reglab/statecodes huggingface dataset:
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175 - Insurance › Section 36b - Health and Accident Insurance Companies; Employees Insurance Benefits

Section 36B. Any domestic company which is authorized to transact business under subdivisions (a) and (d) of clause Sixth of section forty-seven may establish a plan to provide such insurance benefits for its employees. Any such plan may provide for contributions by the employees. Such benefits may be provided in one or more general or blanket accident and health policies issued by such company, or with other benefits in one or more group life policies or group annuity contracts issued by such company, if authorized to issue any such policy or contract, or by any other company so authorized, or in any other manner that the directors of such company may prescribe. If any such benefits are provided otherwise than by any such general or blanket or group policies, the company may in connection therewith establish special funds for the purpose of financing such benefits. Section one hundred and ten A shall apply to any benefits granted under the authority of this section.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175 - Insurance › Section 37 - Vouchers for Disbursements

Section 37. No domestic company shall make any disbursements of twenty-five dollars or more, except disbursements on account of return premiums on cancelled policies, unless the same be evidenced by a voucher signed by or on behalf of the person receiving the money and correctly describing the consideration for the payment; and if the same be for services and disbursements, setting forth the services rendered and an itemized statement of the disbursements made; and if it be in connection with any matter pending before any legislature or public body, or before any department or officer of any government, correctly describing in addition the nature of the matter and of the interest of such company therein; or if such a voucher cannot be obtained, by an affidavit stating the reason for not obtaining such voucher, and setting forth the particulars above mentioned.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175 - Insurance › Section 37a - Relief Fund Contributions by Domestic Company; Charitable, Scientific or Educational Contributions

Section 37A. (a) Every domestic company may, by vote of its directors, contribute such sum or sums of money as said directors may determine to be reasonable to any fund being raised by a relief committee or agency approved by the commissioner of public welfare, as evidenced by a writing filed in his office, and formed for the purpose of raising money to be used for the betterment of social and economic conditions in any community in which such company is doing business.
(b) Every domestic company may, by its articles of organization or by-laws or by a general or special vote of its stockholders or members, authorize its directors to make contributions, in such amounts as said directors may determine to be reasonable, to corporations, trusts, funds or foundations organized and operated exclusively for charitable, scientific or educational purposes, no part of the net earnings of which inures to the benefit of any private shareholder or individual; provided, that in the case of a company having capital stock, contributions in any fiscal year shall not in the aggregate exceed one half of one per cent of its capital and surplus as of the end of the preceding fiscal year, unless contributions in excess of one half of one per cent of such capital and surplus shall be authorized by the stockholders of the company at a regular or special meeting, and, in the case of a company not having capital stock, contributions in any fiscal year shall not in the aggregate exceed one half of one per cent of the surplus of such company as of the end of the preceding fiscal year, unless contributions in excess of one half of one per cent of such surplus shall be authorized by the members of the company at a regular or special meeting.
(c) Nothing in this section shall be construed as directly or indirectly restricting or otherwise affecting, except as herein provided, the rights and powers of any company with reference to payments of the nature above specified.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175 - Insurance › Section 45 - Unauthorized Agencies; Penalty

Section 45. No domestic company shall establish an agency or appoint an agent or other person to solicit, negotiate, continue or renew contracts of insurance on lives, property or interests in, or annuity or pure endowment contracts with residents of, a state, district or territory where such company has not been lawfully authorized to transact business, and no such company or officer or agent thereof shall pay or allow or offer to pay or allow compensation or anything of value to any such person for soliciting, negotiating, continuing or renewing such contracts. Whoever violates this section shall be punished by a fine of not less than three hundred dollars.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175 - Insurance › Section 46 - Insolvent Domestic Companies; Preference of Claims for Unpaid Losses

Section 46. When any domestic company becomes insolvent, or is unable to pay in full its liabilities as set forth in sections ten, eleven and twelve, claims for unpaid losses under its policies, other than life or endowment policies or annuity or pure endowment contracts, shall, in the distribution of its assets, whether liquidation is effected by a receiver or otherwise, be deemed and treated as preferred over claims for return premiums on cancelled or unexpired policies. Nothing in this section shall impair the obligation now or hereafter imposed by law upon the officers of a mutual company, other than a life company, to make assessments on its members to pay its incurred losses and expenses.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175 - Insurance › Section 46a - Insolvent Domestic Workers' Compensation Insurer; Preference of Claims for Unpaid Losses Under Workers' Compensation Policies

Section 46A. Except as otherwise provided in section 180F, when any domestic company which has insured the payment of the compensation provided for by chapter one hundred and fifty-two becomes insolvent, or is unable to pay in full its liabilities as set forth in sections ten and twelve, unpaid losses under its workers' compensation policies shall, in the distribution of its assets, whether liquidation is effected by a receiver or otherwise, be deemed and treated as preferred over all claims except debts due the United States and debts or taxes due the commonwealth or any city or town thereof.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175 - Insurance › Section 46b - By-Laws of Domestic Insurance Companies; Filings

Section 46B. Every domestic company incorporated after September first, nineteen hundred and twenty-three, shall, within thirty days after its incorporation, file with the commissioner a copy of its by-laws and amendments thereto, if any, certified under its corporate seal by its secretary, and every such company, whether existing on said date or incorporated thereafter, shall, within thirty days after the adoption of any amendment to its by-laws, file with the commissioner a copy of such amendment, certified as above provided.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175 - Insurance › Section 47a - Businesses in Which Domestic Insurance Company May Engage

Section 47A. A domestic insurance company may, notwithstanding any limitation otherwise applicable, and provided it maintains books and records which account for such business, engage directly in any of the following businesses: (a) rendering investment advice; (b) rendering services related to the functions involved in the operation of its insurance business including, but not limited to, actuarial, loss prevention, safety engineering, data processing, accounting, claims, appraisal and collection services; (c) acting as administrative agent for a government instrumentality which is performing an insurance function or is responsible for a health or welfare program; (d) any other business activity reasonably complementary or supplementary to its insurance business; either to the extent necessarily or properly incidental to the insurance business the insurer is authorized to do in this commonwealth or to the extent approved by the commissioner and subject to any limitations he may prescribe for the protection of the interests of the policyholders of the insurer after taking into account the effect of such business on the insurer's existing insurance business and its surplus, the proposed allocation of the estimated cost of such business and the risks inherent in such business as well as the relative advantages to the insurer and its policyholders of conducting such business directly instead of through a subsidiary; provided, however, the foregoing authorized direct businesses shall not include the business of acting in this commonwealth for another insurer as insurance agent, insurance broker, special insurance broker, or public insurance adjuster.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175 - Insurance › Section 47bb - Coverage for Children Under Age 18 for Cleft Lip and Cleft Palate

Section 47BB. An individual policy of accident and sickness insurance issued under section 108 that provides hospital expense and surgical expense insurance and any group blanket or general policy of accident and sickness insurance issued under section 110 that provides hospital expense and surgical expense insurance, which is issued or renewed within or without the commonwealth, that covers a child under the age of 18 shall cover the cost of treating cleft lip and cleft palate for the child. The coverage shall include benefits for medical, dental, oral and facial surgery, surgical management and follow-up care by oral and plastic surgeons, orthodontic treatment and management, preventative and restorative dentistry to ensure good health and adequate dental structures for orthodontic treatment or prosthetic management therapy, speech therapy, audiology and nutrition services, if such services are prescribed by the treating physician or surgeon and such physician or surgeon certifies that such services are medically necessary and consequent to the treatment of the cleft lip, cleft palate or both. The coverage required by this section shall be subject to the terms and conditions applicable to other benefits. Payment for dental or orthodontic treatment not related to the management of the congenital conditions of cleft lip and cleft palate shall not be covered under this section.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175 - Insurance › Section 47d - Cardiac Rehabilitation Expense Benefits

Section 47D. Any blanket or general policy of insurance, except a blanket or general policy of insurance which provides supplemental coverage to medicare or other governmental programs, described in subdivision (A), (C) or (D) of section one hundred and ten which provides hospital expense and surgical expense insurance and which is issued or subsequently renewed by agreement between the insurer and the policy holder, within or without the commonwealth, during the period this provision is effective, or any policy of accident or sickness insurance as described in section one hundred and eight which provides hospital expense and surgical expense insurance, except a policy which provides supplemental coverage to medicare or other governmental programs, and which is delivered or issued for delivery or subsequently renewed by agreement between the insurer and the policy holder in the commonwealth, during the period that this provision is effective, or any employees' health and welfare fund which provides hospital expense and surgical expense benefits and which is promulgated or renewed to any person or group of persons in the commonwealth, while this provision is effective, shall provide benefits for the expense of cardiac rehabilitation. Cardiac rehabilitation shall mean multidisciplinary, medically necessary treatment of persons with documented cardiovascular disease, which shall be provided in either a hospital or other setting and which shall meet standards promulgated by the commissioner of public health after reviewing proposals submitted by the Massachusetts Society for Cardiac Rehabilitation, Inc. and after notice and public hearing on the proposed standards. Such standards shall include, but not be limited to, outpatient treatment which is to be initiated within twenty-six weeks after the diagnosis of such disease.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175 - Insurance › Section 47dd - Coverage for Orally Administered Anticancer Medications

Section 47DD. Any policy, contract, agreement, plan or certificate of insurance issued, delivered or renewed within the commonwealth that provides medical expense coverage for cancer chemotherapy treatment shall provide coverage for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells on a basis not less favorable than intravenously administered or injected cancer medications that are covered as medical benefits. An increase in patient cost sharing for anticancer medications shall not be allowed to achieve compliance with this section.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175 - Insurance › Section 47e - Certified Nurse Midwife Services Benefits

Section 47E. Any blanket or general policy of insurance described in subdivision (A), (C), or (D) of section one hundred and ten which is issued or subsequently renewed by agreement between the insurer and the policyholder, within or without the commonwealth, during the period this provision is effective, or any policy of accident and sickness insurance as described in section one hundred and eight which provides hospital expense and surgical expense insurance and which is delivered or issued for delivery or subsequently renewed by agreement between the insurer and the policyholder in the commonwealth during the period that this provision is effective shall provide benefits for services of a certified nurse midwife; provided, however, that expenses for such services are reimbursed when such services are performed by any other duly licensed practitioner; and provided, further, that such services are within the lawful scope of practice for a certified nurse midwife.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175 - Insurance › Section 47ee - Coverage for Abuse Deterrent Opioid Drug Products

Section 47EE. Any policy, contract, agreement, plan or certificate of insurance issued, delivered or renewed within the commonwealth, which is considered creditable coverage under section 1 of chapter 118M, shall provide coverage for abuse deterrent opioid drug products listed on the formulary, compiled pursuant to subsection (b) of section 13 of chapter 17, on a basis not less favorable than non-abuse deterrent opioid drug products that are covered by such policy, contract, agreement, plan or certificate of insurance. An increase in patient cost sharing shall not be allowed to achieve compliance with this section.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175 - Insurance › Section 47ff - Preauthorization or Substance Abuse Treatment Not to Be Required

Section 47FF. For the purposes of this section the term ''substance abuse treatment'' shall include: early intervention services for substance use disorder treatment; a substance use disorder evaluation, as defined in section 511/2 of chapter 111; outpatient services including medically assisted therapies; intensive outpatient and partial hospitalization services; residential or inpatient services, not covered under section 47GG; and medically managed intensive inpatient services, not covered under said section 47GG.
Any policy, contract, agreement, plan or certificate of insurance issued, delivered or renewed within the commonwealth, which is considered creditable coverage under section 1 of chapter 118M, shall not require a member to obtain a preauthorization for substance abuse treatment if the provider is certified or licensed by the department of public health.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175 - Insurance › Section 47g - Cytologic Screening and Mammographic Examination Expense Benefits

Section 47G. Any blanket or general policy of insurance described in subdivision (A), (C), or (D) of section one hundred and ten which is issued or subsequently renewed by agreement between the insurer and the policyholder, within or without the commonwealth, during the period within which this premium is effective, or any policy of accident or sickness insurance as described in section one hundred and eight which provides hospital expense and surgical expense insurance and which is delivered or issued for delivery or subsequently renewed by agreement between the insurer and the policyholder in the commonwealth, during the period within which this provision is effective, or any employers' health and welfare fund which provides hospital expense and surgical expense benefits and which is issued or renewed to any person or group of persons in the commonwealth, during the period within which this provision is effective, shall provide benefits for the expense of residents of the commonwealth covered under any such policy or plan for the expense of cytologic screening and mammographic examination. Said benefits shall be at least equal to the following minimum requirements: (a) in the case of benefits for cytologic screening, said benefits shall provide for an annual cytologic screening for women eighteen years of age and older; and (b), in the case of benefits for mammographic examination said benefits shall provide for a baseline mammogram for women between the ages of thirty-five and forty and for a mammogram on an annual basis for women forty years of age and older.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175 - Insurance › Section 47gg - Coverage for Medically Necessary Acute Treatment and Clinical Stabilization Services

Section 47GG. For the purposes of this section the following terms shall, unless the context clearly requires otherwise, have the following meanings:—
''Acute treatment services'', 24–hour medically supervised addiction treatment for adults or adolescents provided in a medically managed or medically monitored inpatient facility, as defined by the department of public health, that provides evaluation and withdrawal management and which may include biopsychosocial assessment, individual and group counseling, psychoeducational groups and discharge planning.
''Clinical stabilization services'', 24–hour clinically managed post detoxification treatment for adults or adolescents, as defined by the department of public health, usually following acute treatment services for substance abuse, which may include intensive education and counseling regarding the nature of addiction and its consequences, relapse prevention, outreach to families and significant others and aftercare planning, for individuals beginning to engage in recovery from addiction.
Any policy, contract, agreement, plan or certificate of insurance issued, delivered or renewed within the commonwealth, which is considered creditable coverage under section 1 of chapter 111M, shall provide coverage for medically necessary acute treatment services and medically necessary clinical stabilization services for up to a total of 14 days and shall not require preauthorization prior to obtaining acute treatment services or clinical stabilization services; provided that the facility shall provide the carrier both notification of admission and the initial treatment plan within 48 hours of admission; provided further, that utilization review procedures may be initiated on day 7; provided further, any policy, contract, agreement, plan or certificate of insurance issued, delivered or renewed within the commonwealth, which is considered creditable coverage pursuant to section 1 of chapter 111M, shall cover, without preauthorization, a substance use disorder evaluation ordered pursuant to section 511/2 of chapter 111.
Medical necessity shall be determined by the treating clinician in consultation with the patient and noted in the patient's medical record.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175 - Insurance › Section 47h - Infertility, Pregnancy-Related Benefits

Section 47H. Any blanket or general policy of insurance, except a blanket or general policy of insurance which provides supplemental coverage to medicare or other governmental programs, described in subdivisions (A), (C) or (D) of section one hundred and ten which provides hospital expense or surgical expense insurance which includes pregnancy-related benefits and which is issued or subsequently renewed by agreement between the insurer and the policyholder, within or without the commonwealth, while this provision is effective, or any policy of accident and sickness insurance as described in section one hundred and eight which provides hospital expense or surgical expense insurance which includes pregnancy-related benefits and which is delivered or issued for delivery or subsequently renewed by agreement between the insurer and the policyholder in the commonwealth while this provision is effective, or any employees' health and welfare fund which provides hospital expense and surgical expense benefits which includes pregnancy-related benefits and which is promulgated or renewed to any person or group of persons in the commonwealth while this provision is effective shall provide, to the same extent that benefits are provided for other pregnancy-related procedures, coverage for medically necessary expenses of diagnosis and treatment of infertility to persons residing within the commonwealth. For purposes of this section, ''infertility' shall mean the condition of an individual who is unable to conceive or produce conception during a period of 1 year if the female is age 35 or younger or during a period of 6 months if the female is over the age of 35. For purposes of meeting the criteria for infertility in this section, if a person conceives but is unable to carry that pregnancy to live birth, the period of time she attempted to conceive prior to achieving that pregnancy shall be included in the calculation of the 1 year or 6 month period, as applicable.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175 - Insurance › Section 47i - Nonprescription Enteral Formulas for Home Use

Section 47I. Any individual policy of accident and sickness insurance issued pursuant to section one hundred and eight, and any group blanket policy of accident and sickness insurance issued pursuant to section one hundred and ten, shall provide coverage for nonprescription enteral formulas for home use for which a physician has issued a written order and which are medically necessary for the treatment of malabsorption caused by Crohn's disease, ulcerative colitis, gastroesophageal reflux, gastrointestinal motility, chronic intestinal pseudo-obstruction, and inherited diseases of amino acids and organic acids. Coverage for inherited diseases of amino acids and organic acids shall include food products modified to be low protein in an amount not to exceed $5,000 annually for any insured individual.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175 - Insurance › Section 47ii - Coverage for Medical or Drug Treatments to Correct or Repair Disturbances of Body Composition Caused by HIV Associated Lipodystrophy Syndrome

Section 47II. The following shall provide coverage for medical or drug treatments to correct or repair disturbances of body composition caused by HIV associated lipodystrophy syndrome including, but not limited to, reconstructive surgery, such as suction assisted lipectomy, other restorative procedures and dermal injections or fillers for reversal of facial lipoatrophy syndrome: (i) any policy of accident and sickness insurance, as described in section 108, which provides hospital expense and surgical expense insurance and which is delivered, issued or subsequently renewed by agreement between the insurer and policyholder in the commonwealth; (ii) any blanket or general policy of insurance described in subdivision (A), (C) or (D) of section 110 which provides hospital expense and surgical expense insurance and which is delivered, issued or subsequently renewed by agreement between the insurer and the policyholder in or outside of the commonwealth; or (iii) any employees' health and welfare fund which provides hospital expense and surgical expense benefits and which is delivered, issued or renewed to any person or group of persons in the commonwealth. Coverage shall be subject to a statement from a treating provider that the treatment is necessary for correcting, repairing or ameliorating the effects of HIV associated lipodystrophy syndrome. The benefits in this section shall not be subject to any greater deductible, coinsurance, copayments or out-of-pocket limits than any other benefit provided by the insurer.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175 - Insurance › Section 47j - Standardized Claim Form

Section 47J. The commissioner of insurance is hereby directed to produce a standardized claim form to be utilized by all health insurance companies licensed to do business in the commonwealth for billing purposes.
Said form shall be made available to said companies no later than July first, nineteen hundred and ninety-three.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175 - Insurance › Section 47jj - Filling of Remaining Portion of Prescription for Covered Drug That Is a Narcotic Substance Earlier Filled in Lesser Quantity

Section 47JJ. Any policy, contract, agreement, plan or certificate of insurance issued, delivered or renewed within the commonwealth, which is considered creditable coverage under section 1 of chapter 111M, shall provide, for any covered drug that is a narcotic substance contained in schedule II pursuant to chapter 94C and subject to cost sharing, that if a person receives a prescription filled in a lesser quantity pursuant to section 18 of said chapter 94C, said person shall not be subject to an additional payment obligation, including, but not limited to, co-payments, if said person fills the remaining portion of the prescription.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175 - Insurance › Section 47k - Off-Label Drug Use; Cancer Treatment

Section 47K. No individual policy of accident and sickness insurance issued pursuant to section one hundred and eight which provides coverage for prescription drugs, nor any group blanket policy of accident and sickness insurance issued pursuant to section one hundred and ten which provides coverage for prescription drugs, shall exclude coverage of any such drug used for the treatment of cancer on the grounds that the off-label use of the drug has not been approved by the United States Food and Drug Administration for that indication; provided, however, that such drug is recognized for treatment of such indication in one of the standard reference compendia, or in the medical literature, or by the commissioner under the provisions of section forty-seven L.
Any coverage of a drug required by this section shall also include medically necessary services associated with the administration of the drug.
This section shall not be construed to alter existing law with regard to provisions limiting the coverage of drugs that have not been fully licensed or approved by the United States Food and Drug Administration nor shall this section create an exclusionary presumption or inference concerning other appropriate medically accepted indications.
This section shall not be construed to require coverage for any drug when the United States Food and Drug Administration has determined its use to be contraindicated for cancer.
This section shall not be construed to require coverage for experimental drugs not otherwise approved for any indication by the United States Food and Drug Administration.
For the purpose of this section, and section forty-seven L, the following words shall have the following meanings unless the context clearly requires otherwise:—
''Medical literature'', published scientific studies appearing in any peer-reviewed national professional journal.
''Off-label use'', a prescription drug used in the treatment of cancer which has been approved by the United States Food and Drug Administration and such drug is used for indications other than those approved by said Food and Drug Administration.
''Standard reference compendia'', (a) the United States Pharmacopoeia Drug Information; (b) the American Medical Association Drug Evaluations; or (c), the American Hospital Formulary Service Drug Information.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175 - Insurance › Section 47kk - Pain Management Access Plans

Section 47KK. (a) Any policy, contract, agreement, plan or certificate of insurance issued, delivered or renewed within the commonwealth, which is considered creditable coverage under section 1 of chapter 111M, shall develop a plan to provide adequate coverage and access to a broad spectrum of pain management services, including, but not limited to, those that serve as alternatives to opioid prescribing, in accordance with guidelines developed by the division of insurance.
(b) The plan shall be subject to approval and shall be a component of carrier accreditation by the division of insurance pursuant to section 2 of chapter 176O. In its review, the division shall consider the adequacy of access to a broad spectrum of pain management services and any carrier policies that may create unduly preferential coverage to prescribing opioids without other pain management modalities.
(c) Carriers shall distribute educational materials to providers within their networks about the pain management access plan and make information about their plans publicly available on their websites.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175 - Insurance › Section 47l - Off-Label Drug Use; Cancer; Review Panel

Section 47L. The commissioner shall establish a panel of six medical experts to review off-label uses, so-called, for prescription drugs for the treatment of cancer not included in any of the standard reference compendia or in the medical literature and to advise said commissioner in such instances whether a particular off-label use is medically appropriate. The panel shall make such recommendations from time to time and whenever a particular dispute about payment for such off-label use is referred to the panel by the commissioner. The members of said panel shall include: (a) three medical oncologists selected by the state medical oncology association, (b) a physician selected by the Massachusetts medical association, (c) a physician selected by a hospital and medical service corporation and (d), a physician selected by the Massachusetts association of health maintenance organizations from a member plan.
The commissioner shall have the authority to direct any insurer to make payments, consistent with the recommendations of the panel, required by section forty-seven K, section eight N of chapter one hundred and seventy-six A, section four N of chapter one hundred and seventy-six B and section four E of chapter one hundred and seventy-six G.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175 - Insurance › Section 47ll - Coverage for Tobacco Use Cessation Counseling and Tobacco Cessation Products

[Text of section applicable to policies, contracts and subscription certificates delivered, issued or renewed in the commonwealth on or after January 1, 2020. See 2019, 133, Sec. 26.]
Section 47LL. (a) An individual policy of accident and sickness insurance issued under section 108 that provides benefits for hospital expenses and surgical expenses and any group blanket policy of accident and sickness insurance issued under section 110 that provides benefits for hospital expenses and surgical expenses delivered, issued or renewed by agreement between the insurer and the policyholder, within or outside the commonwealth, shall provide benefits for residents of the commonwealth and all group members having a principal place of employment in the commonwealth for: (i) tobacco use cessation counseling; and (ii) all generic United States Food and Drug Administration-approved tobacco cessation products without cost sharing when prescribed by a health care provider.
(b) Carriers shall be permitted to employ reasonable managed care techniques consistent with state and federal law to determine the frequency, method, treatment or setting for the recommended item or service; provided, however, that covered persons shall have access to at least 1 tobacco cessation product without prior authorization.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175 - Insurance › Section 47n - Items Medically Necessary for Diagnosis and Treatment of Diabetes

Section 47N. An individual policy of accident and sickness insurance issued pursuant to section 108 which provides hospital expense and surgical expense insurance, except policies providing supplemental coverage to Medicare or other governmental programs, and any group blanket policy of accident and sickness insurance issued pursuant to section 110 which provides hospital expense and surgical expense insurance, except policies providing supplemental coverage to Medicare or other governmental programs, delivered, issued or renewed by agreement between the insurer and the policyholder, within or without the commonwealth, shall provide benefits for the following items if such items are within a category of benefits or services for which coverage is otherwise afforded by the policy, have been prescribed by a health care professional legally authorized to prescribe such items and if the items are medically necessary for the diagnosis or treatment of insulin-dependent, insulin-using, gestational and non-insulin-dependent diabetes: blood glucose monitors; blood glucose monitoring strips for home use; voice-synthesizers for blood glucose monitors for use by the legally blind; visual magnifying aids for use by the legally blind; urine glucose strips; ketone strips; lancets; insulin; insulin syringes; prescribed oral diabetes medications that influence blood sugar levels; laboratory tests, including glycosylated hemoglobin, or HbAlc, tests; urinary protein/microalbumin and lipid profiles; insulin pumps and insulin pump supplies; insulin pens, so-called; therapeutic/molded shoes and shoe inserts for people who have severe diabetic foot disease when the need for therapeutic shoes and inserts has been certified by the treating doctor and prescribed by a podiatrist or other qualified doctor and furnished by a podiatrist, orthotist, prosthetist or pedorthist; supplies and equipment approved by the Federal Drug Administration for the purposes for which they have been prescribed and diabetes outpatient self-management training and education, including medical nutrition therapy, when provided by a certified diabetes health care provider participating with the insurance contract or affiliated with a provider participating with the insurance contract. As used in this section, ''certified diabetes health care provider'' shall mean a licensed health care professional with expertise in diabetes, a registered dietician or a health care provider certified by the National Certification Board of Diabetes Educators as a certified diabetes educator. Nothing in this section shall be construed to require an insurance company to contract with a certified diabetes health care provider who is not already under contract with the insurance company.
The benefits provided in this section shall meet all other terms and conditions within a policy. Coverage shall not be reduced or eliminated due to the requirements of this section.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175 - Insurance › Section 47nn - Coverage for Treatment of Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections and Pediatric Acute-Onset Neuropsychiatric Syndrome

[Text of section applicable to contracts that take effect or are renewed on or after January 1, 2022. See 2020, 260, Sec. 74.]
Section 47NN. Any policy, contract, agreement, plan or certificate of insurance issued, delivered or renewed within or without the commonwealth shall provide coverage for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute-onset neuropsychiatric syndrome including, but not limited to, the use of intravenous immunoglobulin therapy.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175 - Insurance › Section 47o - HIV/AIDS Treatment; Insurance Coverage for Certain Off-Label Use of Prescription Drugs

Section 47O. No individual policy of accident and sickness insurance issued or renewed pursuant to section one hundred and eight, which provides coverage for prescription drugs, nor any group blanket policy of accident and sickness insurance issued pursuant to section one hundred and ten which provides coverage for prescription drugs, shall exclude coverage of any such drug for HIV/AIDS treatment on the grounds that the off-label use of the drug has not been approved by the federal food and drug administration for that indication, if such drug is recognized for treatment of such indication in one of the standard reference compendia, or in the medical literature, or by the commissioner under the provisions of section forty-seven P of this chapter.
Any coverage of a drug required by this section shall also include medically necessary services associated with the administration of the drug.
This section shall not be construed to alter existing law with regard to provisions limiting the coverage of drugs that have not been fully licensed or approved by the federal food and drug administration nor shall this section create an exclusionary presumption or inference concerning other appropriate medically accepted indications.
This section shall not be construed to require coverage for any drug when the federal food and drug administration has determined its use to be contraindicated.
This section shall not be construed to require coverage for experimental drugs not otherwise approved for any indication by the federal food and drug administration.
For the purpose of this section, and section forty-seven P, the following words shall have the following meanings:
''Standard reference compendia'' means (a) the United States Pharmacopeia Drug Information; (b) the American Medical Association Drug Evaluations; or (c) the American Hospital Formulary Service Drug Information.
''Medical literature'' means published scientific studies published in any peer-reviewed national professional journal.
''HIV/AIDS'' means human immunodeficiency virus or acquired immunodeficiency syndrome.
''Off-label'' means a drug that has not been specifically approved by the Federal food and drug administration for HIV/AIDS treatment but is a drug approved for other indications by the Federal food and drug administration.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175 - Insurance › Section 47p - Off-Label Use of Prescription Drugs for HIV/AIDS Treatment; Advisory Panel

Section 47P. The commissioner shall establish an eleven member advisory panel to advise the commissioner on whether off-label uses for HIV/AIDS treatment not included in any of the standard reference compendia or in the medical literature are medically appropriate. The panel shall advise the commissioner whenever a dispute about coverage of such off-label prescription drugs prescribed by a physician is brought to the commissioner. This eleven member panel shall include: (a) three medical infectious disease specialists selected by the Massachusetts department of public health, (b) two physicians selected by the Massachusetts department of public health, (c) one physician representing a nonprofit hospital and medical service corporation, one physician representing health maintenance organizations, and one physician representing commercial insurers; (d) two consumers selected by the Massachusetts department of public health, and (e) one representative from an AIDS service organization or consumer advocacy group selected by the Massachusetts department of public health.
After consulting with said advisory panel, the commissioner may direct an insurer to make payments required by section forty-seven O of chapter one hundred and seventy-five, section eight P of chapter one hundred and seventy-six A, section four O of chapter one hundred and seventy-six B, and section four F of chapter one hundred and seventy-six G.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175 - Insurance › Section 47pp - Coverage for Prescription Eye Drops

Section 47PP. A policy, contract, agreement, plan or certificate of insurance issued, delivered or renewed within the commonwealth that provides coverage for prescription eye drops shall provide coverage for refills of prescription eye drops in accordance with the Medicare Part D guidelines on early refills of topical ophthalmic products when: (i) the prescribing health care practitioner indicates on the original prescription that additional quantities of the prescription eye drops are needed; (ii) the refill requested by the insured does not exceed the number of additional quantities indicated on the original prescription by the prescribing health care practitioner; and (iii) the prescription eye drops prescribed by the health care practitioner are a covered benefit under the policy or contract of the insured.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175 - Insurance › Section 47q - Insurance Benefits for Services Rendered by Nurse Anesthetists and Nurse Practitioners

Section 47Q. All individual or group accident and health insurance policies and health service contracts delivered, issued or renewed by an insurer or nonprofit health service corporation which provide benefits to individual subscribers and members within the commonwealth or to all group members having a principal place of employment within the commonwealth shall provide benefits for services rendered by a certified registered nurse anesthetist or nurse practitioner designated as such certified registered nurse anesthetist or nurse practitioner by the board of registration in nursing pursuant to the provisions of section eighty B of chapter one hundred and twelve; provided, however, that the following conditions are met: (1) the service rendered is within the scope of the certified registered nurse anesthetist's license or the nurse practitioner's authorization to practice by the board of registration in nursing; and (2) the policy or contract currently provides benefits for identical services rendered by a provider of health care licensed by the commonwealth.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175 - Insurance › Section 47qq - Coverage for Mental Health or Substance Use Disorder Services Delivered Through Psychiatric Collaborative Care Model

Section 47QQ. (a) For the purposes of this section, ''psychiatric collaborative care model'' shall mean the evidence-based, integrated behavioral health service delivery method in which a primary care team consisting of a primary care provider and a care manager provides structured care management to a patient, and that works in collaboration with a psychiatric consultant that provides regular consultations to the primary care team to review the clinical status and care of patients and to make recommendations.
(b) An individual policy of accident and sickness insurance issued pursuant to section 108 that provides hospital expense and surgical expense insurance or a group blanket or general policy of accident and sickness insurance issued pursuant to section 110 that provides hospital expense and surgical expense insurance that is issued or renewed within or without the commonwealth shall provide coverage for mental health or substance use disorder services that are delivered through the psychiatric collaborative care model.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175 - Insurance › Section 47r - Accident and Sickness Insurance Benefits for Bone Marrow Transplants

Section 47R. Any individual policy of accident and sickness insurance issued pursuant to section one hundred and eight, and any group blanket policy of accident and sickness insurance issued pursuant to section one hundred and ten, shall provide coverage for a bone marrow transplant or transplants for persons who have been diagnosed with breast cancer that has progressed to metastatic disease; provided, however, that said person shall meet the criteria established by the department of public health. The department of public health shall promulgate rules and regulations establishing criteria for eligibility for coverage hereunder which shall be consistent with medical research protocols reviewed and approved by the National Cancer Institute.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175 - Insurance › Section 47rr - Benefits for Medically Necessary Emergency Services Programs

Section 47RR. An individual policy of accident and sickness insurance issued under section 108 that provides hospital expense and surgical expense insurance or a group blanket or general policy of accident and sickness insurance issued under section 110 that provides hospital expense and surgical expense insurance that is issued or renewed within or without the commonwealth shall provide benefits on a nondiscriminatory basis for medically necessary emergency services programs.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 175 - Insurance › Section 47s - Accident and Sickness Insurance Benefits for Licensed Hospice Services

Section 47S. Any individual policy of accident and sickness insurance issued pursuant to section one hundred and eight, and any group blanket policy of accident and sickness insurance issued pursuant to section one hundred and ten, shall provide coverage for licensed hospice services to terminally ill patients with a life expectancy of six months or less, as set forth and regulated by the provisions of section fifty-seven D of chapter one hundred and eleven and as authorized by a duly licensed physician.