Bill > H1165

This bill requires various types of health insurance plans in Massachusetts, including state employee plans, individual and group accident and sickness insurance, hospital service plans, medical service agreements, and health maintenance contracts, to provide coverage for enteral formulas (specialized medical nutrition) for home use when prescribed by a physician. The formulas must be deemed medically necessary for treating specific serious medical conditions that could cause malnutrition, chronic physical or intellectual disability, or death if left untreated. The bill specifically lists qualifying conditions, such as inherited metabolic disorders, eosinophilic gastrointestinal disorders, Crohn's Disease, gastroesophageal reflux with failure to thrive, gastrointestinal motility disorders, and multiple severe food allergies. The legislation emphasizes that these medically necessary enteral formulas are distinct from elective nutritional supplements, and requires a written physician's order that clearly explains the medical necessity of the formula for the specific disease being treated. By amending multiple sections of Massachusetts general laws, the bill ensures consistent coverage across different types of health insurance plans.

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https://malegislature.gov/Bills/194/H1165