Bill > S2599

This bill requires insurance providers in Massachusetts to cover medically necessary early intervention treatments for port-wine stains in individuals 18 years of age or younger. Port-wine stains are defined as a capillary malformation skin condition that can be diagnosed as nevus flammeus, Sturge-Weber syndrome, or Klippel-Trénaunay syndrome. Medically necessary treatment is defined as medical interventions intended to prevent or address functional impairments related to vision, oral function, or physical mobility, as well as medical complications like inflammation, bleeding, infection, or lesion hypertrophy, and significant psychosocial distress, particularly in pediatric patients. The bill mandates that insurance policies cannot impose additional deductibles, coinsurance, or treatment limits more restrictive than those for other medically necessary services, and explicitly excludes coverage for purely cosmetic treatments. Additionally, the bill requires the Center for Health Information and Analysis to conduct a comprehensive review of this mandated health benefit, evaluating its potential impact on various health plans and insurance providers, with a report to be filed by January 1, 2026. The provisions will apply to insurance contracts that take effect or are renewed on or after January 1, 2026.

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https://malegislature.gov/Bills/194/S2599