HD 2059 requires Massachusetts health insurance plans to cover medications for opioid use disorder (like naloxone and buprenorphine) without prior authorization, prescriptions, or cost-sharing (deductibles, copays). It directly affects Commonwealth employees (via group insurance), Medicaid patients, and private insurance holders in Massachusetts. The bill mandates coverage as both a medical benefit (when administered at treatment facilities) and pharmacy benefit, with facilities reimbursed at standard rates to prevent balance billing. It also specifies that cost-sharing may still apply if a plan would lose tax-exempt status under IRS rules.
This bill (HD 2117) requires Massachusetts healthcare agencies (Division of Medical Assistance and Health Policy Commission) to use patient-centered research standards when making coverage and treatment decisions. It mandates that research must prioritize outcomes valued by patients and people with disabilities, include analysis of diverse patient subgroups, and follow rigorous scientific practices. Crucially, it prohibits agencies from using "dollars-per-quality adjusted life year" or similar cost-effectiveness metrics to deny coverage or set payment rates. The bill also requires clear appeals processes for physicians to override coverage denials. These changes directly affect how state healthcare decisions are made, aiming to ensure patient perspectives shape coverage policies.
This bill requires Massachusetts insurers to cover opioid use disorder treatment provided by pharmacists at rates comparable to other nonphysician health providers. It mandates coverage under group insurance (Chapter 32A), Medicaid plans (Chapter 118E), private health insurance policies (Chapter 175), and hospital service plans (Chapter 176A). Pharmacists must be reimbursed for this service if it aligns with their scope of practice and would be covered if provided by a physician or nurse practitioner. The policy directly affects patients seeking opioid treatment and pharmacists who can now deliver this care with guaranteed insurance reimbursement.
This bill requires health insurance policies (including group plans, hospital services, and health maintenance contracts) to cover medically necessary treatments for students with disabilities, as specified in their individual education plans or similar federal special education documents. It directly affects students with disabilities whose care is outlined in these plans and their families, ensuring insurers cannot deny coverage based on disability. The law mandates that all qualifying insurance policies issued or renewed after January 1, 2024, provide equal coverage for these treatments without discrimination. It applies broadly to all relevant insurance products under Massachusetts law, aligning with existing federal special education requirements.
This bill (SD 993) requires health care providers to submit cost reports on time and blocks for-profit companies from taking over non-profit hospitals. It amends reporting rules to make submission mandatory ("shall" instead of "may") and adds a requirement for the state center to define "just cause" for reporting exemptions. Crucially, it prohibits for-profit entities from obtaining licenses to operate acute-care hospitals if they acquire a non-profit hospital after April 1, 2024, through sales, mergers, or similar transactions. The bill directly affects hospitals seeking new licenses or renewals and health care providers responsible for cost reporting.
HD 1913 requires health insurance plans covering HIV prevention medication (pre-exposure prophylaxis, or PrEP) to provide full coverage without out-of-pocket costs. It applies to Commonwealth employee health insurance, state health plans, and accident/sickness insurance policies. The bill eliminates cost-sharing (like copays or deductibles), removes prior authorization requirements, and prohibits denying coverage based on the prescriber's type or location. It ensures access to PrEP drugs and required monitoring services (like lab tests or counseling) as defined by federal health agencies. This directly affects individuals seeking HIV prevention medication through these specific insurance programs.
This bill requires all health insurance plans sold in Massachusetts - including state employee group plans, individual policies, and hospital service agreements - to cover biennial echocardiograms (heart screenings) and concussion analysis for children aged 5 to 18. It directly affects insurers and policyholders by mandating this specific preventive care coverage for youth. The key provision adds new requirements to multiple chapters of state law, ensuring consistent coverage across all medical insurance types in the commonwealth. The policy change focuses on making these screenings accessible without out-of-pocket costs for families.
HD 2146 requires Massachusetts' Department of Public Health to create a mandatory assessment tool within 12 months. This tool quantifies health impacts (like asthma, hospital visits, and premature death) and associated costs or savings from energy-related emissions (e.g., pollution from power plants) and energy efficiency/renewable energy benefits. It specifically analyzes effects on environmental justice communities, MassHealth, community hospitals, and state budgets. Starting 24 months after the law takes effect, all new state energy, transportation, or waste policies must explicitly factor in the tool's health cost analysis before adoption.
HD 2122 requires Massachusetts health insurance plans - including Medicaid, private insurers, and employer health plans - to cover services provided by certified community health workers (CHWs), such as health education, care coordination, and resource navigation. It directly affects CHWs, healthcare providers, community organizations, and insurers by mandating payment for these services, including those employed by non-medical entities. The bill also establishes a task force to study CHW workforce challenges and recommend improvements to certification, recruitment, retention, and reimbursement by March 2026. This policy change expands access to community-based health support through standardized insurance coverage and workforce development efforts.
This bill (HD 2064) grants parents or guardians of children under 16 the right to inspect all medical records (including digital records) of their child without needing the child's consent, except for records related to specific sensitive services. The exceptions cover family planning, gender-affirming care, substance use treatment, STI treatment, pregnancy-related care, and mental health treatment. The Department of Public Health must create rules to implement this change. It directly affects parents/guardians of minors under 16 and healthcare facilities handling their records.
