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SENATE DOCKET, NO. 631 FILED ON: 1/14/2025
SENATE . . . . . . . . . . . . . . No. 683
The Commonwealth of Massachusetts
_________________
PRESENTED BY:
Cynthia Stone Creem
_________________
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 special education health care costs.
_______________
PETITION OF:
NAME:DISTRICT/ADDRESS :Cynthia Stone CreemNorfolk and Middlesex 1 of 11
SENATE DOCKET, NO. 631 FILED ON: 1/14/2025
SENATE . . . . . . . . . . . . . . No. 683
By Ms. Creem, a petition (accompanied by bill, Senate, No. 683) of Cynthia Stone Creem for
legislation relative to special education health care costs. Financial Services.
[SIMILAR MATTER FILED IN PREVIOUS SESSION
SEE SENATE, NO. 597 OF 2023-2024.]
The Commonwealth of Massachusetts
_______________
In the One Hundred and Ninety-Fourth General Court
(2025-2026)
_______________
An Act relative to special education health care costs.
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 adding the
2following section:-
3 Section 34. The commission shall provide to an active or retired employee of the
4commonwealth who is insured under the group insurance commission benefits on a
5nondiscriminatory basis for the medically necessary treatment for disease, illness, injury, or
6bodily dysfunction which are required by a student’s individual education program,
7individualized family service plan, individualized service plan or the federal Individuals with
8Disabilities Education Improvement Act.
9 In order to obtain coverage, school districts shall request, but not require, the child’s
10family to provide information about the child’s coverage when a child with a disability begins to 2 of 11
11receive services from the district of a type that are reimbursable and shall request, but may not
12require, updated information as needed.
13 (a) In order to access benefits, a school district must:
14 (i) obtain annual written informed consent from the parent or legal guardian.
15 (1) When obtaining informed consent, the school district must notify the legal guardian
16(a) that the cost of the person's private health insurance premium may increase due to providing
17the covered service in the school setting, (b) that the school district may pay certain enrollee
18health plan costs, including but not limited to, co-payments, coinsurance, deductibles, premium
19increases or other enrollee cost-sharing amounts for health and related services required by an
20individual service plan, or individualized family service plan, and (c) that the school's billing for
21each type of covered service may affect service limits and prior authorization thresholds. The
22informed consent may be revoked in writing at any time by the person authorizing the billing of
23the health plan;
24 (ii) inform the parent or legal representative that a refusal to permit the district to access
25their private health care coverage does not relieve the district of its responsibility to provide all
26services necessary to provide free and appropriate public education at no cost to the parent or
27legal representative.
28 (b) To the extent required by federal law, a school district may not require parents of
29children with disabilities, if they would incur a financial cost, to use private health coverage to
30pay for the services that must be provided under an individualized education program or
31individualized family service plan. 3 of 11
32 (c) To the extent required by federal law, no school district may deny, withhold, or delay
33any service that must be provided under an individualized education program or individualized
34family service plan because a family has refused to provide informed consent to bill a health plan
35for services or a health plan company has refused to pay any, all, or a portion of the cost of
36services billed.
37 (d) A school district may disclose information contained in a student's individualized
38education program, including records of the student's diagnosis and treatment, to a health plan
39company only with the signed and dated consent of the student's parent, or other legally
40authorized individual. The school district shall disclose only that information necessary for the
41health plan company to decide matters of coverage and payment. A health plan company may
42use the information only for making decisions regarding coverage and payment, and for any
43other use permitted by law.
44 SECTION 2. Chapter 175 of the General Laws is hereby amended by inserting after
45section 47UU the following section:-
46 Section 47VV. An individual policy of accident and sickness insurance issued under
47section 108 that provides hospital expense and surgical expense insurance and any group blanket
48or general policy of accident and sickness insurance issued under section 110 that provides
49hospital expense and surgical expense insurance, which is issued or renewed within or without
50the commonwealth, shall provide benefits on a nondiscriminatory basis for the medically
51necessary treatment for disease, illness, injury, or bodily dysfunction which are required by a
52student’s individual education program, individualized family service plan, individualized
53service plan or the federal Individuals with Disabilities Education Improvement Act. 4 of 11
54 In order to obtain coverage, school districts shall request, but not require, the child’s
55family to provide information about the child’s coverage when a child with a disability begins to
56receive services from the district of a type that are reimbursable and shall request, but may not
57require, updated information as needed.
58 (a) In order to access benefits, a school district must:
59 (i) obtain annual written informed consent from the parent or legal guardian.
60 (1) When obtaining informed consent, the school district must notify the legal guardian
61(a) that the cost of the person's private health insurance premium may increase due to providing
62the covered service in the school setting, (b) that the school district may pay certain enrollee
63health plan costs, including but not limited to, co-payments, coinsurance, deductibles, premium
64increases or other enrollee cost-sharing amounts for health and related services required by an
65individual service plan, or individualized family service plan, and (c) that the school's billing for
66each type of covered service may affect service limits and prior authorization thresholds. The
67informed consent may be revoked in writing at any time by the person authorizing the billing of
68the health plan;
69 (ii) inform the parent or legal representative that a refusal to permit the district to access
70their private health care coverage does not relieve the district of its responsibility to provide all
71services necessary to provide free and appropriate public education at no cost to the parent or
72legal representative.
73 (b) To the extent required by federal law, a school district may not require parents of
74children with disabilities, if they would incur a financial cost, to use private health coverage to 5 of 11
75pay for the services that must be provided under an individualized education program or
76individualized family service plan.
77 (c) To the extent required by federal law, no school district may deny, withhold, or delay
78any service that must be provided under an individualized education program or individualized
79family service plan because a family has refused to provide informed consent to bill a health plan
80for services or a health plan company has refused to pay any, all, or a portion of the cost of
81services billed.
82 (d) A school district may disclose information contained in a student's individualized
83education program, including records of the student's diagnosis and treatment, to a health plan
84company only with the signed and dated consent of the student's parent, or other legally
85authorized individual. The school district shall disclose only that information necessary for the
86health plan company to decide matters of coverage and payment. A health plan company may
87use the information only for making decisions regarding coverage and payment, and for any
88other use permitted by law.
89 SECTION 3. Chapter 176A of the General Laws is hereby amended by inserting after
90section 8VV the following section:-
91 Section 8WW. A contract between a subscriber and the corporation under an individual
92or group hospital service plan which is issued or renewed within or without the commonwealth
93shall provide benefits on a nondiscriminatory basis for the medically necessary treatment for
94disease, illness, injury, or bodily dysfunction which are required by a student’s individual
95education program, individualized family service plan, individualized service plan or the federal
96Individuals with Disabilities Education Improvement Act. 6 of 11
97 In order to obtain coverage, school districts shall request, but not require, the child’s
98family to provide information about the child’s coverage when a child with a disability begins to
99receive services from the district of a type that are reimbursable and shall request, but may not
100require, updated information as needed.
101 (a) In order to access benefits, a school district must:
102 (i) obtain annual written informed consent from the parent or legal guardian.
103 (1) When obtaining informed consent, the school district must notify the legal guardian
104(a) that the cost of the person's private health insurance premium may increase due to providing
105the covered service in the school setting, (b) that the school district may pay certain enrollee
106health plan costs, including but not limited to, co-payments, coinsurance, deductibles, premium
107increases or other enrollee cost-sharing amounts for health and related services required by an
108individual service plan, or individualized family service plan, and (c) that the school's billing for
109each type of covered service may affect service limits and prior authorization thresholds. The
110informed consent may be revoked in writing at any time by the person authorizing the billing of
111the health plan;
112 (ii) inform the parent or legal representative that a refusal to permit the district to access
113their private health care coverage does not relieve the district of its responsibility to provide all
114services necessary to provide free and appropriate public education at no cost to the parent or
115legal representative.
116 (b) To the extent required by federal law, a school district may not require parents of
117children with disabilities, if they would incur a financial cost, to use private health coverage to 7 of 11
118pay for the services that must be provided under an individualized education program or
119individualized family service plan.
120 (c) To the extent required by federal law, no school district may deny, withhold, or delay
121any service that must be provided under an individualized education program or individualized
122family service plan because a family has refused to provide informed consent to bill a health plan
123for services or a health plan company has refused to pay any, all, or a portion of the cost of
124services billed.
125 (d) A school district may disclose information contained in a student's individualized
126education program, including records of the student's diagnosis and treatment, to a health plan
127company only with the signed and dated consent of the student's parent, or other legally
128authorized individual. The school district shall disclose only that information necessary for the
129health plan company to decide matters of coverage and payment. A health plan company may
130use the information only for making decisions regarding coverage and payment, and for any
131other use permitted by law.
132 SECTION 4. Chapter 176B of the General Laws is hereby amended by inserting after
133section 4VV the following section:-
134 Section 4WW. A subscription certificate under an individual or group medical service
135agreement which is issued or renewed within or without the commonwealth shall provide
136benefits on a nondiscriminatory basis for the medically necessary treatment for disease, illness,
137injury, or bodily dysfunction which are required by a student’s individual education program,
138individualized family service plan, individualized service plan or the federal Individuals with
139Disabilities Education Improvement Act. 8 of 11
140 In order to obtain coverage, school districts shall request, but not require, the child’s
141family to provide information about the child’s coverage when a child with a disability begins to
142receive services from the district of a type that are reimbursable and shall request, but may not
143require, updated information as needed.
144 (a) In order to access benefits, a school district must:
145 (i) obtain annual written informed consent from the parent or legal guardian.
146 (1) When obtaining informed consent, the school district must notify the legal guardian
147(a) that the cost of the person's private health insurance premium may increase due to providing
148the covered service in the school setting, (b) that the school district may pay certain enrollee
149health plan costs, including but not limited to, co-payments, coinsurance, deductibles, premium
150increases or other enrollee cost-sharing amounts for health and related services required by an
151individual service plan, or individualized family service plan, and (c) that the school's billing for
152each type of covered service may affect service limits and prior authorization thresholds. The
153informed consent may be revoked in writing at any time by the person authorizing the billing of
154the health plan;
155 (ii) inform the parent or legal representative that a refusal to permit the district to access
156their private health care coverage does not relieve the district of its responsibility to provide all
157services necessary to provide free and appropriate public education at no cost to the parent or
158legal representative.
159 (b) To the extent required by federal law, a school district may not require parents of
160children with disabilities, if they would incur a financial cost, to use private health coverage to 9 of 11
161pay for the services that must be provided under an individualized education program or
162individualized family service plan.
163 (c) To the extent required by federal law, no school district may deny, withhold, or delay
164any service that must be provided under an individualized education program or individualized
165family service plan because a family has refused to provide informed consent to bill a health plan
166for services or a health plan company has refused to pay any, all, or a portion of the cost of
167services billed.
168 (d) A school district may disclose information contained in a student's individualized
169education program, including records of the student's diagnosis and treatment, to a health plan
170company only with the signed and dated consent of the student's parent, or other legally
171authorized individual. The school district shall disclose only that information necessary for the
172health plan company to decide matters of coverage and payment. A health plan company may
173use the information only for making decisions regarding coverage and payment, and for any
174other use permitted by law.
175 SECTION 5. Chapter 176G of the General Laws is hereby amended by inserting after
176section 4NN the following section:-
177 Section 4OO. A health maintenance contract issued or renewed within or without the
178commonwealth shall provide benefits on a nondiscriminatory basis for the medically necessary
179treatment for disease, illness, injury, or bodily dysfunction which are required by a student’s
180individual education program, individualized family service plan, individualized service plan or
181the federal Individuals with Disabilities Education Improvement Act. 10 of 11
182 In order to obtain coverage, school districts shall request, but not require, the child’s
183family to provide information about the child’s coverage when a child with a disability begins to
184receive services from the district of a type that are reimbursable and shall request, but may not
185require, updated information as needed.
186 (a) In order to access benefits, a school district must:
187 (i) obtain annual written informed consent from the parent or legal guardian.
188 (1) When obtaining informed consent, the school district must notify the legal guardian
189(a) that the cost of the person's private health insurance premium may increase due to providing
190the covered service in the school setting, (b) that the school district may pay certain enrollee
191health plan costs, including but not limited to, co-payments, coinsurance, deductibles, premium
192increases or other enrollee cost-sharing amounts for health and related services required by an
193individual service plan, or individualized family service plan, and (c) that the school's billing for
194each type of covered service may affect service limits and prior authorization thresholds. The
195informed consent may be revoked in writing at any time by the person authorizing the billing of
196the health plan;
197 (ii) inform the parent or legal representative that a refusal to permit the district to access
198their private health care coverage does not relieve the district of its responsibility to provide all
199services necessary to provide free and appropriate public education at no cost to the parent or
200legal representative.
201 (b) To the extent required by federal law, a school district may not require parents of
202children with disabilities, if they would incur a financial cost, to use private health coverage to 11 of 11
203pay for the services that must be provided under an individualized education program or
204individualized family service plan.
205 (c) To the extent required by federal law, no school district may deny, withhold, or delay
206any service that must be provided under an individualized education program or individualized
207family service plan because a family has refused to provide informed consent to bill a health plan
208for services or a health plan company has refused to pay any, all, or a portion of the cost of
209services billed.
210 (d) A school district may disclose information contained in a student's individualized
211education program, including records of the student's diagnosis and treatment, to a health plan
212company only with the signed and dated consent of the student's parent, or other legally
213authorized individual. The school district shall disclose only that information necessary for the
214health plan company to decide matters of coverage and payment. A health plan company may
215use the information only for making decisions regarding coverage and payment, and for any
216other use permitted by law.
217 SECTION 6. All policies, contracts and certificates of health insurance subject to section
21834 of chapter 32A, section 47VV of chapter 175, section 8WW of chapter 176A, section 4WW
219of chapter 176B, and section 4OO of chapter 176G of the General Laws which are delivered,
220issued or renewed on or after December 31, 2026 shall conform with the provisions of this act.
221Form filings implementing this act shall be subject to the approval of the commissioner of
222insurance.
223 SECTION 7. This act shall take effect on December 31, 2026.