PETITION OF:

SECTION 1. Notwithstanding any general or special law to the contrary, the department of public health shall, no later than December 1, 2008, establish a model framework for the provision of asthma patient education and home-based environmental interventions to people with asthma. The model framework shall be designed to aid health care organizations and health insurers in the design and implementation of asthma management programs and to promote consistent benefits coverage for all insurance subscribers. The department shall work in concert with health care providers, consumers, the office of Medicaid, health insurers including Medicaid managed care organizations, public health experts, and advocacy organizations to review best practice guidelines and model programs and develop said model framework based on the findings. For the purposes of this section, “asthma patient education” shall mean individual education, group education and other programs for individuals with asthma and their families that teach the skills needed to self-manage the disease and to maintain and/or improve life activities. Asthma patient education shall include instruction on (1) the basic physiology of asthma; (2) medications and medication compliance; (3) asthma triggers and trigger avoidance techniques; and (4) self management techniques such as asthma action plans and peak flow monitoring. For the purposes of this section, “home-based environmental interventions” shall mean a home assessment, education, and/or the provision of materials and supplies to mitigate exposures to environmental triggers in the home.

The department shall further develop recommendations for aligning patient and provider incentives and payment policies to encourage appropriate implementation of the model framework. The department shall disseminate model framework and payment strategies to health care organizations and health insurers and monitor the implementation of said framework. The department shall report its findings to the joint committee on public health.

SECTION 2. Chapter 32A of the General Laws is hereby amended by inserting after section 17I the following section:-

Section 17J. The commission shall provide to any active or retired employee of the commonwealth or their dependents who are insured under the group insurance commission coverage for services and items required to practice according to best practices and to follow the nationally accepted guidelines for the management of asthma. The following services and items shall be covered for enrollees with asthma in so far as said services and items are within a category of benefits or services for which coverage is otherwise afforded and have been prescribed by a health care professional legally authorized to prescribe such services for the management and treatment of asthma:

(a) All medically necessary equipment, as determined necessary by the treating health care provider, including:

(1) Inhaler spacers

(2) Nebulizers, including face masks and tubing

(3) Peak flow monitors

(4) Allergen proof bedding covers, HEPA filters and vacuums, and integrated pest management

(b) Asthma educational services to optimally self-manage the disease, as prescribed by the treating health care provider, including:

(1) Group asthma education, individualized asthma education, or both, as appropriate and when provided by a trained individual. Asthma education shall be provided as often as recommended by the treating health care provider based on severity and control. Asthma education shall be culturally competent and linguistically appropriate.

(2) Home based visits through qualified vendors for the identification of home environmental triggers, related education, and the provision of materials and services to mitigate exposures to environmental triggers, if there is evidence of exposure sensitivity to specific allergens or evidence of conditions known to lead to sensitivity, particularly in vulnerable populations.

The benefits provided in this section shall meet all other terms and conditions within an insurance plan. Coverage shall not be reduced or eliminated due to the requirements of this section.

SECTION 3. Chapter 118E of the General Laws is hereby amended by inserting after section 10F, as so appearing, the following section:-

Section 10G. The division shall provide coverage for services and items required to practice according to best practices and to follow the nationally accepted guidelines for the management of asthma. The following services and items shall be covered in so far as said services and items are within a category of benefits or services for which coverage is otherwise afforded and have been prescribed by a health care professional legally authorized to prescribe such services for the management and treatment of asthma:

(a) All medically necessary equipment, as determined necessary by the treating health care provider, including:

(1) Inhaler spacers

(2) Nebulizers, including face masks and tubing

(3) Peak flow monitors

(4) Allergen proof bedding covers, HEPA filters and vacuums, and integrated pest management, if there is evidence of exposure sensitivity to specific allergens or evidence of conditions known to lead to sensitivity

(b) Asthma educational services to optimally self-manage the disease, as prescribed by the treating health care provider, including:

SECTION 4. Chapter 175 of the General Laws is hereby amended by inserting after section 47Z, as so appearing, the following section:-

Section 47AA. An individual policy of accident and sickness insurance issued pursuant to section 108 which provides hospital expense and surgical expense insurance, and any group blanket policy of accident and sickness insurance issued pursuant to section 110 which provides hospital expense and surgical expense insurance, delivered, issued or renewed by agreement between the insurer and the policyholder, within or without the commonwealth, shall provide coverage for services and items required to practice according to best practices and to follow the nationally accepted guidelines for the management of asthma. The following services and items shall be covered for subscribers with asthma in so far as said services and items are within a category of benefits or services for which coverage is otherwise afforded and have been prescribed by a health care professional legally authorized to prescribe such services for the management and treatment of asthma:

(a) All medically necessary equipment, as determined necessary by the treating health care provider, including:

(1) Inhaler spacers

(2) Nebulizers, including face masks and tubing

(3) Peak flow monitors

(b) Asthma educational services to optimally self-manage the disease, as prescribed by the treating health care provider, including:

The benefits provided in this section shall meet all other terms and conditions within a subscription certificate. Hospital service plans shall not reduce or eliminate coverage due to the requirements of this section.

SECTION 5. Chapter 176A of the General Laws is hereby amended by inserting after section 4AA, as so appearing, the following section:-

Section 4BB. Any contract between a subscriber and the corporation under an individual or group hospital service plan, which shall be delivered, issued or renewed by agreement between the insurer and the policyholder, within or without the commonwealth, shall provide coverage for services and items required to practice according to best practices and to follow the nationally accepted guidelines for the management of asthma. The following services and items shall be covered for subscribers with asthma in so far as said services and items are within a category of benefits or services for which coverage is otherwise afforded and have been prescribed by a health care professional legally authorized to prescribe such services for the management and treatment of asthma:

(a) All medically necessary equipment, as determined necessary by the treating health care provider, including:

(1) Inhaler spacers

(2) Nebulizers, including face masks and tubing

(3) Peak flow monitors

(b) Asthma educational services to optimally self-manage the disease, as prescribed by the treating health care provider, including:

The benefits provided in this section shall meet all other terms and conditions within a subscription certificate. Medical service agreements shall not reduce or eliminate coverage due to the requirements of this section.

SECTION 6. Chapter 176B of the General Laws is hereby amended by inserting after section 4AA, as so appearing, the following section:-

Section 4BB. (a) Any subscription certificate under an individual or group medical service agreement which shall be delivered, issued or renewed within the commonwealth shall provide as benefits to all individual subscribers or members within the commonwealth and to all group members having a principal place of employment within the commonwealth, shall provide coverage for services and items required to practice according to best practices and to follow the nationally accepted guidelines for the management of asthma. The following services and items shall be covered for subscribers with asthma in so far as said services and items are within a category of benefits or services for which coverage is otherwise afforded and have been prescribed by a health care professional legally authorized to prescribe such services for the management and treatment of asthma:

(a) All medically necessary equipment, as determined necessary by the treating health care provider, including:

(1) Inhaler spacers

(2) Nebulizers, including face masks and tubing

(3) Peak flow monitors

(b) Asthma educational services to optimally self-manage the disease, as prescribed by the treating health care provider, including:

SECTION 7. Chapter 176G of the General Laws is hereby amended by inserting after section 4S, as so appearing, the following section:-

Section 4T. Any individual or group health maintenance contract delivered, issued or renewed by agreement between the insurer and the policyholder, within or without the commonwealth, shall provide coverage for services and items required to practice according to best practices and to follow the nationally accepted guidelines for the management of asthma. The following services and items shall be covered for subscribers with asthma in so far as said services and items are within a category of benefits or services for which coverage is otherwise afforded and have been prescribed by a health care professional legally authorized to prescribe such services for the management and treatment of asthma:

(a) All medically necessary equipment, as determined necessary by the treating health care provider, including:

(1) Inhaler spacers

(2) Nebulizers, including face masks and tubing

(3) Peak flow monitors

(b) Asthma educational services to optimally self-manage the disease, as prescribed by the treating health care provider, including:

The benefits provided in this section shall meet all other terms and conditions within a health maintenance contract. Health maintenance contracts shall not reduce or eliminate coverage due to the requirements of this section.