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 learn more regarding this topic, please see the additional information below.


Mandated Benefit Reviews (by chronological order)

Proposed Benefit / Legislative Bill
CHIA Review
Date Published
Status of Benefit Mandate
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)
Not in Effect
Prescription Eye Drops (H903)
Not in Effect
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:

  • Abuse-deterrent Opioids;
  • Licensed Alcohol and Drug Counselors I;
  • Acute Treatment and Clinical Stabilization Services; and
  • Substance Abuse Treatment Prior Authorization

(Proposed in Chapter 258 of the Acts of 2014)

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

 

Health Plans Subject to Benefit Mandates

Plan TypeSubject 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.



Additional Information