Massachusetts House Bill H1257

Massachusetts 2025-2026 Regular Session

• Introduced: 2/27/25
• Refer: 2/27/25

Caption

Relative to ensuring treatment for genetic craniofacial conditions

Impact

If enacted, HB 1257 would significantly alter existing health insurance policies and will likely prompt local insurance companies to re-evaluate their coverage criteria. By mandating coverage for specific craniofacial conditions, the bill not only enhances access to necessary medical treatments but also seeks to alleviate the financial burdens associated with managing such disorders. This enhancement in coverage aims to support patients in improving both the function and appearance of affected structures resulting from congenital issues, thereby positively affecting their quality of life.

Summary

House Bill 1257 aims to ensure that health insurance coverage is extended to medically necessary functional repair or restoration of craniofacial disorders for both active and retired employees of the Commonwealth of Massachusetts. This includes treatments for ectodermal dysplasia, dentinogenesis imperfecta, and amelogenesis imperfecta, but notably excludes cosmetic surgery and dental or orthodontic treatments that are not related to these congenital diseases or anomalies. The bill proposes amendments to several chapters of the General Laws to formalize these requirements and ensure equitable treatment under health plans.

Contention

There may be points of contention regarding what constitutes 'medically necessary' treatment and how these guidelines will be interpreted by health insurance providers. The bill specifically notes exclusions for cosmetic surgery, which could lead to disputes over cases where functional and cosmetic needs overlap. Additionally, the bill's financial implications for health insurance companies may lead to debates concerning potential increases in premiums or adjustments in coverage for other services as insurers adapt to these new mandates.