SENATE DOCKET, NO. 1420        FILED ON: 1/21/2011

SENATE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 495

The Commonwealth of Massachusetts

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PRESENTED BY:

Cynthia S. Creem, (BY REQUEST)

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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 to mandate health benefit coverage for certain tests for the early detection of cardiovascular disease.

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PETITION OF:

SENATE DOCKET, NO. 1420        FILED ON: 1/21/2011

SENATE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 495

The Commonwealth of Massachusetts

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In the Year Two Thousand Eleven

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An Act to mandate health benefit coverage for certain tests for the early detection of cardiovascular disease.

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 adding the following section:-

                Section 26. (a) The commission shall provide to an active or retired employee of the commonwealth who is insured under the group insurance commission benefits on a nondiscriminatory basis for the screening medical procedures required by this act to each covered individual who is a:

                                (1)a male older than 45 years of age and younger than 76 years of age; or

                                (2)a female older than 55 years of age and younger than 76 years of age; and

                                (3)who is diabetic or has a risk of developing coronary heart disease, based on a score derived using the Framingham Heart Study coronary prediction algorithm, that is intermediate or higher.

                (b) The minimum coverage required to be provided under this act is coverage of up to $200 for one of the following noninvasive screening tests for atherosclerosis and abnormal artery structure and function every five years by a licensed provider:

                                (1)computed tomography (CT) scanning measuring coronary artery calcification; or

                                (2)ultrasonography measuring carotid intima-media thickness and plaque.

                SECTION 2. Chapter 175 of the General Laws is hereby amended by inserting after section 47AA the following section:-

                Section 47BB.  (a) An individual policy of accident and sickness insurance issued under section 108 that provides hospital expense and surgical expense insurance and any group blanket or general policy of accident and sickness insurance issued under section 110 that provides hospital expense and surgical expense insurance, which is issued or renewed within or without the commonwealth, shall provide benefits on a nondiscriminatory basis for the screening medical procedures required by this act to each covered individual who is a:

                                (1)a male older than 45 years of age and younger than 76 years of age; or

                                (2)a female older than 55 years of age and younger than 76 years of age; and

                                (3)who is diabetic or has a risk of developing coronary heart disease, based on a score derived using the Framingham Heart Study coronary prediction algorithm, that is intermediate or higher.

                (b) The minimum coverage required to be provided under this act is coverage of up to $200 for one of the following noninvasive screening tests for atherosclerosis and abnormal artery structure and function every five years by a licensed provider:

                                (1)computed tomography (CT) scanning measuring coronary artery calcification; or

                                (2)ultrasonography measuring carotid intima-media thickness and plaque.

                SECTION 3. Chapter 176A of the General Laws is hereby amended by inserting after section 8DD the following section:-

                Section 8EE.  (a) A contract between a subscriber and the corporation under an individual or group hospital service plan which is issued or renewed within or without the commonwealth shall provide benefits on a nondiscriminatory basis for the screening medical procedures required by this act to each covered individual who is a:

                                (1)a male older than 45 years of age and younger than 76 years of age; or

                                (2)a female older than 55 years of age and younger than 76 years of age; and

                                (3)who is diabetic or has a risk of developing coronary heart disease, based on a score derived using the Framingham Heart Study coronary prediction algorithm, that is intermediate or higher.

                 (b) The minimum coverage required to be provided under this act is coverage of up to $200 for one of the following noninvasive screening tests for atherosclerosis and abnormal artery structure and function every five years by a licensed provider:

                                (1)computed tomography (CT) scanning measuring coronary artery calcification; or

                                (2)ultrasonography measuring carotid intima-media thickness and plaque.

                SECTION 4. Chapter 176B of the General Laws is hereby amended by inserting after section 4DD the following section:-

                Section 4EE. (a) A subscription certificate under an individual or group medical service agreement which is issued or renewed within or without the commonwealth shall provide benefits on a nondiscriminatory basis for the screening medical procedures required by this act to each covered individual who is a:

                                (1)a male older than 45 years of age and younger than 76 years of age; or

                                (2)a female older than 55 years of age and younger than 76 years of age; and

                                (3)who is diabetic or has a risk of developing coronary heart disease, based on a score derived using the Framingham Heart Study coronary prediction algorithm, that is intermediate or higher.

                (b) The minimum coverage required to be provided under this act is coverage of up to $200 for one of the following noninvasive screening tests for atherosclerosis and abnormal artery structure and function every five years by a licensed provider:

                                (1)computed tomography (CT) scanning measuring coronary artery calcification; or

                                (2)ultrasonography measuring carotid intima-media thickness and plaque.

                SECTION 5. Chapter 176G of the General Laws is hereby amended by inserting after section 4V the following section:-

                Section 4W. (a) A health maintenance contract issued or renewed within or without the commonwealth shall provide benefits on a nondiscriminatory basis for the screening medical procedures required by this act to each covered individual who is a:

                                (1)a male older than 45 years of age and younger than 76 years of age; or

                                (2)a female older than 55 years of age and younger than 76 years of age; and

                                (3)who is diabetic or has a risk of developing coronary heart disease, based on a score derived using the Framingham Heart Study coronary prediction algorithm, that is intermediate or higher.

                (b) The minimum coverage required to be provided under this act is coverage of up to $200 for one of the following noninvasive screening tests for atherosclerosis and abnormal artery structure and function every five years by a licensed provider:

                                (1)computed tomography (CT) scanning measuring coronary artery calcification; or

                                (2)ultrasonography measuring carotid intima-media thickness and plaque.