SENATE DOCKET, NO. 1462 FILED ON: 1/14/2009
SENATE . . . . . . . . . . . . . . No. 529
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The Commonwealth of Massachusetts
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In the Year Two Thousand Nine
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An Act to improve asthma management..
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 17I the following section:-
Section 17J. The commission shall provide to any active or retired employee of the commonwealth or their dependents who are insured under the group insurance commission coverage for the following services and equipment in so far as said services and items are within a category of benefits or services for which coverage is otherwise afforded and have been prescribed by a health care professional legally authorized to prescribe such services for the management and treatment of asthma:
(a) All medically necessary equipment and services, including:
Inhaler spacers
Nebulizers, including face masks and tubing
Peak flow meters
Allergen proof bedding covers, HEPA vacuums and filters, and integrated pest management services, if there is evidence of exposure sensitivity to specific allergens or evidence of conditions known to lead to sensitivity
(b) Asthma education and chronic disease management
(1) As used in this section, asthma education and chronic disease management shall mean instruction that will enable asthmatic patients and their families to understand the disease process, the daily management of asthma, and how to properly use the equipment identified in subdivision (a) following the national asthma management guidelines as published by the National Heart, Lung and Blood Institute. Said services shall include, at a minimum: (i) individualized education or group health education classes in an outpatient setting and (ii) home-based education in disease management and environmental assessment in order to identify and reduce exposures to allergens, as prescribed by a treating provider.
(2) Said services shall be provided by a certified asthma health care provider participating with the insurance contract or affiliated with a provider participating with the insurance contract. As used in this section, a “certified asthma health care provider” shall mean a licensed or registered health care professional, an asthma educator certified by the National Asthma Educator Certification Board, or a community health worker with training in chronic disease management as recognized by the Department of Public Health.
The benefits provided in this section shall meet all other terms and conditions within an insurance plan. Coverage shall not be reduced or eliminated due to the requirements of this section.
SECTION 2. Chapter 118E of the General Laws is hereby amended by inserting after section 10F, as so appearing, the following section:-
Section 10G. The office shall provide coverage for the following services and equipment in so far as said services and items are within a category of benefits or services for which coverage is otherwise afforded and have been prescribed by a health care professional legally authorized to prescribe such services for the management and treatment of asthma:
(a) All medically necessary equipment and services, including:
Inhaler spacers
Nebulizers, including face masks and tubing
Peak flow meters
Allergen proof bedding covers, HEPA vacuums and filters, and integrated pest management services, if there is evidence of exposure sensitivity to specific allergens or evidence of conditions known to lead to sensitivity
(b) Asthma education and chronic disease management
(1) As used in this section, asthma education and chronic disease management shall mean instruction that will enable asthmatic patients and their families to understand the disease process, the daily management of asthma, and how to properly use the equipment identified in subdivision (a) following the national asthma management guidelines as published by the National Heart, Lung and Blood Institute. Said services shall include, at a minimum: (i) individualized education or group health education classes in an outpatient setting and (ii) home-based education in disease management and environmental assessment in order to identify and reduce exposures to allergens, as prescribed by a treating provider.
(2) Said services shall be provided by a certified asthma health care provider participating with the insurance contract or affiliated with a provider participating with the insurance contract. As used in this section, a “certified asthma health care provider” shall mean a licensed or registered health care professional, an asthma educator certified by the National Asthma Educator Certification Board, or a community health worker with training in chronic disease management as recognized by the Department of Public Health.
SECTION 3. Chapter 118H of the General Laws is hereby amended by inserting the following section:
Section 7. Any policy of insurance for accident or sickness, or agreement for medical or health services, which shall be delivered or issued or renewed or certified in this Commonwealth through the Commonwealth Care Health Insurance Program described in Chapter 118H of the General Laws, shall provide as a benefit to all individual subscribers and members within the Commonwealth, the following services and equipment in so far as said services and items are within a category of benefits or services for which coverage is otherwise afforded and have been prescribed by a health care professional legally authorized to prescribe such services for the management and treatment of asthma:
(a) All medically necessary equipment and services, including:
Inhaler spacers
Nebulizers, including face masks and tubing
Peak flow meters
Allergen proof bedding covers, HEPA vacuums and filters, and integrated pest management services, if there is evidence of exposure sensitivity to specific allergens or evidence of conditions known to lead to sensitivity
(b) Asthma education and chronic disease management
(1) As used in this section, asthma education and chronic disease management shall mean instruction that will enable asthmatic patients and their families to understand the disease process, the daily management of asthma, and how to properly use the equipment identified in subdivision (a) following the national asthma management guidelines as published by the National Heart, Lung and Blood Institute. Said services shall include, at a minimum: (i) individualized education or group health education classes in an outpatient setting and (ii) home-based education in disease management and environmental assessment in order to identify and reduce exposures to allergens, as prescribed by a treating provider.
(2) Said services shall be provided by a certified asthma health care provider participating with the insurance contract or affiliated with a provider participating with the insurance contract. As used in this section, a “certified asthma health care provider” shall mean a licensed or registered health care professional, an asthma educator certified by the National Asthma Educator Certification Board, or a community health worker with training in chronic disease management as recognized by the Department of Public Health.
SECTION 4. Chapter 175 of the General Laws is hereby amended by inserting after section 47Z, as so appearing, the following section:-
Section 47AA. An individual policy of accident and sickness insurance issued pursuant to section 108 which provides hospital expense and surgical expense insurance, and any group blanket policy of accident and sickness insurance issued pursuant to section 110 which provides hospital expense and surgical expense insurance, delivered, issued or renewed by agreement between the insurer and the policyholder, within or without the commonwealth, shall provide coverage for the following services and items for subscribers with asthma in so far as said services and items are within a category of benefits or services for which coverage is otherwise afforded and have been prescribed by a health care professional legally authorized to prescribe such services for the management and treatment of asthma:
(a) All medically necessary equipment and services, including:
Inhaler spacers
Nebulizers, including face masks and tubing
Peak flow meters
Allergen proof bedding covers, HEPA vacuums and filters, and integrated pest management services, if there is evidence of exposure sensitivity to specific allergens or evidence of conditions known to lead to sensitivity
(b) Asthma education and chronic disease management
(1) As used in this section, asthma education and chronic disease management shall mean instruction that will enable asthmatic patients and their families to understand the disease process, the daily management of asthma, and how to properly use the equipment identified in subdivision (a) following the national asthma management guidelines as published by the National Heart, Lung and Blood Institute. Said services shall include, at a minimum: (i) individualized education or group health education classes in an outpatient setting and (ii) home-based education in disease management and environmental assessment in order to identify and reduce exposures to allergens, as prescribed by a treating provider.
(2) Said services shall be provided by a certified asthma health care provider participating with the insurance contract or affiliated with a provider participating with the insurance contract. As used in this section, a “certified asthma health care provider” shall mean a licensed or registered health care professional, an asthma educator certified by the National Asthma Educator Certification Board, or a community health worker with training in chronic disease management as recognized by the Department of Public Health.
The benefits provided in this section shall meet all other terms and conditions within a subscription certificate. Hospital service plans shall not reduce or eliminate coverage due to the requirements of this section.
SECTION 5. Chapter 176A of the General Laws is hereby amended by inserting after section 8BB, as so appearing, the following section:-
Section 8CC. Any contract between a subscriber and the corporation under an individual or group hospital service plan, which shall be delivered, issued or renewed by agreement between the insurer and the policyholder, within or without the commonwealth, shall provide coverage for the following services and items for subscribers with asthma in so far as said services and items are within a category of benefits or services for which coverage is otherwise afforded and have been prescribed by a health care professional legally authorized to prescribe such services for the management and treatment of asthma:
(a) All medically necessary equipment and services, including:
Inhaler spacers
Nebulizers, including face masks and tubing
Peak flow meters
Allergen proof bedding covers, HEPA vacuums and filters, and integrated pest management services, if there is evidence of exposure sensitivity to specific allergens or evidence of conditions known to lead to sensitivity
(b) Asthma education and chronic disease management
(1) As used in this section, asthma education and chronic disease management shall mean instruction that will enable asthmatic patients and their families to understand the disease process, the daily management of asthma, and how to properly use the equipment identified in subdivision (a) following the national asthma management guidelines as published by the National Heart, Lung and Blood Institute. Said services shall include, at a minimum: (i) individualized education or group health education classes in an outpatient setting and (ii) home-based education in disease management and environmental assessment in order to identify and reduce exposures to allergens, as prescribed by a treating provider.
(2) Said services shall be provided by a certified asthma health care provider participating with the insurance contract or affiliated with a provider participating with the insurance contract. As used in this section, a “certified asthma health care provider” shall mean a licensed or registered health care professional, an asthma educator certified by the National Asthma Educator Certification Board, or a community health worker with training in chronic disease management as recognized by the Department of Public Health.
The benefits provided in this section shall meet all other terms and conditions within a subscription certificate. Medical service agreements shall not reduce or eliminate coverage due to the requirements of this section.
SECTION 6. Chapter 176B of the General Laws is hereby amended by inserting after section 4BB, as so appearing, the following section:-
Section 4CC. (a) Any subscription certificate under an individual or group medical service agreement which shall be delivered, issued or renewed within the commonwealth shall provide as benefits to all individual subscribers or members within the commonwealth and to all group members having a principal place of employment within the commonwealth, shall provide coverage for following services and items for subscribers with asthma in so far as said services and items are within a category of benefits or services for which coverage is otherwise afforded and have been prescribed by a health care professional legally authorized to prescribe such services for the management and treatment of asthma:
(a) All medically necessary equipment and services, including:
Inhaler spacers
Nebulizers, including face masks and tubing
Peak flow meters
Allergen proof bedding covers, HEPA vacuums and filters, and integrated pest management services, if there is evidence of exposure sensitivity to specific allergens or evidence of conditions known to lead to sensitivity
(b) Asthma education and chronic disease management
(1) As used in this section, asthma education and chronic disease management shall mean instruction that will enable asthmatic patients and their families to understand the disease process, the daily management of asthma, and how to properly use the equipment identified in subdivision (a) following the national asthma management guidelines as published by the National Heart, Lung and Blood Institute. Said services shall include, at a minimum: (i) individualized education or group health education classes in an outpatient setting and (ii) home-based education in disease management and environmental assessment in order to identify and reduce exposures to allergens, as prescribed by a treating provider.
(2) Said services shall be provided by a certified asthma health care provider participating with the insurance contract or affiliated with a provider participating with the insurance contract. As used in this section, a “certified asthma health care provider” shall mean a licensed or registered health care professional, an asthma educator certified by the National Asthma Educator Certification Board, or a community health worker with training in chronic disease management as recognized by the Department of Public Health.
The benefits provided in this section shall meet all other terms and conditions within a subscription certificate. Medical service agreements shall not reduce or eliminate coverage due to the requirements of this section.
SECTION 7. Chapter 176G of the General Laws is hereby amended by inserting after section 4T, as so appearing, the following section:-
Section 4U. Any individual or group health maintenance contract delivered, issued or renewed by agreement between the insurer and the policyholder, within or without the commonwealth, shall provide coverage for the following services and items for subscribers with asthma in so far as said services and items are within a category of benefits or services for which coverage is otherwise afforded and have been prescribed by a health care professional legally authorized to prescribe such services for the management and treatment of asthma:
(a) All medically necessary equipment and services, including:
Inhaler spacers
Nebulizers, including face masks and tubing
Peak flow meters
Allergen proof bedding covers, HEPA vacuums and filters, and integrated pest management services, if there is evidence of exposure sensitivity to specific allergens or evidence of conditions known to lead to sensitivity
(b) Asthma education and chronic disease management
(1) As used in this section, asthma education and chronic disease management shall mean instruction that will enable asthmatic patients and their families to understand the disease process, the daily management of asthma, and how to properly use the equipment identified in subdivision (a) following the national asthma management guidelines as published by the National Heart, Lung and Blood Institute. Said services shall include, at a minimum: (i) individualized education or group health education classes in an outpatient setting and (ii) home-based education in disease management and environmental assessment in order to identify and reduce exposures to allergens, as prescribed by a treating provider.
(2) Said services shall be provided by a certified asthma health care provider participating with the insurance contract or affiliated with a provider participating with the insurance contract. As used in this section, a “certified asthma health care provider” shall mean a licensed or registered health care professional, an asthma educator certified by the National Asthma Educator Certification Board, or a community health worker with training in chronic disease management as recognized by the Department of Public Health.
The benefits provided in this section shall meet all other terms and conditions within a health maintenance contract. Health maintenance contracts shall not reduce or eliminate coverage due to the requirements of this section.