Massachusetts 2025-2026 Regular Session

Massachusetts House Bill H1315 Compare Versions

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

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2	2	HOUSE DOCKET, NO. 3884 FILED ON: 1/17/2025
3	3	HOUSE . . . . . . . . . . . . . . . No. 1315
4	4	The Commonwealth of Massachusetts
5	5	_________________
6	6	PRESENTED BY:
7	7	Lindsay N. Sabadosa
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 IUD pain management coverage.
13	13	_______________
14	14	PETITION OF:
15	15	NAME:DISTRICT/ADDRESS :DATE ADDED:Lindsay N. Sabadosa1st Hampshire1/17/2025Rebecca L. RauschNorfolk, Worcester and Middlesex1/22/2025Samantha Montaño15th Suffolk2/3/2025Danillo A. Sena37th Middlesex2/5/2025John H. Rogers12th Norfolk2/5/2025Marjorie C. Decker25th Middlesex2/14/2025Erika Uyterhoeven27th Middlesex2/19/2025Natalie M. Higgins4th Worcester2/24/2025Manny Cruz7th Essex2/25/2025James C. Arena-DeRosa8th Middlesex3/1/2025 1 of 8
16	16	HOUSE DOCKET, NO. 3884 FILED ON: 1/17/2025
17	17	HOUSE . . . . . . . . . . . . . . . No. 1315
18	18	By Representative Sabadosa of Northampton, a petition (accompanied by bill, House, No. 1315)
19	19	of Lindsay N. Sabadosa and others relative to IUD pain management coverage. Financial
20	20	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 relative to IUD pain management coverage.
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 32A of the General Laws, as appearing in the 2022 official edition,
30	30	2is hereby amended by inserting after Section 28(h) the following section:
31	31	3 Section 28. (i) Any coverage offered by the commission to any active or retired employee
32	32	4of the commonwealth insured under the group insurance commission shall provide coverage for
33	33	5pain control methods during intrauterine device insertion, including but not limited to
34	34	6intravenous sedation, oral sedation, nitrous oxide, local anesthesia, or topical anesthesia as
35	35	7prescribed by a provider, acting within their scope of practice.
36	36	8 (j) (1) Coverage provided under subjection (g) shall not be subject to any deductible,
37	37	9coinsurance, copayment or any other cost-sharing requirement, except as provided for in
38	38	10subclauses (A) and (B) of clause (i) of subsection (a) or as otherwise required under federal law.
39	39	11Coverage offered under this section shall not impose unreasonable restrictions or delays in the 2 of 8
40	40	12coverage; provided, however, that reasonable medical management techniques may be applied to
41	41	13coverage within a method category, as defined by the FDA, but not across types of methods.
42	42	14 (2) Benefits for an enrollee under this section shall also be provided for such enrollee’s
43	43	15covered spouse and covered dependents.
44	44	16 (3) Nothing in this section shall be construed to deny or restrict in any way the group
45	45	17insurance commission’s authority to ensure plan compliance with this chapter.
46	46	18 SECTION 2. Chapter 118E of the General Laws, as appearing in the 2022 official
47	47	19edition, is hereby amended by inserting in section 10K the following subsections:
48	48	20 (g) The division and its contracted health insurers, health plans, health maintenance
49	49	21organizations, behavioral health management firms and third-party administrators under contract
50	50	22to a Medicaid managed care organization or primary care clinician plan shall provide coverage
51	51	23for pain control methods during interuterine device insertion, including but not limited to
52	52	24intravenous sedation, oral sedation, nitrous oxide, local anesthesia, or topical anesthesia as
53	53	25prescribed by a provider, acting within their scope of practice.
54	54	26 (h) (1) Coverage provided under subjection (g) shall not be subject to any deductible,
55	55	27coinsurance, copayment or any other cost-sharing requirement, except as provided for in
56	56	28subclauses (A) and (B) of clause (i) of subsection (a) or as otherwise required under federal law.
57	57	29Coverage provided under this section shall not impose unreasonable restrictions or delays in the
58	58	30coverage; provided, however, that reasonable medical management techniques may be applied to
59	59	31coverage within a method category, as defined by the FDA, but not across types of methods. 3 of 8
60	60	32 (2) Benefits for an enrollee under this section shall be the same for such enrollee’s
61	61	33covered spouse and covered dependents.
62	62	34 (3) Nothing in this section shall be construed to deny or restrict in any way the division of
63	63	35medical assistance’s authority to ensure its contracted health insurers, health plans, health
64	64	36maintenance organizations, behavioral health management firms and third-party administrators
65	65	37under contract to a Medicaid managed care organization or primary care clinician plan are in
66	66	38compliance with this chapter.
67	67	39 SECTION 3. Chapter 175 of the General Laws, as appearing in the 2022 official edition,
68	68	40is hereby amended by inserting after section 47W(j) the following subsections:
69	69	41 (k) An individual policy of accident and sickness insurance issued pursuant to section
70	70	42108 that provides hospital expense and surgical expense and any group blanket policy of accident
71	71	43and sickness insurance issued pursuant to section 110 that provides hospital expense and surgical
72	72	44expense insurance, delivered, issued or renewed by agreement between the insurer and the
73	73	45policyholder, within or without the Commonwealth, (hereinafter “policy”) shall provide benefits
74	74	46for residents of the Commonwealth and all group members having a principal place of
75	75	47employment within the Commonwealth coverage for pain control methods during interuterine
76	76	48device insertion, including but not limited to intravenous sedation, oral sedation, nitrous oxide,
77	77	49local anesthesia, or topical anesthesia as prescribed by a provider, acting within their scope of
78	78	50practice.
79	79	51 (l) (1) Coverage provided under subsection (k) shall not be subject to any deductible,
80	80	52coinsurance, copayment or any other cost-sharing requirement, except as provided for in
81	81	53subclauses (A) and (B) of clause (i) of subsection (d) or as otherwise required under federal law. 4 of 8
82	82	54Coverage offered under said subsection (d) shall not impose unreasonable restrictions or delays
83	83	55in the coverage, in accordance with the requirements of chapter 176O; provided, however, that
84	84	56reasonable medical management techniques may be applied to coverage within a method
85	85	57category, as defined by the FDA, but not across types of methods.
86	86	58 (2) Benefits for an enrollee shall be the same for such enrollee’s covered spouse and
87	87	59covered dependents.
88	88	60 (m) A policy of accident and sickness insurance that is purchased by an employer that is a
89	89	61church or qualified church-controlled organization shall be exempt from subsection (k) at the
90	90	62request of the employer.
91	91	63 (n) The commissioner of insurance shall ensure that plans issued under subsection (k)
92	92	64comply with this chapter.
93	93	65 (o) For purposes of this section, the definitions in subsection (j) apply.
94	94	66 SECTION 4. Chapter 176A of the General Laws, as appearing in the 2022 official
95	95	67edition, is hereby amended by inserting after section 8W(j) the following subsections:
96	96	68 (k) Any contract between a subscriber and the corporation under an individual or group
97	97	69hospital service plan that is delivered, issued or renewed within or without the Commonwealth
98	98	70and that provides benefits for outpatient services shall provide to all individual subscribers and
99	99	71members within the Commonwealth and to all group members having a principal place of
100	100	72employment within the Commonwealth coverage for pain control methods during interuterine
101	101	73device insertion, including but not limited to intravenous sedation, oral sedation, nitrous oxide, 5 of 8
102	102	74local anesthesia, or topical anesthesia as prescribed by a provider, acting within their scope of
103	103	75practice.
104	104	76 (l) Coverage provided under subsection (k) shall not be subject to any deductible,
105	105	77coinsurance, copayment or any cost-sharing requirement except as provided for in subclauses
106	106	78(A) and (B) of clause (i) of subsection (d) or as otherwise required under federal law. Coverage
107	107	79offered under subsection (k) shall not impose any unreasonable restriction or delay in the
108	108	80coverage, in accordance with the requirements of chapter 176O; provided, however, that
109	109	81reasonable medical management techniques may be applied to coverage within a method
110	110	82category, as defined by the FDA, but not across types of methods.
111	111	83 (m) (1) The requirements of subsection (k) shall not apply to a contract between a
112	112	84subscriber and a corporation under an individual or group hospital service plan that is delivered,
113	113	85issued, or renewed within or without the Commonwealth that is purchased by an employer that is
114	114	86a church or qualified church-controlled organization.
115	115	87 (2) A church or qualified church-controlled organization that invokes the exemption
116	116	88provided under subsection (m)(1) shall provide written notice to prospective enrollees prior to
117	117	89enrollment with the plan, listing the contraceptive health care methods and services such
118	118	90employer refuses to cover for religious reasons.
119	119	91 (n) Nothing in this subsection shall be construed to deny or restrict in any way the
120	120	92division of insurance’s authority to ensure contract compliance with this chapter.
121	121	93 (o) For purposes of this section, the definitions set forth in section (j) of this Chapter shall
122	122	94apply, unless the context clearly requires otherwise. 6 of 8
123	123	95 SECTION 5. Chapter 176B of the General Laws, as appearing in the 2022 official
124	124	96edition, is hereby amended by inserting after section 4W(j) the following subsections:
125	125	97 (k) Any subscription certificate under an individual or group medical service agreement
126	126	98that is delivered, issued or renewed within or without the Commonwealth and that provides
127	127	99benefits for outpatient services shall provide to all individual subscribers and members within the
128	128	100Commonwealth and to all group members having a principal place of employment within the
129	129	101Commonwealth coverage for all of the following services and contraceptive methods for pain
130	130	102control methods during intrauterine device insertion, including but not limited to intravenous
131	131	103sedation, oral sedation, nitrous oxide, local anesthesia, or topical anesthesia as prescribed by a
132	132	104provider, acting within their scope of practice.
133	133	105 (l) (1) A medical service agreement subject to subsection (k) shall not impose a
134	134	106deductible, coinsurance, copayment or any other cost-sharing requirement on the coverage
135	135	107provided.
136	136	108 (2) Benefits for an enrollee under this subsection shall be the same for such enrollee’s
137	137	109covered spouse and covered dependents.
138	138	110 (m) (1) The requirements of this subsection shall not apply to a medical service
139	139	111agreement that is delivered, issued, or renewed within or without the Commonwealth that is
140	140	112purchased by an employer that is a church or qualified church-controlled organization.
141	141	113 (2) A church or qualified church-controlled organization that invokes the exemption
142	142	114provided under subsection (m)(1) shall provide written notice to prospective enrollees prior to
143	143	115enrollment with the plan, listing the contraceptive health care methods and services the employer
144	144	116refuses to cover for religious reasons. 7 of 8
145	145	117 (n) Nothing in this subsection shall be construed to deny or restrict in any way the
146	146	118division of insurance’s authority to ensure medical service agreement compliance with this
147	147	119chapter.
148	148	120 (o) For purposes of this section, the definitions set forth in subsection (j) shall apply,
149	149	121unless the context clearly requires otherwise.
150	150	122 SECTION 6. Chapter 176G of the General Laws, as appearing in the 2022 official
151	151	123edition, is hereby amended by inserting after section 4O(c) the following subsections:
152	152	124 (d) Any individual or group health maintenance contract that is issued, renewed or
153	153	125delivered within or without the Commonwealth and that provides benefits for outpatient
154	154	126prescription drugs or devices shall provide to residents of the Commonwealth and to persons
155	155	127having a principal place of employment within the Commonwealth coverage for pain control
156	156	128methods during intrauterine device insertion, including but not limited to intravenous sedation,
157	157	129oral sedation, nitrous oxide, local anesthesia, or topical anesthesia as prescribed by a provider,
158	158	130acting within their scope of practice.
159	159	131 (e) (1) Coverage provided under subsection (d) shall not be subject to any deductible,
160	160	132coinsurance, copayment or any other cost-sharing requirement except as provided for in
161	161	133subclauses (A) and (B) of clause (i) of subsection (d) or otherwise as required under federal law.
162	162	134Coverage offered under said subsection (d) shall not impose unreasonable restrictions or delays
163	163	135in the coverage, in accordance with the requirements of chapter 176O; provided, however, that
164	164	136reasonable medical management techniques may be applied to coverage within a method
165	165	137category, as defined by the FDA, but not across types of methods. 8 of 8
166	166	138 (2) Benefits for an enrollee under this section shall be the same for such enrollee’s
167	167	139covered spouse and covered dependents.
168	168	140 (f) (1) The requirements of this subsection shall not apply to a health maintenance
169	169	141contract if that policy is purchased by an employer that is a church or qualified church-controlled
170	170	142organization.
171	171	143 (2) A church or qualified church-controlled organization that invokes the exemption
172	172	144provided under subsection (f)(1) shall provide written notice to prospective enrollees prior to
173	173	145enrollment with the plan, listing the contraceptive health care services the employer refuses to
174	174	146cover for religious reasons.
175	175	147 (g) Nothing in this subsection shall be construed to deny or restrict in any way the
176	176	148division of insurance’s authority to ensure health maintenance contract compliance with this
177	177	149chapter.
178	178	150 (h) For purposes of this section, the definitions in subjection (j) shall apply, unless the
179	179	151context clearly requires otherwise.
180	180	152 SECTION 7. Sections 1 through 6 of this act shall apply to all policies, contracts and
181	181	153certificates of health insurance subject to chapters 32A, chapter 118E, chapter 175, chapter
182	182	154176A, chapter 176B, and chapter 176G which are delivered, issued or renewed on or after
183	183	155September 1, 2026.