HOUSE DOCKET, NO. 631        FILED ON: 1/13/2019

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 1036

 

The Commonwealth of Massachusetts

_________________

PRESENTED BY:

Dylan A. Fernandes and Daniel R. Carey

_________________

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 ensuring treatment for genetic craniofacial conditions.

_______________

PETITION OF:

 

Name:

District/Address:

Date Added:

Dylan A. Fernandes

Barnstable, Dukes and Nantucket

1/13/2019

Daniel R. Carey

2nd Hampshire

1/15/2019

Angelo J. Puppolo, Jr.

12th Hampden

1/22/2019

David Paul Linsky

5th Middlesex

1/22/2019

Danielle W. Gregoire

4th Middlesex

1/22/2019

Aaron Vega

5th Hampden

1/23/2019

Brian M. Ashe

2nd Hampden

1/24/2019

Carolyn C. Dykema

8th Middlesex

1/24/2019

David Biele

4th Suffolk

2/1/2019

Natalie M. Blais

1st Franklin

1/28/2019

Paul Brodeur

32nd Middlesex

2/1/2019

Joanne M. Comerford

Hampshire, Franklin and Worcester

1/31/2019

Mike Connolly

26th Middlesex

2/1/2019

Julian Cyr

Cape and Islands

1/31/2019

Angelo L. D'Emilia

8th Plymouth

1/29/2019

Marjorie C. Decker

25th Middlesex

2/1/2019

Mindy Domb

3rd Hampshire

1/30/2019

Tricia Farley-Bouvier

3rd Berkshire

1/28/2019

Michael J. Finn

6th Hampden

1/28/2019

Sean Garballey

23rd Middlesex

1/25/2019

Denise C. Garlick

13th Norfolk

1/30/2019

Carlos González

10th Hampden

1/25/2019

Kenneth I. Gordon

21st Middlesex

1/25/2019

Tami L. Gouveia

14th Middlesex

2/1/2019

James K. Hawkins

2nd Bristol

1/31/2019

Jonathan Hecht

29th Middlesex

1/31/2019

Patrick Joseph Kearney

4th Plymouth

1/29/2019

David Henry Argosky LeBoeuf

17th Worcester

1/31/2019

Liz Miranda

5th Suffolk

2/1/2019

Brian W. Murray

10th Worcester

1/29/2019

Maria Duaime Robinson

6th Middlesex

2/1/2019

David M. Rogers

24th Middlesex

1/29/2019

Jon Santiago

9th Suffolk

1/31/2019

José F. Tosado

9th Hampden

1/31/2019

Steven Ultrino

33rd Middlesex

1/25/2019

Susannah M. Whipps

2nd Franklin

2/1/2019


HOUSE DOCKET, NO. 631        FILED ON: 1/13/2019

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 1036

By Messrs. Fernandes of Falmouth and Carey of Easthampton, a petition (accompanied by bill, House, No. 1036) of Dylan A. Fernandes, Daniel R. Carey and others for legislation to provide health insurance coverage for certain medically necessary functional repair or restoration of craniofacial disorders.  Financial Services.

 

[SIMILAR MATTER FILED IN PREVIOUS SESSION
SEE HOUSE, NO. 581 OF 2017-2018.]

 

The Commonwealth of Massachusetts

 

_______________

In the One Hundred and Ninety-First General Court
(2019-2020)

_______________

 

An Act relative to ensuring treatment for genetic craniofacial conditions.

 

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 17N as appearing in the 2014 Official Edition, the following section:-

Section 17O. Any coverage offered by the commission to an active or retired employee of the commonwealth insured under the group insurance commission shall provide coverage for medically necessary functional repair or restoration of craniofacial disorders, with the exception of coverage for cleft lip and cleft palate which is prescribed elsewhere in the General Laws, to improve the function of, or to approximate the normal appearance or any abnormal structures caused by congenital disease of anomaly. Coverage under this section shall include the necessary care and treatment of medically diagnosed congenital disease or anomaly. Including, but not limited to, ectodermal dysplasia, dentinogenesis imperfecta, amelogenesis imperfecta. Coverage shall not include cosmetic surgery or for dental or orthodontic treatment unrelated to congenital disease or anomaly. The benefits in this section shall not be subject to any greater deductible, coinsurance, copayments or out-of-pocket limits than any other benefit provided by the commission.

SECTION 2. Chapter 118E of the General Laws is hereby amended by inserting after section 10I, inserted by section 105 of chapter 46 of the acts of 2015, the following section:-

Section 10J. The division shall provide coverage for medically necessary functional repair or restoration of craniofacial disorders; with the exception of coverage for cleft lip and cleft palate which is prescribed elsewhere in the General Laws, to improve the function of, or to approximate the normal appearance of any abnormal structures caused by congenital disease or anomaly. Coverage under this section shall include the necessary care and treatment of medically diagnosed congenital disease or anomaly, including ectodermal dysplasia, dentinogenesis imperfecta, and amelogenesis imperfecta. Coverage shall not include cosmetic surgery or for dental or orthodontic treatment unrelated to congenital disease or anomaly. The benefits in this section shall not be subject to any greater deductible, coinsurance, copayments or out-of-pocket limits than any other benefit provided by the division. 

SECTION 3. Chapter 175 of the General Laws is hereby amended by inserting after section 47GG, as appearing in the 2014 Official Edition, the following section:- 

Section 47HH. The following shall provide coverage for medically necessary functional repair or restoration of craniofacial disorders; with the exception of coverage for cleft lip and cleft palate which is prescribed elsewhere in the General Laws, to improve the function of, or to approximate the normal appearance of any abnormal structures caused by congenital disease or anomaly. Coverage under this section shall include the necessary care and treatment of medically diagnosed congenital disease or anomaly, including ectodermal dysplasia, dentinogenesis imperfecta, and amelogenesis imperfecta. Coverage shall not include cosmetic surgery or dental or orthodontic treatment unrelated to congenital disease or anomaly.: (i) any policy of accident and sickness insurance, as described in section 108, which provides hospital expense and surgical expense insurance and which is delivered, issued or subsequently renewed by agreement between the insurer and policyholder in the commonwealth; (ii) any blanket or general policy of insurance described in subdivision (A), (C) or (D) of section 110 which provides hospital expense and surgical expense insurance and which is delivered, issued or subsequently renewed by agreement between the insurer and the policyholder in or outside of the commonwealth; or (iii) any employees’ health and welfare fund which provides hospital expense and surgical expense benefits and which is delivered, issued or renewed to any person or group of persons in the commonwealth. The benefits in this section shall not be subject to any greater deductible, coinsurance, copayments or out-of-pocket limits than any other benefit provided by the insurer.

SECTION 4. Chapter 176A of the General Laws is hereby amended by inserting after section 8II, as so appearing, the following section:-

Section 8JJ. Any contract between a subscriber and the corporation under an individual or group hospital service plan which is delivered, issued or renewed within the commonwealth shall provide coverage for medically necessary functional repair or restoration of craniofacial disorders; with the exception of coverage for cleft lip and cleft palate which is prescribed elsewhere in the General Laws, to improve the function of, or to approximate the normal appearance of any abnormal structures caused by congenital disease or anomaly. Coverage under this section shall include the necessary care and treatment of medically diagnosed congenital disease or anomaly, including, ectodermal dysplasia, dentinogenesis imperfecta, and amelogenesis imperfecta. Coverage shall not include cosmetic surgery or dental or orthodontic treatment unrelated to congenital disease or anomaly. The benefits in this section shall not be subject to any greater deductible, coinsurance, copayments or out-of-pocket limits than any other benefit provided by the insurer.

SECTION 5. Chapter 176B of the General Laws is hereby amended by inserting after section 4II, as so appearing, the following section:-

Section 4JJ. Any subscription certificate under an individual or group medical service agreement delivered, issued or renewed within the commonwealth shall provide coverage for medically necessary functional repair or restoration of craniofacial disorders; with the exception of coverage for cleft lip and cleft palate which is prescribed elsewhere in the General Laws, to improve the function of, or to approximate the normal appearance of any abnormal structures caused by disease or anomaly. Coverage under this section shall include the necessary care and treatment of medically diagnosed congenital disease or anomaly, including, ectodermal dysplasia, dentinogenesis imperfecta, and amelogenesis imperfecta. Coverage shall not include cosmetic surgery or dental or orthodontic treatment unrelated to congenital disease or anomaly. The benefits in this section shall not be subject to any greater deductible, coinsurance, copayments or out-of-pocket limits than any other benefit provided by the insurer.

SECTION 6. Chapter 176G of the General Laws, as so appearing, is hereby amended by inserting after section 4AA, as so appearing, the following section:-

Section 4BB. Any individual or group health maintenance contract shall provide coverage for medically necessary functional repair or restoration of craniofacial disorders; with the exception of coverage for cleft lip and cleft palate which is prescribed elsewhere in the General Laws, to improve the function of, or to approximate the normal appearance of any abnormal structures caused by congenital disease or anomaly. Coverage under this section shall include the necessary care and treatment of medically diagnosed congenital disease or anomaly, including, ectodermal dysplasia, dentinogenesis imperfecta, and amelogenesis imperfecta. Coverage shall not include cosmetic surgery or dental or orthodontic treatment unrelated to congenital disease or anomaly. The benefits in this section shall not be subject to any greater deductible, coinsurance, copayments or out-of-pocket limits than any other benefit provided by the insurer.

SECTION 7. Chapter 176I of the General Laws, as so appearing, is hereby amended by inserting after section,12, as so appearing, the following section:-

Section 13. An organization entering into a preferred provider contract shall provide coverage for medically necessary functional repair or restoration of craniofacial disorders; with the exception of coverage for cleft lip and cleft palate which is prescribed elsewhere in the General Laws, to improve the function of, or to approximate the normal appearance of any abnormal structures caused by congenital disease or anomaly. Coverage under this section shall include the necessary care and treatment of medically diagnosed congenital disease or anomaly, including, ectodermal dysplasia, dentinogenesis imperfecta, and amelogenesis imperfecta. Coverage shall not include cosmetic surgery or dental or orthodontic treatment unrelated to congenital defects, developmental deformities, trauma, tumors, infections or disease. The benefits in this section shall not be subject to any greater deductible, coinsurance, copayments or out-of-pocket limits than any other benefit provided by the insurer.

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, as so appearing, issued or renewed, except any entity to the extent it offers a policy, certificate or contract that provides coverage for dental care services or vision care services.