall not include cosmetic surgery or dental or orthodontic treatment
89unrelated to congenital defects, developmental deformities, trauma, tumors, infections or disease.
90The benefits in this section shall not be subject to any greater deductible, coinsurance,
91copayments or out-of-pocket limits than any other benefit provided by the insurer.