Amendment #124 to H4600

Increasing access to applied behavioral analysis therapy

Representatives Lewis of Framingham and Garballey of Arlington moves to amend the bill by adding the following section: SECTION XXXX. Chapter 32A of the General Laws is hereby amended by adding the following section:-

Section 25A. The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for the treatment of Down syndrome through speech therapy, occupational therapy, physical therapy and applied behavior analysis services. For purposes of this section, “Down syndrome” means a chromosomal condition caused by an error in cell division that results in the presence of an extra whole or partial copy of chromosome 21.

SECTION XXXX. Chapter 118E of the General Laws is hereby amended by inserting after section 10L the following section:-

Section 10H1/2 The division and its contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third-party administrators under contract to a Medicaid managed care organization or primary care clinician plan shall provide coverage for the treatment of Down syndrome through speech therapy, occupational therapy, physical therapy and applied behavior analysis services. For purposes of this section, “Down Syndrome” means a chromosomal condition caused by an error in cell division that results in the presence of an extra whole or partial copy of chromosome 21.

SECTION XXXX. Chapter 175 of the General Laws is hereby amended by inserting after section 47KK the following section:-

Section 47AA1/2. Any policy, contract, agreement, plan or certificate of insurance issued, delivered or renewed within the commonwealth, which is considered creditable coverage under section 1 of chapter 111M, shall provide coverage for the treatment of Down syndrome through speech therapy, occupational therapy, physical therapy and applied behavior analysis services. For purposes of this section, “Down syndrome” means a chromosomal condition caused by an error in cell division that results in the presence of an extra whole or partial copy of chromosome 21.

SECTION XXXX. Chapter 176A of the General Laws is hereby amended by inserting after section 8MM the following section:-

Section 8NDD1/2 Any contract between a subscriber and the corporation under an individual or group hospital service plan that is delivered, issued or renewed within the commonwealth shall provide coverage for the treatment of Down syndrome through speech therapy, occupational therapy, physical therapy and applied behavior analysis services. For purposes of this section, “Down syndrome” means a chromosomal condition caused by an error in cell division that results in the presence of an extra whole or partial copy of chromosome 21.

SECTION XXXX. Chapter 176B of the General laws is hereby amended by inserting after section 4MM the following section:-

Section 4DD1/2. Any subscription certificate under an individual or group medical service agreement delivered, issued or renewed within the commonwealth shall provide coverage for the treatment of Down syndrome through speech therapy, occupational therapy, physical therapy and applied behavior analysis services. For purposes of this section, “Down syndrome” means a chromosomal condition caused by an error in cell division that results in the presence of an extra whole or partial copy of chromosome 21.

SECTION XXXX. Chapter 176G of the General Laws is hereby amended by inserting after section 4EE the following section:-

Section 4V1/2. An individual or group health maintenance contract that is issued or renewed shall provide coverage for the treatment of Down syndrome through speech therapy, occupational therapy, physical therapy and applied behavior analysis services. For purposes of this section, “Down syndrome” means a chromosomal condition caused by an error in cell division that results in the presence of an extra whole or partial copy of chromosome 21.

SECTION XXXX. This act shall take effect on January 1, 2025.