HOUSE DOCKET, NO. 3379        FILED ON: 2/19/2021

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 1198

The Commonwealth of Massachusetts

_________________

PRESENTED BY:

Jon Santiago

_________________

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 ensure access to the full range of treatment options for people with obesity.

_______________

PETITION OF:

HOUSE DOCKET, NO. 3379        FILED ON: 2/19/2021

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 1198

The Commonwealth of Massachusetts

_______________

In the One Hundred and Ninety-Second General Court
(2021-2022)

_______________

An Act to ensure access to the full range of treatment options for people with obesity.

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 17Q, the following section:- 

Section 17R. Any coverage offered by the commission to an active or retired employee of the commonwealth insured under the group insurance commission, shall require comprehensive coverage for treatment of obesity.  The term “comprehensive coverage for treatment of obesity” includes coverage for prevention and wellness, nutrition counseling, intensive behavioral therapy, bariatric surgery, and FDA-approved anti-obesity medication.  The term ‘FDA-approved anti-obesity medication’ refers to any medication approved by the US Food and Drug Administration with an indication for chronic weight management in patients with obesity.

Coverage criteria for FDA-approved anti-obesity medications provided under this section shall not be more restrictive than the FDA-approved indications for those treatments.

Coverage under this section shall be neither different nor separate from coverage for any other illness, condition, or disorder for purposes of determining deductibles, lifetime dollar limits, copayment and coinsurance factors, and benefit year maximum for deductibles and copayment and coinsurance factors.

Nothing shall preclude the undertaking of utilization management to determine the medical necessity for treatment of obesity under this section, provided that all such appropriateness and medical necessity determinations are made in the same manner as those determinations are made for the treatment of any other illness, condition, or disorder covered by such policy, contract, or plan.

The Commission shall provide notice to its policyholders regarding the coverage required by this section. The notice shall be in writing and prominently positioned in any literature or correspondence sent to policyholders and shall be transmitted to policyholders within calendar year when annual information is made available to policyholders, or in any other mailing to policyholders.

SECTION 2. Chapter 118E of the General Laws is hereby amended by inserting after section 10L, the following section:-

Section 10M. The division shall require comprehensive coverage for treatment of obesity.  The term “comprehensive coverage for treatment of obesity” includes coverage for prevention and wellness, nutrition counseling, intensive behavioral therapy, bariatric surgery, and FDA-approved anti-obesity medication.  The term ‘FDA-approved anti-obesity medication’ refers to any medication approved by the US Food and Drug Administration with an indication for chronic weight management in patients with obesity.

Coverage criteria for FDA-approved anti-obesity medications provided under this section shall not be more restrictive than the FDA-approved indications for those treatments.

Coverage under this section shall be neither different nor separate from coverage for any other illness, condition, or disorder for purposes of determining deductibles, lifetime dollar limits, copayment and coinsurance factors, and benefit year maximum for deductibles and copayment and coinsurance factors.

Nothing shall preclude the undertaking of utilization management to determine the medical necessity for treatment of obesity under this section, provided that all such appropriateness and medical necessity determinations are made in the same manner as those determinations are made for the treatment of any other illness, condition, or disorder covered by such policy, contract, or plan.

The division shall provide notice to its policyholders regarding the coverage required by this section. The notice shall be in writing and prominently positioned in any literature or correspondence sent to policyholders and shall be transmitted to policyholders within calendar year when annual information is made available to policyholders, or in any other mailing to policyholders.

SECTION 3. Chapter 175 of the General Laws is hereby amended by inserting after section 47KK, the following section:-

Section 47LL. The following shall require comprehensive coverage for treatment of obesity.  The term “comprehensive coverage for treatment of obesity” includes coverage for prevention and wellness, nutrition counseling, intensive behavioral therapy, bariatric surgery, and FDA-approved anti-obesity medication.  The term ‘FDA-approved anti-obesity medication’ refers to any medication approved by the US Food and Drug Administration with an indication for chronic weight management in patients with obesity.

Coverage criteria for FDA-approved anti-obesity medications provided under this section shall not be more restrictive than the FDA-approved indications for those treatments.

Coverage under this section shall be neither different nor separate from coverage for any other illness, condition, or disorder for purposes of determining deductibles, lifetime dollar limits, copayment and coinsurance factors, and benefit year maximum for deductibles and copayment and coinsurance factors.

Nothing shall preclude the undertaking of utilization management to determine the medical necessity for treatment of obesity under this section, provided that all such appropriateness and medical necessity determinations are made in the same manner as those determinations are made for the treatment of any other illness, condition, or disorder covered by such policy, contract, or plan.

The insurer shall provide notice to its policyholders regarding the coverage required by this section. The notice shall be in writing and prominently positioned in any literature or correspondence sent to policyholders and shall be transmitted to policyholders within calendar year when annual information is made available to policyholders, or in any other mailing to policyholders.

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

Section 8NN. 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 require comprehensive coverage for treatment of obesity.  The term “comprehensive coverage for treatment of obesity” includes coverage for prevention and wellness, nutrition counseling, intensive behavioral therapy, bariatric surgery, and FDA-approved anti-obesity medication.  The term ‘FDA-approved anti-obesity medication’ refers to any medication approved by the US Food and Drug Administration with an indication for chronic weight management in patients with obesity.

Coverage criteria for FDA-approved anti-obesity medications provided under this section shall not be more restrictive than the FDA-approved indications for those treatments.

Coverage under this section shall be neither different nor separate from coverage for any other illness, condition, or disorder for purposes of determining deductibles, lifetime dollar limits, copayment and coinsurance factors, and benefit year maximum for deductibles and copayment and coinsurance factors.

Nothing shall preclude the undertaking of utilization management to determine the medical necessity for treatment of obesity under this section, provided that all such appropriateness and medical necessity determinations are made in the same manner as those determinations are made for the treatment of any other illness, condition, or disorder covered by such policy, contract, or plan.

The Commission shall provide notice to its policyholders regarding the coverage required by this section. The notice shall be in writing and prominently positioned in any literature or correspondence sent to policyholders and shall be transmitted to policyholders within calendar year when annual information is made available to policyholders, or in any other mailing to policyholders.

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

Section 4NN. Any subscription certificate under an individual or group medical service agreement delivered, issued or renewed within the commonwealth shall shall require comprehensive coverage for treatment of obesity.  The term “comprehensive coverage for treatment of obesity” includes coverage for prevention and wellness, nutrition counseling, intensive behavioral therapy, bariatric surgery, and FDA-approved anti-obesity medication.  The term ‘FDA-approved anti-obesity medication’ refers to any medication approved by the US Food and Drug Administration with an indication for chronic weight management in patients with obesity.

Coverage criteria for FDA-approved anti-obesity medications provided under this section shall not be more restrictive than the FDA-approved indications for those treatments.

Coverage under this section shall be neither different nor separate from coverage for any other illness, condition, or disorder for purposes of determining deductibles, lifetime dollar limits, copayment and coinsurance factors, and benefit year maximum for deductibles and copayment and coinsurance factors.

Nothing shall preclude the undertaking of utilization management to determine the medical necessity for treatment of obesity under this section, provided that all such appropriateness and medical necessity determinations are made in the same manner as those determinations are made for the treatment of any other illness, condition, or disorder covered by such policy, contract, or plan.

The insurer shall provide notice to its policyholders regarding the coverage required by this section. The notice shall be in writing and prominently positioned in any literature or correspondence sent to policyholders and shall be transmitted to policyholders within calendar year when annual information is made available to policyholders, or in any other mailing to policyholders.

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

Section 4FF. Any individual or group health maintenance contract shall require comprehensive coverage for treatment of obesity.  The term “comprehensive coverage for treatment of obesity” includes coverage for prevention and wellness, nutrition counseling, intensive behavioral therapy, bariatric surgery, and FDA-approved anti-obesity medication.  The term ‘FDA-approved anti-obesity medication’ refers to any medication approved by the US Food and Drug Administration with an indication for chronic weight management in patients with obesity.

Coverage criteria for FDA-approved anti-obesity medications provided under this section shall not be more restrictive than the FDA-approved indications for those treatments.

Coverage under this section shall be neither different nor separate from coverage for any other illness, condition, or disorder for purposes of determining deductibles, lifetime dollar limits, copayment and coinsurance factors, and benefit year maximum for deductibles and copayment and coinsurance factors.

Nothing shall preclude the undertaking of utilization management to determine the medical necessity for treatment of obesity under this section, provided that all such appropriateness and medical necessity determinations are made in the same manner as those determinations are made for the treatment of any other illness, condition, or disorder covered by such policy, contract, or plan.

The insurer shall provide notice to its policyholders regarding the coverage required by this section. The notice shall be in writing and prominently positioned in any literature or correspondence sent to policyholders and shall be transmitted to policyholders within calendar year when annual information is made available to policyholders, or in any other mailing to policyholders.