HOUSE DOCKET, NO. 3391        FILED ON: 1/16/2015

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 3488

 

The Commonwealth of Massachusetts

_________________

PRESENTED BY:

Sean Garballey

_________________

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 providing for certain health insurance coverage.

_______________

PETITION OF:

 

Name:

District/Address:

Date Added:

Sean Garballey

23rd Middlesex

1/16/2015

Paul J. Donato

35th Middlesex

8/6/2019

Sarah K. Peake

4th Barnstable

8/6/2019

David M. Nangle

17th Middlesex

8/6/2019

Carolyn C. Dykema

8th Middlesex

8/6/2019

John C. Velis

4th Hampden

8/6/2019

Brendan P. Crighton

11th Essex

8/6/2019

Jay R. Kaufman

15th Middlesex

8/6/2019

James J. Dwyer

30th Middlesex

8/6/2019

Paul McMurtry

11th Norfolk

8/6/2019

Kay Khan

11th Middlesex

8/6/2019

Jennifer E. Benson

37th Middlesex

2/3/2015

Marjorie C. Decker

25th Middlesex

8/6/2019

Leah Cole

12th Essex

8/6/2019

Kevin G. Honan

17th Suffolk

8/6/2019

David M. Rogers

24th Middlesex

8/6/2019

Chris Walsh

6th Middlesex

8/6/2019

Denise Provost

27th Middlesex

8/6/2019

Angelo M. Scaccia

14th Suffolk

8/6/2019

Christine P. Barber

34th Middlesex

8/6/2019

Jonathan D. Zlotnik

2nd Worcester

8/6/2019

Tricia Farley-Bouvier

3rd Berkshire

8/6/2019

Tom Sannicandro

7th Middlesex

8/6/2019

Gailanne M. Cariddi

1st Berkshire

8/6/2019

Jay D. Livingstone

8th Suffolk

8/6/2019

Mary S. Keefe

15th Worcester

8/6/2019

Tackey Chan

2nd Norfolk

8/6/2019

John H. Rogers

12th Norfolk

8/6/2019

Carmine L. Gentile

13th Middlesex

8/6/2019

Daniel M. Donahue

16th Worcester

8/6/2019

Harold P. Naughton, Jr.

12th Worcester

8/6/2019

Denise C. Garlick

13th Norfolk

8/6/2019

Jonathan Hecht

29th Middlesex

8/6/2019

John J. Lawn, Jr.

10th Middlesex

8/6/2019

Thomas M. Stanley

9th Middlesex

8/6/2019

Walter F. Timilty

7th Norfolk

8/6/2019

Timothy J. Toomey, Jr.

26th Middlesex

8/6/2019

Benjamin Swan

11th Hampden

8/6/2019

Brian M. Ashe

2nd Hampden

8/6/2019

Bruce J. Ayers

1st Norfolk

8/6/2019

James J. O'Day

14th Worcester

8/6/2019


HOUSE DOCKET, NO. 3391        FILED ON: 1/16/2015

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 3488

By Mr. Garballey of Arlington, a petition (accompanied by bill, House, No. 3488) of Sean Garballey and others relative to providing certain health insurance coverage.  Public Service.

 

The Commonwealth of Massachusetts

 

_______________

In the One Hundred and Eighty-Ninth General Court
(2015-2016)

_______________

 

An Act providing for certain health insurance coverage.

 

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. Section 17A of chapter 32A of the General Laws, as appearing in the 2012 Official Edition, is hereby amended by striking out the first sentence and inserting in place thereof the following 4 sentences:-

The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for the cost of enteral formulas for home use, whether administered orally or via tube feeding, for which a physician has issued a written order. Such written order shall state that the enteral formula is clearly medically necessary and has been proven effective as a disease-specific treatment regimen for those individuals who are or will become malnourished or suffer from disorders, which if left untreated, cause chronic physical or intellectual disability or death. Specific diseases for which enteral formulas have been proven effective shall include, but are not limited to, inherited diseases of amino acid or organic acid metabolism; eosinophilic gastrointestinal disorders; Crohn's Disease; gastroesophageal reflux with failure to thrive; disorders of gastrointestinal motility such as chronic intestinal pseudo-obstruction; and multiple, severe food allergies, which if left untreated will cause malnourishment, chronic physical or intellectual disability or death. Enteral formulas which are medically necessary and taken under written order from a physician for the treatment of specific diseases shall be distinguished from nutritional supplements taken electively.

SECTION 2. Section 47I of chapter 175 of the General Laws, as so appearing, is hereby amended by striking out the first sentence and inserting in place thereof the following 4 sentences:-

Any individual policy of accident and sickness insurance issued pursuant to section 108, and any group blanket policy of accident and sickness insurance issued pursuant to section 110, shall provide coverage for the cost of enteral formulas for home use, whether administered orally or via tube feeding, for which a physician has issued a written order. Such written order shall state that the enteral formula is clearly medically necessary and has been proven effective as a disease-specific treatment regimen for those individuals who are or will become malnourished or suffer from disorders, which if left untreated, cause chronic physical or intellectual disability or death. Specific diseases for which enteral formulas have been proven effective shall include, but are not limited to, inherited diseases of amino acid or organic acid metabolism; eosinophilic gastrointestinal disorders;  Crohn's Disease; gastroesophageal reflux with failure to thrive; disorders of gastrointestinal motility such as chronic intestinal pseudo-obstruction; and multiple, severe food allergies, which if left untreated will cause malnourishment, chronic physical or intellectual disability or death. Enteral formulas which are medically necessary and taken under written order from a physician for the treatment of specific diseases shall be distinguished from nutritional supplements taken electively.

SECTION 3. Section 8L of chapter 176A of the General Laws, as so appearing, is hereby amended by striking out the first sentence and inserting in place thereof the following 4 sentences:-

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 the cost of enteral formulas for home use, whether administered orally or via tube feeding, for which a physician has issued a written order. Such written order shall state that the enteral formula is clearly medically necessary and has been proven effective as a disease-specific treatment regimen for those individuals who are or will become malnourished or suffer from disorders, which if left untreated, cause chronic physical or intellectual disability or death. Specific diseases for which enteral formulas have been proven effective shall include, but are not limited to, inherited diseases of amino acid or organic acid metabolism; eosinophilic gastrointestinal disorders; Crohn's Disease; gastroesophageal reflux with failure to thrive; disorders of gastrointestinal motility such as chronic intestinal pseudo-obstruction; and multiple, severe food allergies, which if left untreated will cause malnourishment, chronic physical or intellectual disability or death. Enteral formulas which are medically necessary and taken under written order from a physician for the treatment of specific diseases shall be distinguished from nutritional supplements taken electively.

SECTION 4. Section 4K of chapter 176B of the General Laws, as so appearing, is hereby amended by striking out the first sentence and inserting in place thereof the following 4 sentences:-

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 4C, coverage for the cost of enteral formulas for home use, whether administered orally or via tube feeding, for which a physician has issued a written order. Such written order shall state that the enteral formula is clearly medically necessary and has been proven effective as a disease-specific treatment regimen for those individuals who are or will become malnourished or suffer from disorders, which if left untreated, cause chronic physical or intellectual disability or death. Specific diseases for which enteral formulas have been proven effective shall include, but are not limited to, inherited diseases of amino acid or organic acid metabolism; eosinophilic gastrointestinal disorders; Crohn's Disease; gastroesophageal reflux with failure to thrive; disorders of gastrointestinal motility such as chronic intestinal pseudo-obstruction; and multiple, severe food allergies, which if left untreated will cause malnourishment, chronic physical or intellectual disability or death. Enteral formulas which are medically necessary and taken under written order from a physician for the treatment of specific diseases shall be distinguished from nutritional supplements taken electively.

SECTION 5. Section 4D of chapter 176G of the General Laws, as so appearing, is hereby amended by striking out the first sentence and inserting in place thereof the following 4 sentences:-

A group health maintenance contract shall provide coverage for the cost of enteral formulas for home use, whether administered orally or via tube feeding, for which a physician has issued a written order. Such written order shall state that the enteral formula is clearly medically necessary and has been proven effective as a disease-specific treatment regimen for those individuals who are or will become malnourished or suffer from disorders, which if left untreated, cause chronic physical or intellectual disability or death. Specific diseases for which enteral formulas have been proven effective shall include, but are not limited to, inherited diseases of amino acid or organic acid metabolism; eosinophilic gastrointestinal disorders; Crohn's Disease; gastroesophageal reflux with failure to thrive; disorders of gastrointestinal motility such as chronic intestinal pseudo-obstruction; and multiple, severe food allergies, which if left untreated will cause malnourishment, chronic physical or intellectual disability or death. Enteral formulas which are medically necessary and taken under written order from a physician for the treatment of specific diseases shall be distinguished from nutritional supplements taken electively.