Bill > S691

This bill aims to improve healthcare access and coverage for children with specific medical conditions by defining and mandating coverage for medically necessary food and specialty care. The bill introduces two key definitions: "covered disease or condition" and "medically necessary food," which encompass complex food-related medical issues like food protein allergies, eosinophilic disorders, and conditions requiring specialized nutritional support. Specifically, the bill requires health insurance carriers to cover medically necessary foods that are prescribed by qualified healthcare professionals for managing specific medical conditions, with detailed criteria about the food's formulation, medical purpose, and usage. Additionally, the bill prohibits insurance carriers from requiring prior authorization for specialty care from immunologists or family practitioners, prevents carriers from categorizing prescription coverage as "durable medical equipment," and mandates that insurance plans cannot apply prescription co-pays or deductibles for medically necessary food. These provisions are designed to reduce barriers to essential medical nutrition and specialized care for patients with complex dietary and medical needs, particularly children suffering from specific food-related health conditions.

Business and Industry, Health and Social Services

https://malegislature.gov/Bills/194/S691