Amendment #407 to H3900

Preserving Preventative Services

Mr. Lawn of Watertown moves to amend the bill by adding the following 6 sections: -

SECTION XX. Chapter 32A of the General Laws is hereby amended by adding the following section:-

Section 33. (a) For the purpose of this section, the following words shall have the following meanings unless the context clearly requires otherwise:

“Federally-defined preventive services,” (i) evidence-based items or services that have a rating of A or B in the recommendations of the United States Preventive Services Task Force, with respect to the individual involved; (ii) immunizations for routine use in children, adolescents and adults in accordance with the recommendations and immunization schedules from the Advisory Committee on Immunization Practices and approved by the director of the centers for disease control and prevention, with respect to the individual involved; (iii) evidence-informed preventive care and screenings for infants, children and adolescents, as described in comprehensive guidelines supported by the Health Resources and Services Administration; and (iv) evidence-informed preventive care for women, to the extent not described in clause (i) of this subsection as provided for in the comprehensive guidelines supported by the Health Resources and Services Administration; provided that federally-defined preventive services shall include all services not subject to any cost-sharing, including co-payments, co-insurance and deductibles, as required by established federal regulatory and sub-regulatory guidance issued on or before the effective date of this act.

(b) (1) 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 federally-defined preventive services, as defined by this section. Federally-defined preventive services shall not be subject to any cost-sharing, including co-payments, co-insurance or any deductible.

(2) Benefits for an enrollee under this section shall be the same for the enrollee’s covered spouse and covered dependents.

(c) Nothing in this section shall prohibit a carrier from providing coverage for items and services in addition to those recommended by the United States Preventive Services Task Force, the Advisory Committee on Immunization Practices, and the Health Resources and Services Administration, or denying coverage for items and services that are not recommended.

(d) If a recommendation described in subsection (b) is changed during a health plan year, a carrier is not required to make changes to that health plan during the plan year.

(e) The commission shall issue guidance as necessary to implement and enforce this section, to ensure compliance with all relevant federal requirements, and to add any preventive services that shall not be subject to cost-sharing that are added to relevant federal regulatory and sub-regulatory guidance issued after the effective date of this act.

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

Section 47UU. (a) For the purpose of this section, the following words shall have the following meanings unless the context clearly requires otherwise:

“Federally-defined preventive services,” (i) evidence-based items or services that have a rating of A or B in the recommendations of the United States Preventive Services Task Force, with respect to the individual involved; (ii) immunizations for routine use in children, adolescents and adults in accordance with the recommendations and immunization schedules from the Advisory Committee on Immunization Practices and approved by the director of the centers for disease control and prevention, with respect to the individual involved; (iii) evidence-informed preventive care and screenings for infants, children and adolescents, as described in comprehensive guidelines supported by the Health Resources and Services Administration; and (iv) evidence-informed preventive care for women, to the extent not described in clause (i) of this subsection as provided for in the comprehensive guidelines supported by the Health Resources and Services Administration; provided that federally-defined preventive services shall include all services not subject to any cost-sharing, including co-payments, co-insurance and deductibles, as required by established federal regulatory and sub-regulatory guidance issued on or before the effective date of this act.

(b) A policy, contract, agreement, plan or certificate of insurance issued, delivered or renewed within the commonwealth, which is considered creditable coverage under section 1 of chapter 111M, shall provide coverage for federally-defined preventive services, as defined by this section. Federally-defined preventive services shall not be subject to any cost-sharing, including co-payments, co-insurance or any deductible.

(c) Nothing in this section shall prohibit a carrier from providing coverage for items and services in addition to those recommended by the United States Preventive Services Task Force, the Advisory Committee on Immunization Practices, and the Health Resources and Services Administration, or denying coverage for items and services that are not recommended.

(d) If a recommendation described in subsection (b) is changed during a health plan year, a carrier is not required to make changes to that health plan during the plan year.

(e) The division shall issue guidance as necessary to implement and enforce this section, to ensure compliance with all relevant federal requirements, and to add any preventive services that shall not be subject to cost-sharing that are added to relevant federal regulatory and sub-regulatory guidance issued after the effective date of this act.

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

Section 8VV. (a) For the purpose of this section, the following words shall have the following meanings unless the context clearly requires otherwise:

“Federally-defined preventive services,” (i) evidence-based items or services that have a rating of A or B in the recommendations of the United States Preventive Services Task Force, with respect to the individual involved; (ii) immunizations for routine use in children, adolescents and adults in accordance with the recommendations and immunization schedules from the Advisory Committee on Immunization Practices and approved by the director of the centers for disease control and prevention, with respect to the individual involved; (iii) evidence-informed preventive care and screenings for infants, children and adolescents, as described in comprehensive guidelines supported by the Health Resources and Services Administration; and (iv) evidence-informed preventive care for women, to the extent not described in clause (i) of this subsection as provided for in the comprehensive guidelines supported by the Health Resources and Services Administration; provided that federally-defined preventive services shall include all services not subject to any cost-sharing, including co-payments, co-insurance and deductibles, as required by established federal regulatory and sub-regulatory guidance issued on or before the effective date of this act.

(b) A contract between a subscriber and the corporation under an individual or group hospital service plan which is issued, delivered or renewed within the commonwealth, which is considered creditable coverage under section 1 of chapter 111M, shall provide coverage for federally-defined preventive services, as defined by this section. Federally-defined preventive services shall not be subject to any cost-sharing, including co-payments, co-insurance or any deductible.

(c) Nothing in this section shall prohibit a carrier from providing coverage for items and services in addition to those recommended by the United States Preventive Services Task Force, the Advisory Committee on Immunization Practices, and the Health Resources and Services Administration, or denying coverage for items and services that are not recommended.

(d) If a recommendation described in subsection (b) is changed during a health plan year, a carrier is not required to make changes to that health plan during the plan year.

(e) The division shall issue guidance as necessary to implement and enforce this section, to ensure compliance with all relevant federal requirements, and to add any new preventive services not subject to cost-sharing that may be added to relevant federal requirements after the effective date of this act.

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

Section 4VV. (a) For the purpose of this section, the following words shall have the following meanings unless the context clearly requires otherwise:

“Federally-defined preventive services,” (i) evidence-based items or services that have a rating of A or B in the recommendations of the United States Preventive Services Task Force, with respect to the individual involved; (ii) immunizations for routine use in children, adolescents and adults in accordance with the recommendations and immunization schedules from the Advisory Committee on Immunization Practices and approved by the director of the centers for disease control and prevention, with respect to the individual involved; (iii) evidence-informed preventive care and screenings for infants, children and adolescents, as described in comprehensive guidelines supported by the Health Resources and Services Administration; and (iv) evidence-informed preventive care for women, to the extent not described in clause (i) of this subsection as provided for in the comprehensive guidelines supported by the Health Resources and Services Administration; provided that federally-defined preventive services shall include all services not subject to any cost-sharing, including co-payments, co-insurance and deductibles, as required by established federal regulatory and sub-regulatory guidance issued on or before the effective date of this act.

(b) A subscription certificate under an individual or group medical service agreement which is issued, delivered or renewed within the commonwealth, which is considered creditable coverage under section 1 of chapter 111M, shall provide coverage for federally-defined preventive services, as defined by this section. Federally-defined preventive services shall not be subject to any cost-sharing, including co-payments, co-insurance or any deductible.

(c) Nothing in this section shall prohibit a carrier from providing coverage for items and services in addition to those recommended by the United States Preventive Services Task Force, the Advisory Committee on Immunization Practices, and the Health Resources and Services Administration, or denying coverage for items and services that are not recommended.

(d) If a recommendation described in subsection (b) is changed during a health plan year, a carrier is not required to make changes to that health plan during the plan year.

(e) The division shall issue guidance as necessary to implement and enforce this section, to ensure compliance with all relevant federal requirements, and to add any preventive services that shall not be subject to cost-sharing that are added to relevant federal regulatory and sub-regulatory guidance issued after the effective date of this act.

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

Section 4NN. (a) For the purpose of this section, the following words shall have the following meanings unless the context clearly requires otherwise:

“Federally-defined preventive services,” (i) evidence-based items or services that have a rating of A or B in the recommendations of the United States Preventive Services Task Force, with respect to the individual involved; (ii) immunizations for routine use in children, adolescents and adults in accordance with the recommendations and immunization schedules from the Advisory Committee on Immunization Practices and approved by the director of the centers for disease control and prevention, with respect to the individual involved; (iii) evidence-informed preventive care and screenings for infants, children and adolescents, as described in comprehensive guidelines supported by the Health Resources and Services Administration; and (iv) evidence-informed preventive care for women, to the extent not described in clause (i) of this subsection as provided for in the comprehensive guidelines supported by the Health Resources and Services Administration; provided that federally-defined preventive services shall include all services not subject to any cost-sharing, including co-payments, co-insurance and deductibles, as required by established federal regulatory and sub-regulatory guidance issued on or before the effective date of this act.

(b) An individual or group health maintenance contract that is issued, delivered or renewed within the commonwealth, which is considered creditable coverage under section 1 of chapter 111M, shall provide coverage for federally-defined preventive services, as defined by this section. Federally-defined preventive services shall not be subject to any cost-sharing, including co-payments, co-insurance or any deductible.

(c) Nothing in this section shall prohibit a carrier from providing coverage for items and services in addition to those recommended by the United States Preventive Services Task Force, the Advisory Committee on Immunization Practices, and the Health Resources and Services Administration, or denying coverage for items and services that are not recommended.

(d) If a recommendation described in subsection (b) is changed during a health plan year, a carrier is not required to make changes to that health plan during the plan year.

(e) The division shall issue guidance as necessary to implement and enforce this section, to ensure compliance with all relevant federal requirements, and to add any preventive services that shall not be subject to cost-sharing that are added to relevant federal regulatory and sub-regulatory guidance issued after the effective date of this act.

SECTION XX. The division of insurance shall issue guidance to ensure compliance with this act not later than 90 days after the effective date of this act.

Additional co-sponsor(s) added to Amendment #407 to H3900

Preserving Preventative Services