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HOUSE DOCKET, NO. 2601         FILED ON: 1/17/2013

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 916

 

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

_______________

PETITION OF:

 

Name:

District/Address:

Sean Garballey

23rd Middlesex

James B. Eldridge

Middlesex and Worcester

Sal N. DiDomenico

Middlesex and Suffolk

Kay Khan

11th Middlesex

Ruth B. Balser

12th Middlesex

Denise Provost

27th Middlesex

David M. Rogers

24th Middlesex

Michael D. Brady

9th Plymouth

Patricia D. Jehlen

Second Middlesex

Denise Andrews

2nd Franklin

Frank I. Smizik

15th Norfolk

Danielle W. Gregoire

4th Middlesex

Benjamin Swan

11th Hampden

Karen E. Spilka

Second Middlesex and Norfolk


HOUSE DOCKET, NO. 2601        FILED ON: 1/17/2013

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 916

By Mr. Garballey of Arlington, a petition (accompanied by bill, House, No. 916) of Sean Garballey and others relative to coverage standards for children under private insurance .  Financial Services. 


The Commonwealth of Massachusetts
 

_______________

In the Year Two Thousand Thirteen

_______________

 

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, 2016.

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