reglab/statecodes huggingface dataset:
2023 Massachusetts General Laws › Part I - Administration of the Government › Title IV - Civil Service, Retirements and Pensions › Chapter 32a - Contributory Group General or Blanket Insurance for Persons in the Service of the Commonwealth › Section 13 - Approval of Applications by Political Subdivisions for Life and Health Insurance Covering Retired Teachers

Section 13. Upon receipt of application from a political subdivision of the commonwealth having accepted the provisions of section eleven E of chapter thirty-two B, the commission shall determine whether the addition of the retired teachers, including dependents and surviving spouses, of the political subdivision to the group life and health insurance coverages provided to employees under this chapter would be in the best interests of the commonwealth, the political subdivision and all insured employees with particular consideration being given to claim experience and premium costs. Upon approval by the commission, the political subdivision having been duly notified shall then comply with the procedures outlined in the rules and regulations of the commission. The commission shall secure reimbursement to the commonwealth for the governmental units' share of the premiums, subsidiary or additional rates if any, and administrative expenses in accordance with the provisions of section ten B which are hereby made applicable to this section.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title IV - Civil Service, Retirements and Pensions › Chapter 32a - Contributory Group General or Blanket Insurance for Persons in the Service of the Commonwealth › Section 15 - Catastrophic Illness Coverage; Contracts; Premiums; Dividends; Conversion; Rules and Regulations

Section 15. The commission may negotiate with and purchase on such terms as it deems to be in the best interest of the commonwealth and its active and retired employees and their dependents eligible under this chapter, from one or more insurance carriers authorized to sell health insurance in the commonwealth, a policy or policies providing basic and extended coverage for catastrophic illness such as cancer and other dread diseases as may be included from time to time by the commission. Such insurance shall provide basic and extended coverage including, but not limited to, ambulance services, in-patient and out-patient hospital services, blood and plasma, medicines and drugs, x-ray and other related treatments, nursing care, surgical, medical and other licensed practitioners' services, services of institutions providing rehabilitative care, or nursing or convalescent home care, and, for custodial care necessitated as a result of an illness covered under such policy or policies of insurance.
The commission shall negotiate a contract that assures sound financial stability consistent with insurance risks for long-term catastrophic illnesses, and shall be for a period of time and from time to time continuously without interruption of coverage; but any such contract with a carrier may be terminated by the commission provided that reasonable advance notice is given by the commission as provided in said policy or policies of insurance. The scope of insurance coverage under this section may relate to other health insurance coverages and experience accounting as provided in appropriate sections of this chapter, in order to attain the broadest possible basis of risk and protection.
Payment of premiums for catastrophic illness insurance provided in this section shall be made by the active and retired employee or surviving spouse thereof with no contribution by the commonwealth, and the method for such payments shall be as provided in sections eight, ten, ten B, ten C, eleven, twelve and fourteen, as may be applicable. Any dividend, refund or its equivalent accepted by the commission from the carrier or carriers shall be applied as provided in section nine.
Any policy or policies issued pursuant to this section shall provide that on termination of employment of an employee, or of coverage if a retiree, an employee or retiree shall be entitled, subject to the requirements of the commission, to convert his catastrophic illness coverage to a nongroup type of policy.
The commission may promulgate rules and regulations implementing and maintaining the provisions of this section, and such rules and regulations shall not be subject to the provisions of chapter thirty A.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title IV - Civil Service, Retirements and Pensions › Chapter 32a - Contributory Group General or Blanket Insurance for Persons in the Service of the Commonwealth › Section 16 - Election to Continue Insurance Coverages; Notice

Section 16. (a) An employee, in addition to the right of a deferred retiree status, or, conversion of insurance coverages to a non-group policy as provided in this chapter, and upon his involuntary termination of employment due to lack of funds, lack of work, or abolition of the position, may elect to continue all or part of his insurance coverages, including group membership in a health maintenance organization, until such employee and dependents become eligible and insured under another group plan of health insurance but in no event shall such extension of coverages exceed a period of thirty-nine weeks computed from the date of termination of employment or the date to which insurance premiums have been regularly paid whichever is the later.
(b) Upon determination by the employer of the termination of employment as described in this section the appointing authority, as the employer, shall notify in writing the employee of the right to elect to continue coverages under this section and a copy of such notification shall be sent to the commission at least fifteen working days prior to the date of termination of employment.
(c) The involuntarily terminated insured employee and on behalf of his dependents shall, upon election to continue insurance coverages under this section, give at least thirty days written notice thereof to the employer with a copy to the commission. For premium payment and reporting purposes, the appointing authority shall comply with the administrative and accounting procedures as established by the rules and regulations of the commission. Such employee shall be responsible for making payment to the commission of the total monthly premiums or rates, with no contribution by the commonwealth. The commission shall send a written notice by regular mail of the monthly premium when due to the last known address of the terminated employee, who, upon making timely monthly payments to the commission shall be required to certify under the penalty of perjury that the employee is not eligible or insured under another group policy or plan. Failure on the part of the commission to transmit the terminated employee's premiums to the commission's insurance carrier in a timely manner shall nevertheless render the insurance carrier and the commission liable under its contracts or policies for payment of claims to the same extent as if the commission had transmitted the employee's premiums in a timely manner to the insurance carriers or plans.
(d) Upon expiration of the period of the extension as provided in this section, the commission shall provide to the terminated employee and dependents conversion rights to non-group coverages to the extent that such rights had not been exercised heretofore during the latest period of employment.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title IV - Civil Service, Retirements and Pensions › Chapter 32a - Contributory Group General or Blanket Insurance for Persons in the Service of the Commonwealth › Section 17 - Dental and Vision Expenses; Reimbursement of Employees

Section 17. The commission shall, subject to appropriation, establish a plan of benefits for certain employees which shall, subject to the procedures and conditions established by the commission, reimburse these employees for eligible dental and vision expenses up to but not exceeding two hundred dollars per year. The commission shall collect and manage the moneys transferred to it for the funding of this plan of benefits and may make any legal deposit, investment or reinvestment of these moneys and any income derived therefrom. As used in this section, ''employees'' shall mean employees who are classified as managers in the management classification and pay plans in accordance with chapter thirty, sections forty-five and forty-six, unclassified managers who have classified positions reporting to them directly or through intermediate managers or supervisors, incumbents of positions in the executive branch assigned to collective bargaining units but designated as confidential, employees and members of the general court, and retirees who had been in the service of the commonwealth. If an employee is not described in the preceding sentence, but the employee's position is subsequently changed, reorganized or reclassified so as to be covered by the previous sentence, the employee holding such position will be considered an ''employee'' for the purposes of this section as of the date of such change.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title IV - Civil Service, Retirements and Pensions › Chapter 32a - Contributory Group General or Blanket Insurance for Persons in the Service of the Commonwealth › Section 17a - Coverage for Nonprescription Enteral Formulas for Home Use

Section 17A. The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission 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 IV - Civil Service, Retirements and Pensions › Chapter 32a - Contributory Group General or Blanket Insurance for Persons in the Service of the Commonwealth › Section 17b - Hospice Services for Commonwealth Employees Insured Under Group Insurance Commission

Section 17B. The commission shall provide to any active or retired employee of the commonwealth, who is insured under the group insurance commission, 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.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title IV - Civil Service, Retirements and Pensions › Chapter 32a - Contributory Group General or Blanket Insurance for Persons in the Service of the Commonwealth › Section 17c - Required Coverage for Abortion, Abortion-Related Care, Prenatal Care, Childbirth, and Postpartum Care

[First paragraph applicable as provided by 2022, 127, Sec. 44.]
Section 17C. The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for abortion as defined in section 12K of chapter 112, abortion-related care, prenatal care, childbirth and postpartum care, with a minimum of forty-eight hours of in-patient care following a vaginal delivery and a minimum of ninety-six hours of in-patient care following a caesarean section for a mother and her newly born child. Any decision to shorten these minimum coverages shall be made by the attending physician in consultation with the mother. Any such decision shall be made in accordance with rules and regulations promulgated by the department of public health. Said regulations shall be relative to early discharge, defined as less than forty-eight hours for a vaginal delivery and ninety-six hours for a caesarean delivery and post-delivery care and shall include, but not be limited to, home visits, parent education, assistance and training in breast or bottle feeding and the performance of any necessary and appropriate clinical tests; provided, however, that the first home visit shall be conducted by a registered nurse, physician, or certified nurse midwife; and provided, further, that any subsequent home visit determined to be clinically necessary shall be provided by a licensed health care provider.
For the purposes of this section, attending physician shall include the attending obstetrician, pediatrician, or certified nurse midwife attending the mother and newly born child.
[Third and fourth paragraphs applicable as provided by 2022, 127, Sec. 44.]
Coverage provided under this section for abortion or abortion-related care shall not be subject to any deductible, coinsurance, copayment or any other cost-sharing requirement; provided, however, that deductibles, coinsurance or copayments shall be required if the applicable plan is governed by the federal Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on deductibles, coinsurance or copayments for these services. Coverage for abortion or abortion-related care offered under this section shall not impose unreasonable restrictions or delays in the coverage.
Benefits for an enrollee under this section shall be the same for the enrollee's covered spouse and covered dependents.
Any subscriber or member who is aggrieved by a denial of benefits to be provided under this section may appeal said denial in accordance with regulations of the department of public health.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title IV - Civil Service, Retirements and Pensions › Chapter 32a - Contributory Group General or Blanket Insurance for Persons in the Service of the Commonwealth › Section 17d - Coverage for Bone Marrow Transplants

Section 17D. The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for a bone marrow transplant 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 IV - Civil Service, Retirements and Pensions › Chapter 32a - Contributory Group General or Blanket Insurance for Persons in the Service of the Commonwealth › Section 17e - Scalp Hair Prostheses Necessary Due to Cancer or Leukemia Treatment

Section 17E. (a) For the purposes of this section, the following words shall have the following meanings:
''Prosthesis'', an artificial appliance used to replace a lost natural structure; provided, however, that prosthesis shall include, but not be limited to, artificial arms, legs, breasts, scalp hair or glass eyes.
''Scalp hair prosthesis'', an artificial substitute for scalp hair.
(b) The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission, if such group coverage provides for any other prosthesis, coverage for expenses for scalp hair prostheses worn for hair loss suffered as a result of the treatment of any form of cancer or leukemia; provided, however, that such coverage shall be subject to a written statement by the treating physician that the scalp hair prosthesis is medically necessary; and provided, further, that such coverage shall be subject to the same limitations and guidelines as other prostheses. Scalp hair prosthesis coverage pursuant to this section shall not exceed an amount of $350 per year.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title IV - Civil Service, Retirements and Pensions › Chapter 32a - Contributory Group General or Blanket Insurance for Persons in the Service of the Commonwealth › Section 17f - Newborn Hearing Screening Test; Group Insurance Commission Coverage

Section 17F. The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for the cost of a newborn hearing screening test to be performed before the newborn infant is discharged from the hospital or birthing center to the care of the parent or guardian or as provided by regulations of the department of public health. Nothing contained in this section shall be construed to abrogate any obligation to provide coverage for a hearing screening test or any other hearing screening test or audiological diagnostic procedure pursuant to any law or regulation of the commonwealth or of the United States or under any of the terms or provisions of any policy, contract or certification.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title IV - Civil Service, Retirements and Pensions › Chapter 32a - Contributory Group General or Blanket Insurance for Persons in the Service of the Commonwealth › Section 17h - Coverage for Human Leukocyte or Histocompatibility Locus Antigen Testing

Section 17H. The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for the cost of human leukocyte antigen testing or histocompatibility locus antigen testing that is necessary to establish bone marrow transplant donor suitability. The coverage shall cover the costs of testing for A, B or DR antigens, or any combination thereof, consistent with guidelines, criteria, rules or regulations established by the department of public health pursuant to section 218 of chapter 111.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title IV - Civil Service, Retirements and Pensions › Chapter 32a - Contributory Group General or Blanket Insurance for Persons in the Service of the Commonwealth › Section 17i - Prosthetic Devices and Repairs; Group Insurance Commission Coverage

Section 17I. (a) The commission shall provide coverage for prosthetic devices and repairs to any active or retired employee of the commonwealth who is insured under the group insurance commission under the same terms and conditions that apply to other durable medical equipment covered under the policy, except as otherwise provided in this section.
(b) In this section, ''prosthetic device'' shall mean an artificial limb device to replace, in whole or in part, an arm or leg.
(c) Such coverage shall not impose any annual or lifetime dollar maximum on coverage for prosthetic devices other than an annual or lifetime dollar maximum that applies in the aggregate to all items and services covered under the policy.
(d) Such coverage shall not apply amounts paid for prosthetic devices to any annual or lifetime dollar maximum applicable to other durable medical equipment covered under the policy other than an annual or lifetime dollar maximum that applies in the aggregate to all items and services covered under the policy.
(e) Such coverage may include a reasonable coinsurance requirement for prosthetic devices and repairs, not to exceed 20 per cent of the allowable cost of the prosthetic device or repair, unless all covered benefits applying coinsurance under the plan do so at a higher amount. If the policy provides coverage for services from nonparticipating providers, the policy may include a reasonable coinsurance requirement for prosthetic devices and repairs, not to exceed 40 per cent of the allowable cost of the device or repair when obtained from a nonparticipating provider, unless all covered benefits applying coinsurance under the plan do so at a higher amount.
(f) Such coverage may require prior authorization as a condition of coverage for prosthetic devices.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title IV - Civil Service, Retirements and Pensions › Chapter 32a - Contributory Group General or Blanket Insurance for Persons in the Service of the Commonwealth › Section 17j - Coverage for Children Under Age 18 for Cleft Lip and Cleft Palate

Section 17J. The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for the cost of treating cleft lip and cleft palate for children under the age of 18 covered by that employee's health plan. 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 IV - Civil Service, Retirements and Pensions › Chapter 32a - Contributory Group General or Blanket Insurance for Persons in the Service of the Commonwealth › Section 17k - Coverage for Orally Administered Anticancer Medications

Section 17K. Any coverage offered by the commission to an active or retired employee of the commonwealth insured under the group insurance commission that provides 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 IV - Civil Service, Retirements and Pensions › Chapter 32a - Contributory Group General or Blanket Insurance for Persons in the Service of the Commonwealth › Section 17l - Coverage for Abuse Deterrent Opioid Drug Products

Section 17L. Any coverage offered by the commission to an active or retired employee of the commonwealth insured under the group insurance commission 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 the commission. 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 IV - Civil Service, Retirements and Pensions › Chapter 32a - Contributory Group General or Blanket Insurance for Persons in the Service of the Commonwealth › Section 17m - Preauthorization for Substance Abuse Treatment Not to Be Required

Section 17M. 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 17N; and medically managed intensive inpatient services, not covered under said section 17N.
Any coverage offered by the commission to an active or retired employee of the commonwealth insured under the group insurance commission 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 IV - Civil Service, Retirements and Pensions › Chapter 32a - Contributory Group General or Blanket Insurance for Persons in the Service of the Commonwealth › Section 17n - Coverage for Medically Necessary Acute Treatment and Clinical Stabilization Services; Preauthorization Not to Be Required; Notice to Carrier of Admission and Initial Treatment Plan

Section 17N. For the purposes of this section the following terms shall have the following meanings, unless the context clearly requires otherwise:—
''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.
The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission 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 such 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 in initiated on day 7; and provided further, that the commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for, without preauthorization, substance use disorder evaluations 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 IV - Civil Service, Retirements and Pensions › Chapter 32a - Contributory Group General or Blanket Insurance for Persons in the Service of the Commonwealth › Section 17o - Coverage for Medical or Drug Treatments to Correct or Repair Disturbances of Body Composition Caused by HIV Associated Lipodystrophy Syndrome

[Text of section added by 2016, 233, Sec. 1. See also, Section 17O as added by 2016, 454, Sec. 1, below.]
Section 17O. Any coverage offered by the commission to an active or retired employee of the commonwealth insured under the group insurance commission 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. 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 commission.
Chapter 32A: Section 17O. Coverage for refills of prescription eye drops
[Text of section added by 2016, 454, Sec. 1. See also, Section 17O added by 2016, 233, Sec. 1, above.]
Section 17O. Coverage offered by the commission to an active or retired employee of the commonwealth insured through the group insurance commission 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 IV - Civil Service, Retirements and Pensions › Chapter 32a - Contributory Group General or Blanket Insurance for Persons in the Service of the Commonwealth › Section 17p - Filling of Remaining Portion of Prescription for Covered Drug That Is a Narcotic Substance Earlier Filled in Lesser Quantity

Section 17P. The commission shall provide, to an active or retired employee of the commonwealth who is insured under the group insurance commission, 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, that person shall not be subject to an additional payment obligation, including but not limited to co-payments, if that person fills the remaining portion of the prescription.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title IV - Civil Service, Retirements and Pensions › Chapter 32a - Contributory Group General or Blanket Insurance for Persons in the Service of the Commonwealth › Section 17q - Pain Management Access Plan

Section 17Q. (a) The commission shall develop a plan to provide active or retired employees 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 review by the division of insurance. 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) The commission shall distribute educational materials to providers within their networks about the pain management access plan and make information about its plan publicly available on its website.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title IV - Civil Service, Retirements and Pensions › Chapter 32a - Contributory Group General or Blanket Insurance for Persons in the Service of the Commonwealth › Section 17r - Coverage for Treatment of Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections and Pediatric Acute-Onset Neuropsychiatric Syndrome

[Text of section effective as applied to contracts that take effect or are renewed on or after January 1, 2022. See 2020, 260, Sec. 74.]
Section 17R. The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission 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 IV - Civil Service, Retirements and Pensions › Chapter 32a - Contributory Group General or Blanket Insurance for Persons in the Service of the Commonwealth › Section 17s - Coverage for Medically Necessary Mental Health Acute Treatment, Community-Based Acute Treatment and Intensive Community-Based Acute Treatment

Section 17S. (a) For the purposes of this section, the following terms shall have the following meanings unless the context clearly requires otherwise:-
''Community-based acute treatment'', 24–hour clinically managed mental health diversionary or step-down services for children and adolescents that is usually provided as an alternative to mental health acute treatment.
''Intensive community-based acute treatment'', intensive 24–hour clinically managed mental health diversionary or step-down services for children and adolescents that is usually provided as an alternative to mental health acute treatment.
''Mental health acute treatment'', 24–hour medically supervised mental health services provided in an inpatient facility, licensed by the department of mental health, that provides psychiatric evaluation, management, treatment and discharge planning in a structured treatment milieu.
(b) The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for medically necessary mental health acute treatment, community-based acute treatment and intensive community-based acute treatment and shall not require a preauthorization before obtaining treatment; provided, however, that the facility shall notify the carrier of the admission and the initial treatment plan not more than 72 hours after admission.
(c) Benefits for an employee under this section shall be the same for the employee's covered spouse and covered dependents.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title IV - Civil Service, Retirements and Pensions › Chapter 32a - Contributory Group General or Blanket Insurance for Persons in the Service of the Commonwealth › Section 18 - Medicare Health Benefits Supplement Plan, Mandatory Transfer; Payment of Penalty

Section 18. Notwithstanding any other provision of this chapter, all retirees, their spouses and dependents insured or eligible to be insured under sections five, ten B and twelve, if enrolled in medicare part A at no cost to the retiree, spouse or dependents, or eligible for coverage thereunder at no cost to the retiree, spouse or dependents, shall be required to transfer to a medicare health benefits supplement plan offered by the commission under section ten C or section fourteen; provided, that benefits under said plan and medicare part A and part B together shall be of comparable actuarial value to those under the retiree's existing coverage. Each retiree shall provide the commission, in such form as the commission shall prescribe, such information as is necessary to transfer to a medicare health benefits supplement plan. If a retiree does not submit the information required, he shall no longer be eligible for his existing health coverage. The commonwealth shall pay any medicare part B premium penalty assessed by the federal government on said retirees, spouses and dependents as a result of enrollment in medicare part B at the time of transfer into the medicare health benefits supplement plan.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title IV - Civil Service, Retirements and Pensions › Chapter 32a - Contributory Group General or Blanket Insurance for Persons in the Service of the Commonwealth › Section 19 - Release From Insurance Coverage; Payment; Reinstatement of Coverage

Section 19. Effective January 1 and July 1 of each year, the commission may pay to any active or retired employee of the commonwealth who has been continuously insured by the commonwealth for the prior 6 months pursuant to the provisions of this chapter for hospital, surgical, medical or other health insurance benefits and who gives written notice in accordance with the provisions of section seven indicating his desire not to be so insured by the commonwealth, an amount of money to be determined by the secretary of administration and finance; provided that such amount shall equal no less than twenty-five percent of twelve times the total monthly rate in effect for individual insurance coverage as determined by the commission; provided further, that the commission shall pay such amount to such active or retired employee in payments or in one lump sum.
The commission shall require that any active or retired employee choosing to accept such payment shall verify that he is insured under a qualifying policy toward which the commonwealth makes no contribution; provided, that for the purpose of this section, a ''qualifying policy'' shall be any policy which provides a schedule of benefits comparable to that to which the employee would be eligible to receive if he were insured by the commonwealth under this chapter. The commission shall provide that if such active or retired employee ceases to be so insured under such a qualifying policy, such active or retired employee shall thereupon have his insurance coverage pursuant to this chapter reinstated by the commonwealth on the date on which he informs the commission of such termination of insurance coverages; provided, however, that any amounts to be paid to such active or retired employee in accordance with this section shall be ratably reduced and any amounts paid hereunder which are allocable to periods after insurance coverage pursuant to this chapter is reinstated by the commonwealth may be recovered by the commission under such terms and conditions as the commission shall determine.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title IV - Civil Service, Retirements and Pensions › Chapter 32a - Contributory Group General or Blanket Insurance for Persons in the Service of the Commonwealth › Section 20 - Charges or Collections of Excess Compensation

Section 20. No physician or other provider of services, who treats or provides services to an individual covered by hospital, surgical, medical or catastrophic illness coverage offered by the commission under section four, four A, ten B, twelve or fifteen, shall charge to or collect from any insured or other beneficiary any amount in excess of that amount of compensation determined or allowed for a particular service by the insurer or by the administrator. For purposes of this section the words insurer and administrator shall include any insurance carrier, nonprofit hospital or medical service corporation or third-party health care administrator operating within the scope of its license. Nothing in this section shall be construed to prevent the collection of any copayments or deductibles allowed for in the plan design.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title IV - Civil Service, Retirements and Pensions › Chapter 32a - Contributory Group General or Blanket Insurance for Persons in the Service of the Commonwealth › Section 21 - Health Care Services Evaluation; Vendor Quality Improvement Program; Annual Report

Section 21. The commission is hereby authorized and directed to establish and implement a vendor quality improvement program for purposes including, but not limited to: the evaluation and improvement of all health care services as applied to those contracts and the promotion of customer-oriented quality management techniques. Such program shall include both long and short-term objectives, quantifiable improvement goals, benchmarks for evaluating vendors and mechanisms to promote collaboration between the commission and health care vendors to improve health care services. The commission shall file an annual report with the clerks of the senate and house of representatives and with the governor not later than September 30 concerning such vendor quality improvement program.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title IV - Civil Service, Retirements and Pensions › Chapter 32a - Contributory Group General or Blanket Insurance for Persons in the Service of the Commonwealth › Section 22a - Coverage for Mental Health or Substance Use Disorder Services Delivered Through the Psychiatric Collaborative Care Model

Section 22A. (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) The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission 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 IV - Civil Service, Retirements and Pensions › Chapter 32a - Contributory Group General or Blanket Insurance for Persons in the Service of the Commonwealth › Section 23 - Coverage for Speech, Hearing and Language Disorders

Section 23. The commission shall provide to any active or retired employee of the commonwealth who is insured under the commission coverage for expenses incurred in the medically necessary diagnosis and treatment of speech, hearing and language disorders by individuals licensed as speech-language pathologists or audiologists under chapter 112, if such services are rendered within the lawful scope of practice for such speech-language pathologists or audiologists regardless of whether the services are provided in a hospital, clinic or private office; provided, however, that such coverage shall not extend to the diagnosis or treatment of speech, hearing and language disorders in a school-based setting. The coverage provided by this section shall be subject to the same terms and conditions established for any other medical condition covered by the commission.
The commission shall provide to any child, who is 21 years of age or younger, of an active or retired employee of the commonwealth and who is insured under the group insurance commission coverage for the cost of 1 hearing aid per hearing-impaired ear up to $2,000 for each hearing aid, as defined in section 196 of chapter 112, every 36 months upon a written statement from the child's treating physician that the hearing aids are necessary regardless of etiology. Coverage under this section shall include all related services prescribed by a licensed audiologist or hearing instrument specialist, as defined in said section 196 of said chapter 112, including the initial hearing aid evaluation, fitting and adjustments and supplies, including ear molds. The insured may choose a higher priced hearing aid and may pay the difference in cost above the $2,000 limit in this section without any financial or contractual penalty to the insured or to the provider of the hearing aid. The benefits in this section shall not be subject to any greater deductible, coinsurance, copayments or out-of-pocket limits than other benefits provided by the insurer. Nothing in this section shall prohibit the commission from offering greater coverage for hearing aids than required by this section. This section shall also require coverage for such hearing aids under any non-group policy.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title IV - Civil Service, Retirements and Pensions › Chapter 32a - Contributory Group General or Blanket Insurance for Persons in the Service of the Commonwealth › Section 27 - Toll-Free Telephone Number and Website Providing Customers With Estimated or Maximum Allowed Amount or Charge for Proposed Admission, Procedure or Service

Section 27. The commission shall require any carriers or third party administrators with whom it contracts to provide a toll-free telephone number and website that enables consumers to request and obtain from the carrier or third party administrator, in real time, the estimated or maximum allowed amount or charge for a proposed admission, procedure or service and the estimated amount the insured will be responsible to pay for a proposed admission, procedure or service that is a medically necessary covered benefit, based on the information available to the carrier or third party administrator at the time the request is made, including any facility fee, copayment, deductible, coinsurance or other out of pocket amount for any covered health care benefits; provided, that the insured shall not be required to pay more than the disclosed amounts for the covered health care benefits that were actually provided; provided, however, that nothing in this section shall prevent carriers from imposing cost sharing requirements disclosed in the insured's evidence of coverage for unforeseen services that arise out of the proposed admission, procedure or service; and provided further, that the carrier shall alert the insured that these are estimated costs, and that the actual amount the insured will be responsible to pay may vary due to unforeseen services that arise out of the proposed admission, procedure or service.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title IV - Civil Service, Retirements and Pensions › Chapter 32a - Contributory Group General or Blanket Insurance for Persons in the Service of the Commonwealth › Section 29 - Tobacco Cessation

Section 29. (a) The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage 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) The commission may 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 IV - Civil Service, Retirements and Pensions › Chapter 32a - Contributory Group General or Blanket Insurance for Persons in the Service of the Commonwealth › Section 31 - Benefits for Medically Necessary Emergency Services Programs to Be Provided on Nondiscriminatory Basis

Section 31. The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission benefits on a nondiscriminatory basis for medically necessary emergency services programs, as defined in section 1 of chapter 175.