CHIA evaluates the impact of health benefit mandate bills referred by Massachusetts legislative committees. These evaluations provide a medical efficacy analysis and an estimate of the effect on health insurance costs. CHIA performs a comprehensive retrospective review, typically every four years, of all mandates in effect.
Health benefit mandates are laws passed by states that require state-licensed health insurance carriers to include specific health care benefits in certain coverage plans. All states have such benefit mandates. Examples range from commonly offered services, such as emergency department services or diabetic supplies, to less standard benefits, such as in vitro fertilization and applied behavior treatment for autism. While mandates may make health insurance more comprehensive, they also may make it more expensive. Thus, 29 states, including Massachusetts, have systematic processes in place to study the efficacy and cost of existing and proposed health benefit mandates.
The review of health benefit mandates supports balancing the goal of ensuring adequate protection for health care consumers with the goal of managing increasing health care costs. The new requirements introduced by the federal Patient Protection and Affordable Care Act (ACA) may impact the types and number of benefit mandate bills passed in Massachusetts. By evaluating the medical efficacy and cost impact of proposed benefit mandate bills, CHIA provides stakeholders with neutral, reliable information.
This page was last updated on July 26, 2024.
| Proposed Benefit / Legislative Bill |
CHIA Review
Date Published |
Status of Benefit Mandate
|
|---|---|---|
|
An Act to increase access to nurse-midwifery services (H1069/S607) |
July 2024 | Not in Effect |
| July 2024 | Not in Effect | |
| An Act to Patient Access to Biomarker Testing to Provide Appropriate Therapy (S685/H1074) |
Not in Effect
|
|
| An Act Relative to LGBTQ Family Building (S622) |
Not in Effect
|
|
| An Act Relative to Applied Behavioral Analysis Therapy (H1084 / S617) |
Not in Effect
|
|
| An Act Relative to Newborn Screenings for Congenital Cytomegalovirus (H2338 / S1471) |
Not in Effect
|
|
| An Act Providing Access to Full Spectrum Addiction Treatment Services (H2116 / S1292) |
Not in Effect
|
|
| An Act Relative to Human Donor Milk Coverage (H1106 / S717) |
Not in Effect
|
|
| An Act Relative to Breast Cancer Equity and Early Detection (H4748 / S2856) |
Not in Effect
|
|
| An Act Relative to Dual Diagnosis Treatment Coverage (H1147/S685 ) |
Not in Effect
|
|
| An Act to Update Mental Health Parity (H2065) |
Not in Effect
|
|
| An Act Relative to Collaborative Care (S769) | ||
| An Act Relative to Mental Health Providers (H1114 and S1262) |
Not in Effect
|
|
| An Act Promoting Consumer Choice In Health Care (H1194 And S673) |
Not in Effect
|
|
| An Act Ensuring Access To Full Spectrum Pregnancy Care (H1196 And S673) |
Not in Effect
|
|
| An Act Relative To Preserving Fertility (H1116 And S640) |
Not in Effect
|
|
| An Act Relative to Ensuring Treatment for Genetic Craniofacial Conditions (H988) |
Not in Effect
|
|
| An Act providing coverage for hearing aids (S597) |
Not in Effect
|
|
| An Act providing hearing aids for persons with sensory impairedness (S540) |
Not in Effect
|
|
| An Act for Prevention and Access to Appropriate Care and Treatment of Addiction (H4742) |
Not in Effect
|
|
| An Act Relative to Osteoporosis Screening and Treatment to Prevent Fractures and Reduce Health Care Costs (H2169) |
Not in Effect
|
|
| An Act to Provide Equal Access to Medication Assisted Treatment (S543) |
Not in Effect
|
|
| An Act Relative to Women’s Health (H2207 and S507) |
Not in Effect
|
|
| An Act providing insurance coverage for biennial echocardiogram and concussion analysis for persons under the age of eighteen (H2978) |
Not in Effect
|
|
| An Act to Require Health Care Coverage for Emergency Psychiatric Services (S2282) |
Not in Effect
|
|
| An Act Relative to Certain Genetically Targeted Drug Coverage for Duchenne Muscular Dystrophy (H3644) |
Not in Effect
|
|
| An Act Providing Health Insurance Coverage for Scalp and Facial Hair Prosthesis (S553) |
Not in Effect
|
|
| An Act Relative to Advancing Contraceptive Coverage and Economic Security in our States (ACCESS) (H536 and S499) | ||
| An Act Recognizing Pharmacists as Healthcare Providers (H2041) |
Not in Effect
|
|
| An Act Promoting Continuity of Care for Multiple Sclerosis Treatment (H800) |
Not in Effect
|
|
| An Act Relative to Cognitive Rehabilitation (H843) |
Not in Effect
|
|
| An Act Advancing and Expanding Access to Telemedicine Services (H267) |
Not in Effect
|
|
| An Act Relative to Full Application of Telemedicine Coverage (S1154) |
Not in Effect
|
|
| An Act Providing for Certain Health Insurance Coverage (Enteral Formula) (H 3488) |
Not in Effect
|
|
| Women's Health and Economic Equity (S483 and H948) |
Not in Effect
|
|
| Access to Full Spectrum Addiction Treatment Services (S1502) |
Not in Effect
|
|
| Rehabilitation Periods for Substance Abusers (H3264) |
Not in Effect
|
|
| Technology-Assisted Tracking Device for Autistic and Alzheimer Individuals (H956) |
Not in Effect
|
|
| Treatment for PANDAS/PANS (H984) | ||
| Prescription Eye Drops (H903) | ||
| Acupuncture for Pain Management, PTSD, Substance Abuse, and Nausea (H3972) |
Not in Effect
|
|
| Early and Periodic Screening, Diagnosis, and Treatment to Privately Insured Children Under 21 (H916) |
Not in Effect
|
|
| Medication-assisted opioid treatment (Proposed in Chapter 258 of the Acts of 2014) | ||
| Mental health and substance abuse screening (Proposed in Chapter 258 of the Acts of 2014) | ||
Increase Opportunities for Long-Term Substance Abuse Recovery including provisions for:
|
||
| Improve Access to Educational Psychologists (H1808) |
Not in Effect
|
|
| Pancreatic Cancer Screening (S471) |
Not in Effect
|
|
| Annual cytologic screenings (H847) |
Not in Effect
|
|
| HIV-Associated Lipodystrophy Treatment (H986) | ||
| Lyme Disease Treatment (H989) | ||
| Tobacco Cessation Treatment (S550) |
Not in Effect
|
|
| Care of Patients with Mitochondrial Disease (H977) |
Not in Effect
|
|
|
An Act Relative to Mastectomies (H931) |
Not in Effect
|
|
| Insurance Coverage for Devic’s Disease (H941) |
Not in Effect
|
|
| Craniofacial Disorders (H321) |
Not in Effect
|
| Plan Type | Subject to Benefit Mandates |
Organizing Statute or Description of Plan Type |
|---|---|---|
| Commercial Health Insurance Companies |
✓
|
M.G.L. Chapter 175 |
| Hospital Service Corporations |
✓
|
M.G.L. Chapter 176A |
| Medical Service Corporations |
✓
|
M.G.L. Chapter 176B |
| HMOs |
✓
|
M.G.L. Chapter 176G |
| Group Insurance Commission (GIC) Plans |
✓
|
M.G.L. Chapter 32A |
| Self-Insured Plans (Except the GIC population for some mandates) |
Employer pays for employees’ health care costs out of a fund that the company has set aside for medical expenses. | |
| Federal Employees Health Benefit Program |
Employer-sponsored group health insurance program for federal workers, dependents, and retirees. | |
| TRICARE (military and dependents) |
Health care program serving Uniformed Service members, retirees and their families, managed by the federal Defense Health Agency (DHA). | |
| Medicare | Federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease. | |
| MassHealth (Medicaid) |
Joint federal-state health insurance program with eligibility standards based on income or other criteria. |
