This bill requires all health insurance plans in Massachusetts to cover biennial echocardiograms and concussion analysis for children aged 5 to 18. It applies to group coverage for state employees, standard health insurance policies, hospital service plans, medical service agreements, and health maintenance contracts. The coverage must be provided every two years at no additional cost to the patient. It directly affects insurers offering these plans and children in the specified age range.
This bill (H 4938) requires health insurance plans to cover Technology-Assisted Tracking Devices for individuals diagnosed with dementia, Alzheimer's disease, or autism spectrum disorder. It defines these devices to be waterproof (IP66/IP68), indoor-compatible using Radio Frequency (not GPS), independent of cellular networks, tamper-resistant with caregiver-adjustable straps, and designed to prevent false alarms. The coverage must include the device subject to standard insurance cost-sharing like co-pays and deductibles. The bill directly affects insured individuals with these diagnoses and their caregivers by mandating insurance access to these safety devices.
This bill modifies Massachusetts health insurance regulations to make it easier for certain insurers to operate. It allows health insurance carriers to be exempt from specific network rules if they primarily serve members in single-rate regions, subsidized plans (like MassHealth), or rely heavily on government program income. Additionally, it requires insurers to include entire provider groups (not just parts of them) in network plans, either fully or not at all, and prevents restricting provider participation in tiered networks. These changes directly affect health insurance carriers operating in Massachusetts, aiming to simplify network requirements for some plans while expanding provider access. The bill focuses on procedural adjustments to existing coverage frameworks, not creating new subsidies or benefits.
This bill modifies Massachusetts health insurance regulations to create new exemptions for health insurance companies (carriers) and changes how provider networks must operate. It allows carriers to be exempt from certain requirements if most members are in single-rate regions, subsidized plans, or rely heavily on government programs. The bill also requires carriers to include entire provider groups in networks on an "all-or-nothing" basis, rather than selectively adding parts of a group. These changes directly affect health insurance companies and the providers they contract with, aiming to improve network access for members.
This bill (H 4937) requires all health insurance plans in Massachusetts - covering both group and individual policies - to cover medically necessary enteral formulas for home use (administered orally or via tube feeding) when prescribed by a physician for specific serious conditions. It directly affects insured individuals with conditions like Crohn's Disease, inherited metabolic disorders, severe food allergies, or gastrointestinal motility disorders that could cause malnutrition or disability if untreated. The key provision mandates that a physician's written order must confirm the formula is medically necessary as a disease-specific treatment, distinguishing it from elective nutritional supplements. Coverage applies to all policyholders, including Commonwealth employees and retirees under group insurance plans.
H 4947 updates Massachusetts' process for reviewing health insurance mandates requiring coverage for specific treatments, services, or equipment. The bill requires the Center for Health Information and Analysis to analyze proposed mandates, assessing public health impacts (like disease prevention), medical effectiveness (using peer-reviewed research), financial effects (costs to insurers and consumers), and other factors. The Center must submit written reports within 180 days, including data on how mandates affect essential health benefits, premiums, and access to care. This directly affects health insurers, employers offering group coverage, and patients covered by Massachusetts health plans. The bill aims to ensure new mandates are evidence-based and financially sustainable before becoming law.
H 4956 requires health insurance plans to cover clinician-administered drugs (outpatient prescriptions typically given in clinics or hospitals, like IV therapies) without extra costs or restrictions. It prohibits insurers from charging patients higher copays, denying coverage, or forcing them to use specific pharmacies when getting these drugs from their chosen provider or pharmacy. The bill also bans insurers from limiting coverage based on where the drug is dispensed or reducing payments to providers who source drugs from non-network pharmacies. This directly affects patients seeking these treatments, healthcare providers, and health benefit carriers. Insurers may offer but cannot mandate home infusion services or external infusion sites.
This bill requires most health insurance plans in Massachusetts to cover FDA-approved epinephrine injectors (auto-injectors or pre-filled syringes) for weight-based dosing without higher out-of-pocket costs than other prescribed drugs. It directly affects Commonwealth employee insurance, Medicaid, private health insurance plans, and employer health funds by mandating this coverage. Key provisions ensure no additional deductibles, copays, or coinsurance apply specifically to these injectors compared to standard medications. The law applies to all relevant insurance policies delivered or renewed in Massachusetts, focusing solely on coverage requirements for existing FDA-approved devices.
By Representative Decker of Cambridge, a petition (accompanied by bill, House, No. 2801) of Marjorie C. Decker relative to health insurance benefits for certain surviving spouses. Public Service.
By Mr. Driscoll, a petition (accompanied by bill, Senate, No. 727) of William J. Driscoll, Jr. relative to protections and health insurance coverage for living organ donors. Financial Services.
