HOUSE DOCKET, NO. 611        FILED ON: 1/13/2017

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 528

The Commonwealth of Massachusetts

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PRESENTED BY:

Sean Garballey

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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 provide early and periodic screening, diagnosis and treatment to privately insured children under the age of 21.

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PETITION OF:

HOUSE DOCKET, NO. 611        FILED ON: 1/13/2017

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 528

[SIMILAR MATTER FILED IN PREVIOUS SESSION
SEE HOUSE, NO. 856 OF 2015-2016.]

The Commonwealth of Massachusetts

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In the One Hundred and Ninetieth General Court
(2017-2018)

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An Act to provide early and periodic screening, diagnosis and treatment to privately insured children under the age of 21.

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 17J the following section:-

Section 17K. The commission shall cover early and periodic screening, diagnosis and treatment (EPSDT) services for children and adolescents under age 21 in a manner equal to the amount, duration and scope of those services provided to Medicaid children and adolescents as required by 42 USC §1396(a)10A, §1396(a)(a)(43), §1396d(a)(4)(B) and §1396d(r).

SECTION 2. Chapter 175 of the General Laws is hereby amended by inserting after section 47BB 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 early and periodic screening, diagnosis and treatment (EPSDT) services for children and adolescents under age 21 in a manner equal to the amount, duration and scope of those services provided to Medicaid children and adolescents as required by 42 USC §1396(a)10A, §1396(a)(a)(43), §1396d(a)(4)(B) and §1396d(r).

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

Section 8FF.  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 cover early and periodic screening, diagnosis and treatment (EPSDT) services for children and adolescents under age 21 in a manner equal to the amount, duration and scope of those services provided to Medicaid children and adolescents as required by 42 USC §1396(a)10A, §1396(a)(a)(43), §1396d(a)(4)(B) and §1396d(r).

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

Section 4FF. A subscription certificate under an individual or group medical service agreement which is issued or renewed within or without the commonwealth shall cover early and periodic screening, diagnosis and treatment (EPSDT) services for children and adolescents under age 21 in a manner equal to the amount, duration and scope of those services provided to Medicaid children and adolescents as required by 42 USC §1396(a)10A, §1396(a)(a)(43), §1396d(a)(4)(B) and §1396d(r).

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

Section 4X. A health maintenance contract issued or renewed within or without the commonwealth shall cover early and periodic screening, diagnosis and treatment (EPSDT) services for children and adolescents under age 21 in a manner equal to the amount, duration and scope of those services provided to Medicaid children and adolescents as required by 42 USC §1396(a)10A, §1396(a)(a)(43), §1396d(a)(4)(B) and §1396d(r).

SECTION 6. Chapter 176I of the General Laws is hereby amended by adding the following section:-

Section 13. An organization entering into a preferred provider contract shall cover early and periodic screening, diagnosis and treatment (EPSDT) services for children and adolescents under age 21 in a manner equal to the amount, duration and scope of those services provided to Medicaid children and adolescents as required by 42 USC §1396(a)10A, §1396(a)(a)(43), §1396d(a)(4)(B) and §1396d(r).

SECTION 7. This act shall apply to all policies, contracts and certificates of health insurance subject to chapters 32A, 175, 176A, 176B, 176G and 176I of the General Laws which are delivered, issued or renewed on or after December 31, 2018.