Session Laws

Whereas, The deferred operation of this act would tend to defeat its purpose, which is to immediately regulate insurance coverage for certain inherited diseases, therefore it is hereby declared to be an emergency law, necessary for the immediate preservation of the public convenience.

Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:

SECTION 1. Chapter 32A of the General Laws is hereby amended by inserting after section 17 the following section:-

Section 17A. The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for nonprescription enteral formulas for home use for which a physician has issued a written order and which are medically necessary for the treatment of malabsorption caused by Crohn's disease, ulcerative colitis, gastroesophageal reflux, gastrointestinal motility, chronic intestinal pseudo-obstruction, and inherited diseases of amino acids and organic acids. Coverage for inherited diseases of amino acids and organic acids shall include food products modified to be low protein in an amount not to exceed two thousand five hundred dollars annually for any insured individual.

Section 2. Chapter 175 of the General Laws is hereby amended by striking out section 47I, as appearing in the 1992 Official Edition, and inserting in place thereof the following section:-

Section 47I. Any individual policy of accident and sickness insurance issued pursuant to section one hundred and eight, and any group blanket policy of accident and sickness insurance issued pursuant to section one hundred and ten, shall provide coverage for nonprescription enteral formulas for home use for which a physician has issued a written order and which are medically necessary for the treatment of malabsorption caused by Crohn's disease, ulcerative colitis, gastroesophageal reflux, gastrointestinal motility, chronic intestinal pseudo-obstruction, and inherited diseases of amino acids and organic acids. Coverage for inherited diseases of amino acids and organic acids shall include food products modified to be low protein in an amount not to exceed two thousand five hundred dollars annually for any insured individual.

SECTION 3. Said chapter 175 is hereby further amended by striking out section 47I, as amended by section 2 of this act, and inserting in place thereof the following section:-

Section 47I. Any individual policy of accident and sickness insurance issued pursuant to section one hundred and eight, and any group blanket policy of accident and sickness insurance issued pursuant to section one hundred and ten, shall provide coverage for nonprescription enteral formulas for home use for which a physician has issued a written order and which are medically necessary for the treatment of malabsorption caused by Crohn's disease, ulcerative colitis, gastroesophageal reflux, gastrointestinal motility, or chronic intestinal pseudo-obstruction.

Section 4. Chapter 176A of the General Laws is hereby amended by striking out section 8L, as appearing in the 1992 Official Edition, and inserting in place thereof the following section:-

Section 8L. Any contract between a subscriber and the corporation under an individual or group hospital service plan that shall be delivered, issued or renewed in the commonwealth shall provide, as benefits to all individual subscribers and members within the commonwealth, coverage for nonprescription enteral formulas for home use for which a physician has issued a written order and which are medically necessary for the treatment of malabsorption caused by Crohn's disease, ulcerative colitis, gastroesophageal reflux, gastrointestinal motility, chronic intestinal pseudo-obstruction, and inherited diseases of amino acids and organic acids. Coverage for inherited diseases of amino acids and organic acids shall include food products modified to be low protein in an amount not to exceed two thousand five hundred dollars annually for any insured individual.

SECTION 5. Said chapter 176A is hereby further amended by striking out section 8L, as amended by section 4 of this act, and inserting in place thereof the following section:-

Section 8L. Any contract between a subscriber and the corporation under an individual or group hospital service plan that shall be delivered, issued or renewed in the commonwealth shall provide, as benefits to all individual subscribers and members within the commonwealth and to all group members having a principal place of employment within the commonwealth, coverage for nonprescription enteral formulas for home use, for which a physician has issued a written order and which are medically necessary for the treatment of malabsorption caused by Crohn's disease, ulcerative colitis, gastroesophageal reflux, gastrointestinal motility or chronic intestinal pseudo-obstruction.

Section 6. Chapter 176B of the General Laws is hereby amended by striking out section 4K, as appearing in the 1992 Official Edition, and inserting in place thereof the following section:-

Section 4K. Any subscription certificate under an individual or group medical service agreement that shall be delivered, issued or renewed in the commonwealth shall provide, as benefits to all individual subscribers and members within the commonwealth, all group members having a principal place of employment within the commonwealth and all persons included in section four C, coverage for nonprescription enteral formulas for home use for which a physician has issued a written order and which are medically necessary for the treatment of malabsorption caused by Crohn's disease, ulcerative colitis, gastroesophageal reflux, gastrointestinal motility, chronic intestinal pseudo-obstruction, and inherited diseases of amino acids and organic acids. Coverage for inherited diseases of amino acids and organic acids shall include food products modified to be low protein in an amount not to exceed two thousand five hundred dollars annually for any insured individual.

SECTION 7. Said chapter 176B is hereby further amended by striking out section 4K, as amended by section 6 of this act, and inserting in place thereof the following section:-

Section 4K. Any subscription certificate under an individual or group medical service agreement that shall be delivered, issued or renewed in the commonwealth shall provide, as benefits to all individual subscribers and members within the commonwealth, all group members having a principal place of employment within the commonwealth and all persons included in section four C, coverage for nonprescription enteral formulas for home use for which a physician has issued a written order and which are medically necessary for the treatment of malabsorption caused by Crohn's disease, ulcerative colitis, gastroesophageal reflux, gastrointestinal motility, or chronic intestinal pseudo-obstruction.

Section 8. Chapter 176G of the General Laws is hereby amended by striking out section 4D, as appearing in the 1992 Official Edition, and inserting in place thereof the following section:-

Section 4D. A group health maintenance contract shall provide coverage for nonprescription enteral formulas for home use for which a physician has issued a written order and which are medically necessary for the treatment of malabsorption caused by Crohn's disease, ulcerative colitis, gastroesophageal reflux, gastrointestinal motility, chronic intestinal pseudo-obstruction, and inherited diseases of amino acids and organic acids. Coverage for inherited diseases of amino acids and organic acids shall include food products modified to be low protein in an amount not to exceed two thousand five hundred dollars annually for any insured individual.

SECTION 9. Said chapter 176G is hereby further amended by striking out section 4D, as amended by section 8 of this act, and inserting in place thereof the following section:-

Section 4D. Any group health maintenance contract shall provide coverage for nonprescription enteral formulas for home use as set forth in section forty-seven I of chapter one hundred and seventy-five.

SECTION 10. The commissioner of the department of public health, in consultation with the commissioner of the division of insurance, is hereby authorized and directed to report on the practices of other states with respect to public or private programs that assist, subsidize, purchase or otherwise ensure the availability of modified low protein foods, including but not limited to milk, to persons with phenylketonuria, or PKU, so-called. Said report shall examine the incidence of PKU in such states and to the extent feasible, the income distribution of such persons. Said report shall examine the legal basis for making or requiring such public or private assistance, including, but not limited to, mandatory insurance requirements and publicly supported assistance programs. Said report shall examine the administrative and direct service costs of and funding sources for said programs and the range and average amounts of assistance obtained by such persons. Said report shall further include a survey of the types and costs of such foods, their availability in the commonwealth and an assessment of whether group or bulk purchasing would result in savings for such persons. The commissioner shall file said report, and recommendations, if any, for making such assistance available in the commonwealth, with the house committee on ways and means not later than May first, nineteen hundred and ninety-four.

SECTION 11. Sections two, four, six, and eight of this act shall take effect on January first, nineteen hundred and ninety-four. Sections three, five, seven and nine shall take effect on January first, nineteen hundred and ninety-five.