Amendment ID: S2499-18
Amendment 18
No cost sharing for infectious disease drugs
Ms. Comerford and Ms. Rausch move that the proposed new draft be amended by inserting after section 41 the following section:-
“SECTION 41A. Chapter 111 of the General Laws is hereby amended by adding after section 7 the following section:-
Section 7A. (a) The commissioner is hereby authorized to designate contagious and infectious diseases of heightened public health importance.
(b) Upon the designation of a contagious or infectious disease pursuant to subsection (a), the commissioner shall: (1) provide forthwith written notice of such designation and the requirements of this section to the secretary of health and human services, who shall enforce this section with respect to programs of medical assistance and medical benefits established under chapter 118E; the group insurance commission which shall enforce this section for coverage established under chapter 32A; and the division of insurance which shall immediately notify commercial health insurers, Blue Cross and Blue Shield of Massachusetts, Inc., health maintenance organizations, and all other entities that provide health coverage and medical assistance and benefit programs within the scope of the division’s regulation, of a designation pursuant to paragraph (a) and the requirements of this section; (2) take steps to ensure that the public health council shall have the opportunity in an advisory capacity to comment upon such designation; and (3) take reasonable steps to notify health care institutions, health care providers, and consumers of the provisions of this section, including as applicable through clinical advisories, posting to the department’s website, or other means.
(c) The commissioner shall maintain a publicly accessible list of contagious or infectious diseases that have been designated as of public health importance pursuant to subsection (a). The commissioner shall at least annually review the list and shall either renew or remove each designation. When a contagious or infectious disease is removed from the list of designations made under subsection (a), the commissioner shall provide written notice of such removal to the entities specified in subsection (c).
(d) The requirements of subsection (b) shall be effective 30 days from a designation pursuant to subsection (a).” and, in section 41, in line 778, by adding the following paragraph:-
“Section 17U. The commission shall provide to any active or retired employee of the commonwealth who is insured under the group health insurance commission, coverage without cost sharing or utilization review for any health care service for the prevention, diagnosis, or treatment of a contagious or infectious disease designated as of heightened public health importance section 7A of Chapter 111. For purposes of this section, cost sharing shall include payments required from a consumer in connection with the provision of a health care service, including but not limited to co-payments, coinsurance and deductibles. Utilization review shall include prior authorization, step therapy, or any other protocol that could restrict or delay the provision of any health care service.”; and, in section 44, in line 981, by adding the following paragraph:-
“Section 10S: The division shall cover without cost sharing or utilization review any health care service for the prevention, diagnosis, or treatment of a contagious disease designated as of heightened public health importance pursuant to Section 7A of chapter 111. For purposes of this section, cost sharing shall include payments required from a consumer in connection with the provision of a health care service, including but not limited to co-payments, coinsurance and deductibles. Utilization review shall include prior authorization, step therapy, or any other protocol that could restrict or delay the provision of any health care service.”; and in section 45, in line 1097, by adding the following paragraph:-
“Section 47VV. 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 under section 110 that provides hospital expense and surgical expense insurance, which is issued or renewed within or without the commonwealth, shall cover without cost sharing or utilization review any health care service for the prevention, diagnosis, or treatment of a contagious or infectious disease designated as of public health importance pursuant to Section 7A of chapter 111. For purposes of this section, cost sharing shall include payments required from a consumer in connection with the provision of a health care service, including but not limited to co-payments, coinsurance and deductibles. Utilization review shall include prior authorization, step therapy, or any other protocol that could restrict or delay the provision of any health care service.”; and in section 47, in line 1229, by adding the following paragraph:-
“Section WW. 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, shall cover without cost sharing or utilization review any health care service for the prevention, diagnosis, or treatment of a contagious or infectious disease designated as of heightened public health importance pursuant to section 7A of chapter 111. For purposes of this section, cost sharing shall include payments required from a consumer in connection with the provision of a health care service, including but not limited to co-payments, coinsurance and deductibles; provided, however, that co-payments, coinsurance or deductibles shall be required if the applicable plan is governed by the Federal Internal Revenue code and would lose its tax-exempt status as a result of the prohibition on co-payments, coinsurance or deductibles for these services. Utilization review shall include prior authorization, step therapy, or any other protocol that could restrict or delay the provision of any health care service.”; and, in section 48, in line 1347, by adding the following paragraph:-
“Section WW. Any subscription certificate under an individual or group medical service agreement, except certificates that provide supplemental coverage to Medicare or other governmental programs, issued, delivered or renewed within or without the commonwealth, shall cover without cost sharing or utilization review any health care service for the prevention, diagnosis, or treatment of a contagious or infectious disease designated as of heightened public health importance pursuant to section 7A of chapter 111; provided, however, that co-payments, coinsurance or deductibles shall be required if the applicable plan is governed by the Federal Internal Revenue code and would lose its tax-exempt status as a result of the prohibition on co-payments, coinsurance or deductibles for these services. Utilization review shall include prior authorization, step therapy, or any other protocol that could restrict or delay the provision of any health care service.”; and in section 52, in line 1479, by adding the following paragraph:-
“Section 4NN. A health maintenance contract issued or renewed within or without the commonwealth shall cover without cost sharing or utilization review any health care service for the prevention, diagnosis, or treatment of a contagious or infectious disease designated as of heightened public health importance pursuant to section 7A of chapter 111. For purposes of this section, cost sharing shall include payments required from a consumer in connection with the provision of a health care service, including but not limited to co-payments, coinsurance and deductibles; provided, however, that co-payments, coinsurance or deductibles shall be required if the applicable plan is governed by the Federal Internal Revenue code and would lose its tax-exempt status as a result of the prohibition on co-payments, coinsurance or deductibles for these services. Utilization review shall include prior authorization, step therapy, or any other protocol that could restrict or delay the provision of any health care service.”; and by inserting after section 52 the following section:-
“SECTION 52A. Chapter 176I of the General Laws is hereby amended by adding the following section:-
Section 14 An organization entering into a preferred provider contract shall cover without cost sharing or utilization review any health care service for the prevention, diagnosis, or treatment of a contagious or infectious disease designated as of heightened public health importance pursuant to section 7A of chapter 111. For purposes of this section, cost sharing shall include payments required from a consumer in connection with the provision of a health care service, including but not limited to co-payments, coinsurance, and deductibles. Utilization review shall include prior authorization, step therapy, or any other protocol that could restrict or delay the provision of any health care service.”