SENATE, No. 586

SECTION 1. Chapter 32A is hereby amended by inserting after section 17I, inserted by section 1of chapter 292 of the acts of 2006, the following section:-

Section 17J. (a) 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 treatment and follow-up treatment for lymphedema including but not limited to complete decongestive therapy, manual lymph drainage, surgical treatments, compression garments, bandages, replacement garments or bandages or other course of treatment recommended by a health care provider in accordance with generally accepted current medical standards.  The course of treatment for lymphedema shall be determined by a health care provider authorized under law to prescribe or provide lymphedema treatments, products, and services, including but not limited to the prescribed number of visits for complete decongestive therapy, supplies required for complete decongestive therapy, bandages and the full range of compression garments, follow-up treatment, out-patient self-management training and education, lymphedema and lymphedema-related surgery, and hospitalization for third-stage lymphedema treatment  A health care provider authorized under law to prescribe or provide lymphedema treatments, products, and services shall include, but not be limited to a health care provider licensed under chapter 112.  No person other than a health care provider health care provider authorized under law to prescribe or provide lymphedema treatments, products, and services or licensed under chapter 112 and competent to evaluate the specific clinical issues involved in the treatment of lymphedema may deny requests for the payment of benefits under this section.  The commission shall also provide coverage for treatment of lymphedema by a physical therapist licensed under section 23B of chapter 112.

            (b) The commission shall not impose upon any person receiving benefits under this section any co-payment, fee or condition that is not equally imposed upon all individuals in the same benefit category.  The commission also shall not impose any policy year or calendar year dollar or durational benefit limitations or maximums for benefits or services provided to a person under this section.

SECTION 2.  Chapter 118E, as appearing in the 2004 Official Edition, is hereby amended by inserting after section 10F the following section:-

Section 10G.  (a) The division shall provide coverage for the cost of treatment and follow-up treatment for lymphedema, including but not limited to complete decongestive therapy, manual lymph drainage, surgical treatments, compression garments, bandages, replacement garments or bandages or other course of treatment recommended by a health care provider in accordance with generally accepted current medical standards.  The course of treatment for lymphedema shall be determined by a health care provider authorized under law to prescribe or provide lymphedema treatments, products, and services, including but not limited to the prescribed number of visits for complete decongestive therapy, supplies required for complete decongestive therapy, bandages and the full range of compression garments, follow-up treatment, out-patient self-management training and education, lymphedema and lymphedema-related surgery, and hospitalization for third-stage lymphedema treatment  A health care provider authorized under law to prescribe or provide lymphedema treatments, products, and services shall include, but not be limited to a health care provider licensed under chapter 112.  No person other than a health care provider health care provider authorized under law to prescribe or provide lymphedema treatments, products, and services or licensed under chapter 112 and competent to evaluate the specific clinical issues involved in the treatment of lymphedema may deny requests for the payment of benefits under this section.  The commission shall also provide coverage for treatment of lymphedema by a physical therapist licensed under section 23B of chapter 112.

(b)    The division shall not impose upon any person receiving benefits under this section any co-payment, fee or condition that is not equally imposed upon all individuals in the same benefit category.  The division also shall not impose any policy year or calendar year dollar or durational benefit limitations or maximums for benefits or services provided to a person under this section.

SECTION 3.  Chapter 175 is hereby amended by inserting after section 47Z, inserted by section 2 of chapter 292 of the acts of 2006, the following section:-

Section 47AA.  (a) Any policy of accident and sickness insurance described in section 108 which provides hospital expense and surgical expense insurance and which is delivered, issued or subsequently renewed by agreement between the insurer and policyholder in the commonwealth; any blanket or general policy of insurance described in subdivision (A), (C) or (D) of section 110 which provides hospital expense and surgical expense insurance and which is delivered, issued or subsequently renewed by agreement between the insurer and the policyholder, within or without the commonwealth, except policies providing supplemental coverage to Medicare; or any employers’ health and welfare fund which provides hospital expense and surgical expense benefits and which is delivered, issued or renewed to any person or group of persons in the commonwealth, shall provide coverage for the cost of treatment and follow-up treatment for lymphedema, including but not limited to complete decongestive therapy, manual lymph drainage, surgical treatments, compression garments, bandages, replacement garments or bandages or other course of treatment recommended by a health care provider in accordance with generally accepted current medical standards.  The course of treatment for lymphedema shall be determined by a health care provider authorized under law to prescribe or provide lymphedema treatments, products, and services, including but not limited to the prescribed number of visits for complete decongestive therapy, supplies required for complete decongestive therapy, bandages and the full range of compression garments, follow-up treatment, out-patient self-management training and education, lymphedema and lymphedema-related surgery, and hospitalization for third-stage lymphedema treatment  A health care provider authorized under law to prescribe or provide lymphedema treatments, products, and services shall include, but not be limited to a health care provider licensed under chapter 112.  No person other than a health care provider health care provider authorized under law to prescribe or provide lymphedema treatments, products, and services or licensed under chapter 112 and competent to evaluate the specific clinical issues involved in the treatment of lymphedema may deny requests for the payment of benefits under this section.  The commission shall also provide coverage for treatment of lymphedema by a physical therapist licensed under section 23B of chapter 112.

(b)    No insurer shall impose upon any person receiving benefits under this section any co-payment, fee or condition that is not equally imposed upon all individuals in the same benefit category.  No insurer shall impose any policy year or calendar year dollar or durational benefit limitations or maximums for benefits or services provided to a person under this section.

SECTION 4.  Chapter 176A is hereby amended by inserting after section 8AA, inserted by section 3 of chapter 292 of the acts of 2006, the following section:-

Section 8BB.  Any contract, except contracts providing supplemental coverage to Medicare or other governmental programs, between a subscriber and the corporation under an individual or group hospital service plan which is delivered, issued or renewed in 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 coverage for expenses incurred in the treatment and follow-up treatment for lymphedema, including but not limited to complete decongestive therapy, manual lymph drainage, surgical treatments, compression garments, bandages, replacement garments or bandages or other course of treatment recommended by a health care provider in accordance with generally accepted current medical standards.  The course of treatment for lymphedema shall be determined by a health care provider authorized under law to prescribe or provide lymphedema treatments, products, and services, including but not limited to the prescribed number of visits for complete decongestive therapy, supplies required for complete decongestive therapy, bandages and the full range of compression garments, follow-up treatment, out-patient self-management training and education, lymphedema and lymphedema-related surgery, and hospitalization for third-stage lymphedema treatment  A health care provider authorized under law to prescribe or provide lymphedema treatments, products, and services shall include, but not be limited to a health care provider licensed under chapter 112.  No person other than a health care provider health care provider authorized under law to prescribe or provide treatments, products, and services or licensed under chapter 112 and competent to evaluate the specific clinical issues involved in the treatment of lymphedema may deny requests for the payment of benefits under this section.  The commission shall also provide coverage for treatment of lymphedema by a physical therapist licensed under section 23B of chapter 112.

            (b) No corporation shall impose upon any person receiving benefits under this section any co-payment, fee or condition that is not equally imposed upon all individuals in the same benefit category.  No corporation shall impose any policy year or calendar year dollar or durational benefit limitations or maximums for benefits or services provided to a person under this section.

SECTION 5.  Chapter 176B is hereby amended by inserting after section 4AA, inserted by section 4 of chapter 292 of the acts of 2006, the following section:-

Section 4BB.  Any subscription certificate under an individual or group medical service agreement, except certificates which provide supplemental coverage to Medicare or other governmental programs, 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 in the commonwealth, coverage for expenses incurred in the treatment and follow-up treatment for lymphedema, including but not limited to complete decongestive therapy, manual lymph drainage, surgical treatments, compression garments, bandages, replacement garments or bandages or other course of treatment recommended by a health care provider in accordance with generally accepted current medical standards.  The course of treatment for lymphedema shall be determined by a health care provider authorized under law to prescribe or provide lymphedema treatments, products, and services, including but not limited to the prescribed number of visits for complete decongestive therapy, supplies required for complete decongestive therapy, bandages and the full range of compression garments, follow-up treatment, out-patient self-management training and education, lymphedema and lymphedema-related surgery, and hospitalization for third-stage lymphedema treatment  A health care provider authorized under law to prescribe or provide lymphedema treatments, products, and services shall include, but not be limited to a health care provider licensed under chapter 112.  No person other than a health care provider health care provider authorized under law to prescribe or provide lymphedema treatments, products, and services or licensed under chapter 112 and competent to evaluate the specific clinical issues involved in the treatment of lymphedema may deny requests for the payment of benefits under this section.  The commission shall also provide coverage for treatment of lymphedema by a physical therapist licensed under section 23B of chapter 112.

            (b) No corporation shall impose upon any person receiving benefits under this section any co-payment, fee or condition that is not equally imposed upon all individuals in the same benefit category.  No corporation shall impose any policy year or calendar year dollar or durational benefit limitations or maximums for benefits or services provided to a person under this section.

SECTION 6.  Chapter 176G is hereby amended by inserting after section 4S, inserted by section 5 of chapter 292 of the acts of 2006, the following section:-

Section 4T.  An individual or group health maintenance contract, except contracts providing supplemental coverage to Medicare or to other government programs, shall provide coverage and benefits for expenses incurred in the treatment and follow-up treatment for lymphedema, including but not limited to complete decongestive therapy, manual lymph drainage, surgical treatments, compression garments, bandages, replacement garments or bandages or other course of treatment recommended by a health care provider in accordance with generally accepted current medical standards.  The course of treatment for lymphedema shall be determined by a health care provider authorized under law to prescribe or provide lymphedema treatments, products, and services, including but not limited to the prescribed number of visits for complete decongestive therapy, supplies required for complete decongestive therapy, bandages and the full range of compression garments, follow-up treatment, out-patient self-management training and education, lymphedema and lymphedema-related surgery, and hospitalization for third-stage lymphedema treatment  A health care provider authorized under law to prescribe or provide lymphedema treatments, products, and services shall include, but not be limited to a health care provider licensed under chapter 112.  No person other than a health care provider health care provider authorized under law to prescribe or provide lymphedema treatments, products, and services or licensed under chapter 112 and competent to evaluate the specific clinical issues involved in the treatment of lymphedema may deny requests for the payment of benefits under this section.  The commission shall also provide coverage for treatment of lymphedema by a physical therapist licensed under section 23B of chapter 112.

            (b) No health maintenance organization shall impose upon any person receiving benefits under this section any co-payment, fee or condition that is not equally imposed upon all individuals in the same benefit category.  No health maintenance organization shall impose any policy year or calendar year dollar or durational benefit limitations or maximums for benefits or services provided to a person under this section.