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HOUSE DOCKET, NO.                 FILED ON: 1/25/2012

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 3928

 


The Commonwealth of Massachusetts
 

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In the Year Two Thousand Twelve

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An Act relative to the treatment of cleft palate and cleft lip.
 

              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 appearing in the 2010 Official Edition, is hereby amended by inserting after section 17I the following section:-

              Section  17J.  The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for the cost of treating cleft lip and cleft palate for children under the age of 18 covered by that employee’s health plan.  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, only 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 cleft lip or palate.  The coverage required by this section is subject to the terms and conditions applicable to other benefits.  Payment for dental or orthodontic treatment not related to the management of the congenital condition of cleft lip and cleft palate shall not be covered under this provision.

              SECTION 2.  Chapter 118E, as so appearing,  is hereby amended by inserting after section 10F the following section:-

              Section  10G.  For children under the age of 18, the division shall cover the cost of treating cleft lip and cleft palate.  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, only 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 cleft lip or palate.  The coverage required by this section is subject to the terms and conditions applicable to other benefits.  Payment for dental or orthodontic treatment not related to the management of the congenital condition of cleft lip and cleft palate shall not be covered under this provision.

              SECTION 3.  Chapter 175, as so appearing, is hereby amended by inserting after section 47AA the following section:-

              Section  47BB.  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, that covers a child under the age of 18 shall provide coverage for treatment of 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, only 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 cleft lip or palate.  The coverage required by this section is subject to the terms and conditions applicable to other benefits.  Payment for dental or orthodontic treatment not related to the management of the congenital condition of cleft lip and cleft palate shall not be covered under this provision. 

              SECTION 4.  Chapter 176A of the General Laws, as so appearing, is hereby amended by inserting after section 8DD 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 that covers a child under the age of 18 shall provide coverage for treatment of 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, only 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 cleft lip or palate.  The coverage required by this section is subject to the terms and conditions applicable to other benefits.  Payment for dental or orthodontic treatment not related to the management of the congenital condition of cleft lip and cleft palate shall not be covered under this provision. 

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

              Section  4EE.  Any subscription certificate under an individual or group medical service agreement, except certificates that provide supplemental coverage to Medicare or other governmental programs, that shall be delivered, issued or renewed within or without the commonwealth that covers a child under the age of 18 shall provide coverage for treatment of 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, only 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 cleft lip or palate.  The coverage required by this section is subject to the terms and conditions applicable to other benefits.  Payment for dental or orthodontic treatment not related to the management of the congenital condition of cleft lip and cleft palate shall not be covered under this provision. 

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

              Section  4W.  A health maintenance contract issued or renewed within or without the commonwealththat covers a child under the age of 18 shall provide coverage for treatment of 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, only 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 cleft lip or palate.  The coverage required by this section is subject to the terms and conditions applicable to other benefits.  Payment for dental or orthodontic treatment not related to the management of the congenital condition of cleft lip and cleft palate shall not be covered under this provision. 

              SECTION 7.  Chapter 176I of the General Laws, as so appearing, is hereby amended by inserting after section 11 the following section:-

              Section  12.  An organization entering into a preferred provider contract that covers a child under the age of 18 shall provide coverage for treatment of 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, only 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 cleft lip or palate.  The coverage required by this section is subject to the terms and conditions applicable to other benefits.  Payment for dental or orthodontic treatment not related to the management of the congenital condition of cleft lip and cleft palate shall not be covered under this provision.

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