Mandated Benefit Reviews


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.

To read additional information regarding this topic:


Individual Reviews Performed by CHIA

BenefitReview PublishedActuarial Analysis (if Published Separately)Status of Benefit Mandate
An Act Relative to Certain Genetically Targeted Drug Coverage for Duchenne Muscular Dystrophy (HB 3644) March 2018   Not in Effect
An Act Providing Health Insurance Coverage for Scalp and Facial Hair Prosthesis (SB 553) March 2018   Not in Effect
An Act Relative to Advancing Contraceptive Coverage and Economic Security in our States (ACCESS) (HB 536 / SB 499) October 2017   In Effect
An Act Recognizing Pharmacists as Healthcare Providers December 2016   Not in Effect
An Act Promoting Continuity of Care for Multiple Sclerosis Treatment October 2016   Not in Effect
An Act Relative to Cognitive Rehabilitation October 2016   Not in Effect
An Act Advancing and Expanding Access to Telemedicine Services (House Bill 267) October 2016   Not in Effect
An Act Relative to Full Application of Telemedicine Coverage (Senate Bill 1154) October 2016   Not in Effect
An Act Providing for Certain Health Insurance Coverage (Enteral Formula) July 2016   Not in Effect
Women's Health and Economic Equity May 2016   Not in Effect
Access to Full Spectrum Addiction Treatment Services March 2016   Not in Effect
Rehabilitation Periods for Substance Abusers March 2016   Not in Effect
Technology-Assisted Tracking Device for Autistic and Alzheimer Individuals May 2015   Not in Effect
Treatment for PANDAS/PANS May 2015   Not in Effect
Prescription Eye Drops April 2015   Not in Effect
Acupuncture for Pain Management, PTSD, Substance Abuse, and Nausea April 2015   Not in Effect
Early and Periodic Screening, Diagnosis, and Treatment to Privately Insured Children Under 21 March 2015   Not in Effect
Medication-assisted opioid treatment December 2014   Not in Effect
Mental health and substance abuse screening December 2014   Not in Effect

Increase Opportunities for Long-Term Substance Abuse Recovery including provisions for:

  • Abuse-deterrent Opioids;
  • Licensed Alcohol and Drug Counselors I;
  • Acute Treatment and Clinical Stabilization Services; and
  • Substance Abuse Treatment Prior Authorization
December 2014   In Effect
Improve Access to Educational Psychologists July 2014    Not in Effect
Pancreatic Cancer Screening July 2014    Not in Effect
Annual cytologic screenings May 2014    Not in Effect
HIV-Associated Lipodystrophy Treatment May 2014   In Effect
Lyme Disease Treatment May 2014   In Effect
Tobacco Cessation Treatment May 2014    Not in Effect
Care of Patients with Mitochondrial Disease September 2013   Not in Effect
Mastectomies September 2013   Not in Effect
Insurance Coverage for Devic’s Disease September 2013   Not in Effect
Craniofacial Disorders February 2013 October 2012 Not in Effect
Marriage and Family Therapy August 2012   Not in Effect
Hearing Aids for Children June 2012 June 2012 In Effect
Oral Cancer Therapy June 2012 June 2012 In Effect
Children’s Medical Security Plan December 2010   Not in Effect
Colorectal Cancer Screenings December 2010   Not in Effect
Women’s Health and Cancer Recovery December 2010 December 2010 Not in Effect
Childhood Vaccine Program and Immunization Registry August 2010   Not in Effect
Hearing Aids May 2010   Not in Effect
Insurance Coverage for Autism March 2010   In Effect
Infertility Treatments August 2009   In Effect
Cleft Palate and Cleft Lip May 2009   In Effect
Prescription Drug Voice Synthesizers May 2009   Not in Effect
Vision Screening for Children May 2009   Not in Effect
Urea Cycle Disorders May 2009   Not in Effect
Prescription Drug Coverage May 2009   Not in Effect
Mental Health Parity July 2008 July 2008 In Effect
Children’s Mental Health July 2008 July 2008 Not in Effect
Eating Disorders October 2007 October 2007 Not in Effect
Educational Psychologists July 2005   Not in Effect
Certain Prosthetic Devices April 2005   In Effect
Ectodermal Dysplasia March 2005   Not in Effect
Chiropractic Services January 2005   In Effect
Marriage and Family Therapists January 2005   Not in Effect
Scalp Hair Prosthesis September 2004   In Effect
Equitable Coverage for Substance Abuse June 2004   Not in Effect
Senior Citizen Hearing Tests February 2004   Not in Effect
Asthma Rates November 2003   Not in Effect

 

Health Plans Subject to Benefit Mandates

Plan TypeSubject to Benefit MandatesOrganizing 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.

Retrospective Reviews

2015: An Overview of Massachusetts Health Benefit Mandates (June 2015) | Word

2012: State-Mandated Health Insurance Benefits and Health Insurance Costs in Massachusetts (PDF)

2008: Comprehensive Review of Mandated Benefits in Massachusetts (PDF)