This bill requires health insurance plans in Massachusetts to cover prescription medications for gender-affirming care services as defined in state law. It mandates coverage for up to a 12-month period for subsequent dispensings of the same medication, allowing full or partial dispensing within that timeframe. Coverage must be provided regardless of enrollment status when the prescription was first issued, but insurers are not required to cover more than one 12-month prescription per plan year. The bill directly affects insured individuals seeking ongoing gender-affirming medication treatment.
H 4933 requires Massachusetts health insurance plans to cover colorectal cancer screening with no out-of-pocket costs for people aged 30 and older. It applies to Commonwealth employees (active and retired), Medicaid recipients, private insurance policies, and employer health plans. The law mandates coverage for multiple screening methods - including colonoscopy every 5-10 years, annual stool tests, and other medically necessary procedures - as recommended by a doctor. Crucially, it eliminates copays, deductibles, and other cost-sharing for these screenings, except for tax-exempt plans that would lose status if cost-sharing were prohibited.
H 4935 requires health insurance plans and medical assistance programs in Massachusetts to cover prevention, diagnosis, and treatment of diseases designated by the commissioner as "of heightened public health importance" without cost-sharing (like copays or deductibles) or prior authorization. It applies to all health coverage under specific Massachusetts laws, including group insurance (Chapter 32A), Medicaid (Chapter 118E), and individual hospital/surgical plans (Chapters 175, 176A, 176B, 176G). The commissioner must publicly list designated diseases, review the list annually, and notify insurers and providers. An exception allows cost-sharing for tax-exempt plans that would lose their status if prohibited.
H 4893 requires health insurance plans in Massachusetts to cover at least six sessions of preventive behavioral health services for individuals under 21 who have a positive screening for depression, anxiety, or other emotional concerns (or for infants whose caregivers screen positive for postpartum depression), without cost-sharing or prior authorization. This applies to group insurance plans for state employees, private insurance policies, and health plans governed by state law, covering individual, family, or group sessions delivered in pediatric primary care, community, or school settings. Insurers must accept alternative diagnosis codes (like Social Determinants of Health Z-codes) for billing these services. The bill directly affects children, adolescents, and infants with early behavioral health screenings by mandating accessible, no-cost preventive care to help prevent more severe conditions.
This bill (H 4958) requires all health insurance plans in Massachusetts - covering Commonwealth employees, Medicaid recipients, and private insurance policies - to provide full coverage for medications treating opioid use disorder, including opioid antagonists and agonists (like methadone or buprenorphine). It eliminates prior authorization requirements and removes all out-of-pocket costs (deductibles, copays, coinsurance) for these medications, treating them as medically necessary. The coverage applies whether the medication is dispensed by a pharmacy or administered at a treatment facility, with facilities reimbursed at standard rates to prevent balance billing. This directly affects patients seeking opioid use disorder treatment and the insurers/health plans providing their coverage.
H 4895 removes preauthorization requirements for insured patients seeking specific mental health services, including inpatient psychiatric care, crisis stabilization, substance use disorder treatment, and community-based acute care. It directly affects Commonwealth employees with group insurance and Medicaid recipients by ensuring coverage for these services without prior insurer approval. Key provisions require facilities to notify insurers within 3 business days of admission (limited to basic patient and treatment details) while guaranteeing coverage for services provided before notification. The bill also expands the definition of "licensed mental health professional" to include more provider types, such as licensed clinical social workers and master's-level clinicians under supervision. These changes aim to streamline access to critical mental health care by reducing administrative barriers.
This bill requires health insurance companies to reimburse licensed athletic trainers (with physician referrals) for services they're legally allowed to provide, on the same terms as other covered providers. It applies only to health plans that already cover similar services or conditions within athletic trainers' scope of practice. Insurers cannot impose additional cost-sharing (like higher deductibles) or utilization restrictions that unfairly target athletic trainer care, though standard plan rules still apply. The law ensures athletic trainers are treated equally for covered services without expanding their scope of practice.
This bill (H 4951) requires Massachusetts health insurance plans and state employee health coverage to fully cover HIV prevention medications (like PrEP) without cost-sharing (no copays, deductibles) or prior approval delays. It applies to state employees, retirees, and all health insurance policies (individual and group) covering hospital/surgical expenses. Key provisions mandate that insurers cannot deny coverage based on the type of healthcare provider prescribing the medication or where it's prescribed (e.g., clinic vs. hospital), as long as the provider is licensed. The law also ensures coverage includes necessary monitoring services like lab tests and counseling, as defined by federal health agencies.
This bill amends state law to align with federal requirements for health savings account (HSA)-qualified health insurance plans. It exempts these specific plans from state rules prohibiting cost-sharing (like copays or deductibles) for covered benefits, as long as the exemption is necessary to meet federal HSA criteria. However, the exemption does not apply to preventive care services covered under federal guidance. The bill directly affects insurers offering HSA-qualified plans and consumers enrolled in such plans, ensuring state regulations don't conflict with federal HSA eligibility rules.
H 4952 amends Massachusetts health insurance laws to expand who can diagnose and treat autism spectrum disorder (ASD) for insurance coverage. The bill updates definitions in multiple statutes to include licensed nurse practitioners and psychiatric nurse mental health clinical specialists alongside physicians for ASD diagnosis, treatment, and related pharmacy care. These changes require health insurance policies to cover services by these providers starting January 1, 2027, directly affecting individuals seeking ASD care and insurers managing coverage.
