HOUSE DOCKET, NO. 1702        FILED ON: 1/15/2015

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 953

The Commonwealth of Massachusetts

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PRESENTED BY:

John W. Scibak

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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 relative to insurance coverage for craniofacial disorders.

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PETITION OF:

HOUSE DOCKET, NO. 1702        FILED ON: 1/15/2015

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 953

The Commonwealth of Massachusetts

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

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An Act relative to insurance coverage for craniofacial disorders.

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, as so appearing, is hereby amended by striking out section 17J, as amended by section 1 of chapter 234 of the acts of 2012, and inserting in the place thereof the following section:-

Section 17J. The commission shall provide to any active or retired employee of the commonwealth or spouse/dependent who is insured under the group insurance commission coverage for the cost of treating the following medically diagnosed, congenital craniofacial defects: ectodermal dysplasia, dentinogenesis imperfecta, amelogenesis imperfecta, and congenital oligodontia and for the cost of treating cleft lip and cleft palate for children under the age of 18.  The coverage shall include benefits for medical, dental, oral and facial surgery, surgical management and follow-up care by oral and plastic surgeons, orthodontic treatment and management, preventative and restorative dentistry to ensure good health and adequate dental structures for orthodontic treatment or prosthetic management therapy, speech therapy, audiology and nutrition services, if such services are prescribed by the treating physician or surgeon and such physician or surgeon certifies that such services are medically necessary and consequent to the treatment of the medically diagnosed congenital craniofacial defects and birth abnormalities. The coverage required by this section shall be subject to the terms and conditions applicable to other benefits. Payment for dental or orthodontic treatment not related to the management of the medically diagnosed congenital craniofacial defects and birth abnormalities shall not be covered under this section.

SECTION 2. Chapter 118E of the General Laws, as so appearing, is hereby amended by striking out section 10G, as amended by section 2 of chapter 234 of the acts of 2012, and inserting in the place thereof the following section:-

Section 10G. The division shall cover the cost of treating the following medically diagnosed congenital craniofacial defects: ectodermal dysplasia, dentinogenesis imperfecta, amelogenesis imperfecta, and congenital oligodontia and for the cost of treating cleft lip and cleft palate for children under the age of 18.  The coverage shall include benefits for medical, dental, oral and facial surgery, surgical management and follow-up care by oral and plastic surgeons, orthodontic treatment and management, preventative and restorative dentistry to ensure good health and adequate dental structures for orthodontic treatment or prosthetic management therapy, speech therapy, audiology and nutrition services, if such services are prescribed by the treating physician or surgeon and such physician or surgeon certifies that such services are medically necessary and consequent to the treatment of the medically diagnosed congenital craniofacial defects and birth abnormalities. The coverage required by this section shall be subject to the terms and conditions applicable to other benefits. Payment for dental or orthodontic treatment not related to the management of the medically diagnosed congenital craniofacial defects and birth abnormalities shall not be covered under this section.

SECTION 3. Chapter 175 of the General Laws, as so appearing, is hereby amended by striking out section 47BB, as amended by section 3 of chapter 234 of the acts of 2012, and inserting in the place thereof the following section:-

Section 47CC. 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 cover the cost of treating the following medically diagnosed congenital craniofacial defects: ectodermal dysplasia, dentinogenesis imperfecta, amelogenesis imperfecta, and congenital oligodontia and for the cost of treating cleft lip and cleft palate for children under the age of 18.   that covers a child under the age of 18 shall cover the cost of treating cleft lip and cleft palate for the child. The coverage shall include benefits for medical, dental, oral and facial surgery, surgical management and follow-up care by oral and plastic surgeons, orthodontic treatment and management, preventative and restorative dentistry to ensure good health and adequate dental structures for orthodontic treatment or prosthetic management therapy, speech therapy, audiology and nutrition services, if such services are prescribed by the treating physician or surgeon and such physician or surgeon certifies that such services are medically necessary and consequent to the treatment of the medically diagnosed congenital craniofacial defects and birth abnormalities. The coverage required by this section shall be subject to the terms and conditions applicable to other benefits. Payment for dental or orthodontic treatment not related to the management of the medically diagnosed congenital craniofacial defects and birth abnormalities shall not be covered under this section.

SECTION 4. Chapter 176A of the General Laws, as so appearing, is hereby amended by striking out section 8EE, as amended by section 3 of chapter 234 of the acts of 2012, and inserting in the place thereof the following section:-

Section 8EE. A contract between a subscriber and the corporation under an individual or group hospital service plan which provides hospital expense and surgical expense insurance, except contracts providing supplemental coverage to Medicare or other governmental programs, delivered, issued or renewed by agreement between the insurer and the policyholder, within or without the commonwealth shall provide coverage for the cost of treating congenital craniofacial defects and birth abnormalities including, but not limited to cleft lip, cleft palate, ectodermal dysplasia, dentinogenesis imperfecta, amelogenesis imperfecta, and other maxillofacial abnormalities for the child. The coverage shall include benefits for medical, dental, oral and facial surgery, surgical management and follow-up care by oral and plastic surgeons, orthodontic treatment and management, preventative and restorative dentistry to ensure good health and adequate dental structures for orthodontic treatment or prosthetic management therapy, speech therapy, audiology and nutrition services, if such services are prescribed by the treating physician or surgeon and such physician or surgeon certifies that such services are medically necessary and consequent to the treatment of the medically diagnosed congenital craniofacial defects and birth abnormalities. The coverage required by this section shall be subject to the terms and conditions applicable to other benefits. Payment for dental or orthodontic treatment not related to the management of the medically diagnosed congenital craniofacial defects and birth abnormalities shall not be covered under this section.

Section 8EE. A contract between a subscriber and the corporation under an individual or group hospital service plan which provides hospital expense and surgical expense insurance, except contracts providing supplemental coverage to Medicare or other governmental programs, delivered, issued or renewed by agreement between the insurer and the policyholder, within or without the commonwealth, shall cover the cost of treating the following medically diagnosed congenital craniofacial defects: ectodermal dysplasia, dentinogenesis imperfecta, amelogenesis imperfecta, and congenital oligodontia and for the cost of treating cleft lip and cleft palate for children under the age of 18.    The coverage shall include benefits for medical, dental, oral and facial surgery, surgical management and follow-up care by oral and plastic surgeons, orthodontic treatment and management, preventative and restorative dentistry to ensure good health and adequate dental structures for orthodontic treatment or prosthetic management therapy, speech therapy, audiology and nutrition services, if such services are prescribed by the treating physician or surgeon and such physician or surgeon certifies that such services are consequent to the treatment of the medically diagnosed congenital craniofacial defects and birth abnormalities. The coverage required by this section shall be subject to the terms and conditions applicable to other benefits. Payment for dental or orthodontic treatment not related to the management of the medically diagnosed congenital craniofacial defects and birth abnormalities shall not be covered under this section.

SECTION 5. Chapter 176B of the General Laws, as so appearing, is hereby amended by striking out section 4EE, as amended by section 3 of chapter 234 of the acts of 2012, and inserting in the place thereof the following section:-

Section 4GG. Any subscription certificate under an individual or group medical service agreement, except certificates that provide supplemental coverage to Medicare or other governmental programs, issued, delivered or renewed within or without the commonwealth, that covers a child under the age of 18 shall provide coverage for the cost of treating the following medically diagnosed congenital craniofacial defects: ectodermal dysplasia, dentinogenesis imperfecta, amelogenesis imperfecta, and congenital oligodontia and for the cost of treating cleft lip and cleft palate for children under the age of 18.  The coverage shall include benefits for medical, dental, oral and facial surgery, surgical management and follow-up care by oral and plastic surgeons, orthodontic treatment and management, preventative and restorative dentistry to ensure good health and adequate dental structures for orthodontic treatment or prosthetic management therapy, speech therapy, audiology and nutrition services, if such services are prescribed by the treating physician or surgeon and such physician or surgeon certifies that such services are medically necessary and consequent to the treatment of the medically diagnosed congenital craniofacial defects and birth abnormalities. The coverage required by this section shall be subject to the terms and conditions applicable to other benefits. Payment for dental or orthodontic treatment not related to the management of the medically diagnosed congenital craniofacial defects and birth abnormalities shall not be covered under this section.

SECTION 6. Chapter 176G of the General Laws, as so appearing, is hereby amended by striking out section 4W, as amended by section 3 of chapter 234 of the acts of 2012, and inserting in the place thereof the following section:-

Section 4W. A health maintenance contract issued or renewed within or without the commonwealth shall provide coverage for the cost of treating treating the following medically diagnosed congenital craniofacial defects: ectodermal dysplasia, dentinogenesis imperfecta, amelogenesis imperfecta, and congenital oligodontia and for the cost of treating cleft lip and cleft palate for children under the age of 18.  The coverage shall include benefits for medical, dental, oral and facial surgery, surgical management and follow-up care by oral and plastic surgeons, orthodontic treatment and management, preventative and restorative dentistry to ensure good health and adequate dental structures for orthodontic treatment or prosthetic management therapy, speech therapy, audiology and nutrition services, if such services are prescribed by the treating physician or surgeon and such physician or surgeon certifies that such services are medically necessary and consequent to the treatment of the medically diagnosed congenital craniofacial defects and birth abnormalities. The coverage required by this section shall be subject to the terms and conditions applicable to other benefits. Payment for dental or orthodontic treatment not related to the management of the medically diagnosed congenital craniofacial defects and birth abnormalities shall not be covered under this section.

SECTION 7. Chapter 176I of the General Laws, as so appearing, is hereby amended by striking out section 12, as amended by section 3 of chapter 234 of the acts of 2012, and inserting in the place thereof the following section:-

Section 12. An organization entering into a preferred provider contract shall provide coverage for the cost of treating treating the following medically diagnosed congenital craniofacial defects: ectodermal dysplasia, dentinogenesis imperfecta, amelogenesis imperfecta, and congenital oligodontia and for the cost of treating cleft lip and cleft palate for children under the age of 18.  The coverage shall include benefits for medical, dental, oral and facial surgery, surgical management and follow-up care by oral and plastic surgeons, orthodontic treatment and management, preventative and restorative dentistry to ensure good health and adequate dental structures for orthodontic treatment or prosthetic management therapy, speech therapy, audiology and nutrition services, if such services are prescribed by the treating physician or surgeon and such physician or surgeon certifies that such services are medically necessary and consequent to the treatment of the medically diagnosed congenital craniofacial defects and birth abnormalities. The coverage required by this section shall be subject to the terms and conditions applicable to other benefits. Payment for dental or orthodontic treatment not related to the management of the medically diagnosed congenital craniofacial defects and birth abnormalities shall not be covered under this section.

SECTION 8. This act shall apply to all policies, contracts and certificates of health insurance subject to chapters 32A, 118E, 175, 176A, 176B, 176G and 176I of the General Laws which are delivered, issued or renewed on or after January 1, 2016.