Massachusetts 2025-2026 Regular Session

Massachusetts House Bill H1257 Compare Versions

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

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2	2	HOUSE DOCKET, NO. 1173 FILED ON: 1/14/2025
3	3	HOUSE . . . . . . . . . . . . . . . No. 1257
4	4	The Commonwealth of Massachusetts
5	5	_________________
6	6	PRESENTED BY:
7	7	Paul McMurtry and Brian W. Murray
8	8	_________________
9	9	To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
10	10	Court assembled:
11	11	The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:
12	12	An Act relative to ensuring treatment for genetic craniofacial conditions.
13	13	_______________
14	14	PETITION OF:
15	15	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
16	16	Jay D. Livingstone8th Suffolk3/10/2025 1 of 5
17	17	HOUSE DOCKET, NO. 1173 FILED ON: 1/14/2025
18	18	HOUSE . . . . . . . . . . . . . . . No. 1257
19	19	By Representatives McMurtry of Dedham and Murray of Milford, a petition (accompanied by
20	20	bill, House, No. 1257) of Paul McMurtry, Steven Owens and others relative to health insurance
21	21	coverage for treatment for genetic craniofacial conditions. Financial Services.
22	22	The Commonwealth of Massachusetts
23	23	_______________
24	24	In the One Hundred and Ninety-Fourth General Court
25	25	(2025-2026)
26	26	_______________
27	27	An Act relative to ensuring treatment for genetic craniofacial conditions.
28	28	Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
29	29	of the same, as follows:
30	30	1 SECTION 1. Chapter 32A of the General Laws is hereby amended by inserting after
31	31	2section 17S the following section:-
32	32	3 Section 17T. Any coverage offered by the commission to an active or retired employee of
33	33	4the commonwealth insured under the group insurance commission shall provide coverage for
34	34	5medically necessary functional repair or restoration of craniofacial disorders, with the exception
35	35	6of coverage for cleft lip and cleft palate which is prescribed under section 17J , to improve the
36	36	7function of, or to approximate the normal appearance or any abnormal structures caused by
37	37	8congenital disease of anomaly. Coverage under this section shall include the necessary care and
38	38	9treatment of ectodermal dysplasia, dentinogenesis imperfecta and amelogenesis imperfecta.
39	39	10Coverage under this section shall not include cosmetic surgery or for dental or orthodontic
40	40	11treatment unrelated to said congenital disease or anomaly. The benefits in this section shall not 2 of 5
41	41	12be subject to any greater deductible, coinsurance, copayments or out-of-pocket limits than any
42	42	13other benefit provided by the commission.
43	43	14 SECTION 2. Chapter 118E of the General Laws is hereby amended by inserting after
44	44	15section 10Q the following section:-
45	45	16 Section 10R. The division shall provide coverage for medically necessary functional
46	46	17repair or restoration of craniofacial disorders; with the exception of coverage for cleft lip and
47	47	18cleft palate which is prescribed pursuant to section 10G, to improve the function of, or to
48	48	19approximate the normal appearance of any abnormal structures caused by congenital disease or
49	49	20anomaly. Coverage under this section shall include the necessary care and treatment of
50	50	21ectodermal dysplasia, dentinogenesis imperfecta and amelogenesis imperfecta. Coverage under
51	51	22this section shall not include cosmetic surgery or for dental or orthodontic treatment unrelated to
52	52	23said congenital disease or anomaly. The benefits in this section shall not be subject to any greater
53	53	24deductible, coinsurance, copayments or out-of-pocket limits than any other benefit provided by
54	54	25the division.
55	55	26 SECTION 3. Chapter 175 of the General Laws is hereby amended by inserting after
56	56	27section 47UU the following section:-
57	57	28 Section 47VV. Any blanket or general policy of insurance under section 110 that
58	58	29provides hospital expense and surgical expense insurance and which is delivered, issued or
59	59	30subsequently renewed by agreement between the insurer and the policyholder in or outside of the
60	60	31commonwealth and any employees’ health and welfare fund that provides hospital expense and
61	61	32surgical expense benefits and which is delivered, issued or renewed to any person or group of
62	62	33persons in the commonwealth shall provide coverage for medically necessary functional repair 3 of 5
63	63	34or restoration of craniofacial disorders; with the exception of coverage for cleft lip and cleft
64	64	35palate which is prescribed under section 47BB, to improve the function of, or to approximate the
65	65	36normal appearance of any abnormal structures caused by congenital disease or anomaly.
66	66	37Coverage under this section shall include the necessary care and treatment of ectodermal
67	67	38dysplasia, dentinogenesis imperfecta and amelogenesis imperfecta. Coverage under this section
68	68	39shall not include cosmetic surgery or dental or orthodontic treatment unrelated to said congenital
69	69	40disease or anomaly. The benefits in this section shall not be subject to any greater deductible,
70	70	41coinsurance, copayments or out-of-pocket limits than any other benefit provided by the insurer.
71	71	42 SECTION 4. Chapter 176A of the General Laws is hereby amended by inserting after
72	72	43section 8VV, the following section:-
73	73	44 Section 8WW. Any contract between a subscriber and the corporation under an
74	74	45individual or group hospital service plan which is delivered, issued or renewed within the
75	75	46commonwealth shall provide coverage for medically necessary functional repair or restoration of
76	76	47craniofacial disorders; with the exception of coverage for cleft lip and cleft palate which is
77	77	48prescribed pursuant to section 8EE of this section, to improve the function of, or to approximate
78	78	49the normal appearance of any abnormal structures caused by congenital disease or anomaly.
79	79	50Coverage under this section shall include the necessary care and treatment of ectodermal
80	80	51dysplasia, dentinogenesis imperfecta and amelogenesis imperfecta. Coverage under this section
81	81	52shall not include cosmetic surgery or dental or orthodontic treatment unrelated to said congenital
82	82	53disease or anomaly. The benefits in this section shall not be subject to any greater deductible,
83	83	54coinsurance, copayments or out-of-pocket limits than any other benefit provided by the insurer. 4 of 5
84	84	55 SECTION 5. Chapter 176B of the General Laws is hereby amended by inserting after
85	85	56section 4VV the following section:-
86	86	57 Section 4WW. Any subscription certificate under an individual or group medical service
87	87	58agreement delivered, issued or renewed within the commonwealth shall provide coverage for
88	88	59medically necessary functional repair or restoration of craniofacial disorders; with the exception
89	89	60of coverage for cleft lip and cleft palate, to improve the function of, or to approximate the normal
90	90	61appearance of any abnormal structures caused by congenital disease or anomaly. Coverage under
91	91	62this section shall include the necessary care and treatment of ectodermal dysplasia,
92	92	63dentinogenesis imperfecta and amelogenesis imperfecta. Coverage under this section shall not
93	93	64include cosmetic surgery or dental or orthodontic treatment unrelated to said congenital disease
94	94	65or anomaly. The benefits in this section shall not be subject to any greater deductible,
95	95	66coinsurance, copayments or out-of-pocket limits than any other benefit provided by the insurer.
96	96	67 SECTION 6. Chapter 176G of the General Laws is hereby amended by inserting after
97	97	68section 4NN the following section:-
98	98	69 Section 4OO. Any individual or group health maintenance contract shall provide
99	99	70coverage for medically necessary functional repair or restoration of craniofacial disorders; with
100	100	71the exception of coverage for cleft lip and cleft palate which is prescribed under section 4W of
101	101	72this chapter, to improve the function of, or to approximate the normal appearance of any
102	102	73abnormal structures caused by congenital disease or anomaly. Coverage under this section shall
103	103	74include the necessary care and treatment of ectodermal dysplasia, dentinogenesis imperfecta and
104	104	75amelogenesis imperfecta. Coverage under this section shall not include cosmetic surgery or
105	105	76dental or orthodontic treatment unrelated to said congenital disease or anomaly. The benefits in 5 of 5
106	106	77this section shall not be subject to any greater deductible, coinsurance, copayments or out-of-
107	107	78pocket limits than any other benefit provided by the insurer.
108	108	79 SECTION 7. Chapter 176I of the General Laws, as so appearing, is hereby amended by
109	109	80inserting after section 13 the following section:-
110	110	81 Section 14 An organization entering into a preferred provider contract shall provide
111	111	82coverage for medically necessary functional repair or restoration of craniofacial disorders; with
112	112	83the exception of coverage for cleft lip and cleft palate which is prescribed under section 12 of
113	113	84this chapter, to improve the function of, or to approximate the normal appearance of any
114	114	85abnormal structures caused by congenital disease or anomaly. Coverage under this section shall
115	115	86include the necessary care and treatment of medically diagnosed congenital disease or anomaly,
116	116	87including, ectodermal dysplasia, dentinogenesis imperfecta, and amelogenesis imperfecta.
117	117	88Coverage under this section shall not include cosmetic surgery or dental or orthodontic treatment
118	118	89unrelated to congenital defects, developmental deformities, trauma, tumors, infections or disease.
119	119	90The benefits in this section shall not be subject to any greater deductible, coinsurance,
120	120	91copayments or out-of-pocket limits than any other benefit provided by the insurer.