SENATE, No. 2185

SECTION 1. WHEREAS the National Center for Health Statistics reported in July 2003 that an estimated 9 million children under 18 years of age in the United States have asthma, of which 4.2 million suffered from an asthma attack or episode in 2002;

WHEREAS in September 2004 the American Lung Association estimated that 441,954 adults and 121,604 children under the age of eighteen had asthma in Massachusetts;

WHEREAS asthma is the most common chronic illness among children and is one of the leading causes of emergency room visits, hospitalizations, and school absences, with nearly fourteen million lost school days per year nationwide;

WHEREAS research shows that asthma education can be cost-effective and can reduce morbidity for both adults and children, especially among high-risk patients, and is an essential component of successful asthma management;

 Be it enacted by the General Court:

SECTION 1.  Chapter 32A of the General Laws is hereby amended by inserting after section 17H the following section:-

Section 17I. The commission shall provide to an active or retired employee of the commonwealth who is insured under the group insurance commission coverage for asthma education and training for patient self-management if such services have been prescribed by a health care professional legally authorized to prescribe such services and when provided by a certified asthma health care provider participating with said insurance contract or affiliated with a provider participating with said insurance contract. Education and training services shall be authorized for not less than one hundred twenty minutes per year and delivered in the context of an office visit, home visit, or group education, as determined by the referring physician or qualified nonphysician practitioner.

Asthma education and training services shall be consistent with the standards outlined in the National Asthma Education and Prevention Program’s Guidelines for the Diagnosis and Management of Asthma and shall include (1) instruction about asthma and asthma triggers, (2) instruction on how and why to take long-term control and quick relief medications, (3) demonstrations concerning correct technique for use of inhalers and spacing devices to dispense medications, and nebulizers, (4) instruction about self-monitoring techniques such as peak flow monitoring and symptom recognition with patients, when appropriate, (5) instruction about factors that worsen asthma, how to practice allergen avoidance, and actions enrollees and their family can take to control asthma attacks; and (6) development of a written asthma management individual treatment plan.

As used in this section, "certified asthma health care provider" shall mean a licensed health care professional with expertise in asthma or an individual certified as an asthma educator by a nationally recognized certification program, including but not limited to National Asthma Educator Certification Board.

When coverage is provided through a nonprofit hospital service corporation or a nonprofit medical corporation, outpatient self-management training and education shall be provided by a certified asthma health care provider participating with the hospital service plan or medical service agreement or affiliated with a provider participating with the hospital service plan or medical service agreement. When coverage is provided through a health maintenance contract, outpatient self-management training and education, shall be provided by a certified asthma health care provider participating with the health maintenance contract or affiliated with a provider participating with the health maintenance contract. Nothing in this section shall be construed to require the commission to contract with a certified asthma health care provider who is not already under contract with the commission.

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 2. 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 asthma education and training for patient self-management if such services have been prescribed by a health care professional legally authorized to prescribe such services and when provided by a certified asthma health care provider participating with the division or affiliated with a provider participating with the division.  Education and training services shall be authorized for not less than one hundred twenty minutes per year and delivered in the context of an office visit, home visit, or group education, as determined by the referring physician or qualified nonphysician practitioner.

Asthma education and training services shall be consistent with the standards outlined in the National Asthma Education and Prevention Program’s Guidelines for the Diagnosis and Management of Asthma and shall include (1) instruction about asthma and asthma triggers, (2) instruction on how and why to take long-term control and quick relief medications, (3) demonstrations concerning correct technique for use of inhalers and spacing devices to dispense medications, and nebulizers, (4) instruction about self-monitoring techniques such as peak flow monitoring and symptom recognition with patients, when appropriate (5) instruction about factors that worsen asthma, how to practice allergen avoidance, and actions enrollees and their family can take to control asthma attacks; and (6) development of a written asthma management individual treatment plan.

As used in this section, "certified asthma health care provider" shall mean a licensed health care professional with expertise in asthma or an individual certified as an asthma educator by a nationally recognized certification program, including but not limited to National Asthma Educator Certification Board.

SECTION 3. Chapter 175 of the General Laws is hereby amended by inserting after section 47X, as so appearing, the following section:

Section 47Y. 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 benefits for asthma management training and education if such services have been prescribed by a health care professional legally authorized to prescribe such services and when provided by a certified asthma health care provider participating with said insurance contract or affiliated with a provider participating with said insurance contract.  Education and training services shall be authorized for not less than one hundred twenty minutes per year and delivered in the context of an office visit, home visit, or group education, as determined by the referring physician or qualified nonphysician practitioner.

Asthma education and training services shall be consistent with the standards outlined in the National Asthma Education and Prevention Program’s Guidelines for the Diagnosis and Management of Asthma and shall include (1) instruction about asthma and asthma triggers, (2) instruction on how and why to take long-term control and quick relief medications, (3) demonstrations concerning correct technique for use of inhalers and spacing devices to dispense medications, and nebulizers, (4) instruction about self-monitoring techniques such as peak flow monitoring and symptom recognition with patients, when appropriate (5) instruction about factors that worsen asthma, how to practice allergen avoidance, and actions enrollees and their family can take to control asthma attacks; and (6) development of a written asthma management individual treatment plan.

As used in this section, "certified asthma health care provider" shall mean a licensed health care professional with expertise in asthma or an individual certified as an asthma educator by a nationally recognized certification program, including but not limited to National Asthma Educator Certification Board.

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

SECTION 4. Chapter 176A of the General Laws is hereby amended by inserting after section 8Y, as so appearing, the following section:-

Section 8Z. A contract between a subscriber and the corporation under an individual or group hospital service plan 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 benefits to all individual subscribers and members within the commonwealth and to all group members having a principal place of employment within the commonwealth for asthma education and training for patient self-management if such services have been prescribed by a health care professional legally authorized to prescribe such services and when provided by a certified asthma health care provider participating with said insurance contract or affiliated with a provider participating with said insurance contract.  Education and training services shall be authorized for not less than one hundred twenty minutes per year and delivered in the context of an office visit, home visit, or group education, as determined by the referring physician or qualified nonphysician practitioner.

Asthma education and training services shall be consistent with the standards outlined in the National Asthma Education and Prevention Program’s Guidelines for the Diagnosis and Management of Asthma and shall include (1) instruction about asthma and asthma triggers, (2) instruction on how and why to take long-term control and quick relief medications, (3) demonstrations concerning correct technique for use of inhalers and spacing devices to dispense medications, and nebulizers, (4) instruction about self-monitoring techniques such as peak flow monitoring and symptom recognition with patients, when appropriate (5) instruction about factors that worsen asthma, how to practice allergen avoidance, and actions enrollees and their family can take to control asthma attacks; and (6) development of a written asthma management individual treatment plan.

As used in this section, "certified asthma health care provider" shall mean a licensed health care professional with expertise in asthma or an individual certified as an asthma educator by a nationally recognized certification program, including but not limited to National Asthma Educator Certification Board.

Administration for the purposes or which they have been prescribed and asthma management training and education when provided by a certified asthma health care provider participating with the nonprofit service corporation or affiliated with a provider participating with the nonprofit service corporation.  As used in this section, "certified asthma health care provider" shall mean a licensed health care professional with expertise in asthma or an individual certified as an asthma educator by a nationally recognized certification program, including but not limited to National Asthma Educator Certification Board.

Nothing in this section shall be construed to require a nonprofit service corporation to contract with a certified asthma health care provider who is not already under contract with such nonprofit service corporation.

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 176B of the General Laws is hereby amended by striking inserting after section 4Y, as so appearing, and inserting in place thereof the following section:-

Section 4Z. A subscription certificate under an individual or group medical service agreement 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 benefits to all individual subscribers and members within the commonwealth and to all group members having a principal place of employment within the commonwealth coverage for asthma education and training for patient self-management if such services have been prescribed by a health care professional legally authorized to prescribe such services and when provided by a certified asthma health care provider participating with said insurance contract or affiliated with a provider participating with said insurance contract.  Education and training services shall be authorized for not less than one hundred twenty minutes per year and delivered in the context of an office visit, home visit, or group education, as determined by the referring physician or qualified nonphysician practitioner.

Asthma education and training services shall be consistent with the standards outlined in the National Asthma Education and Prevention Program’s Guidelines for the Diagnosis and Management of Asthma and shall include (1) instruction about asthma and asthma triggers, (2) instruction on how and why to take long-term control and quick relief medications, (3) demonstrations concerning correct technique for use of inhalers and spacing devices to dispense medications, and nebulizers, (4) instruction about self-monitoring techniques such as peak flow monitoring and symptom recognition with patients, when appropriate (5) instruction about factors that worsen asthma, how to practice allergen avoidance, and actions enrollees and their family can take to control asthma attacks; and (6) development of a written asthma management individual treatment plan.

As used in this section, "certified asthma health care provider" shall mean a licensed health care professional with expertise in asthma or an individual certified as an asthma educator by a nationally recognized certification program, including but not limited to National Asthma Educator Certification Board.

Nothing in this section shall be construed to require a medical service corporation to contract with a certified asthma health care provider who is not already under contract with such medical service corporation.

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 176G of the General Laws is hereby amended by inserting after section 4Q, as so appearing, and inserting in place thereof the following section:-

Section 4R. 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, as set forth in section 47Yof chapter 175, coverage for asthma education and training for patient self-management if such services have been prescribed by a health care professional legally authorized to prescribe such services and when provided by a certified asthma health care provider participating with said insurance contract or affiliated with a provider participating with said insurance contract.  Education and training services shall be authorized for not less than one hundred twenty minutes per year and delivered in the context of an office visit, home visit, or group education, as determined by the referring physician or qualified nonphysician practitioner.

Asthma education and training services shall be consistent with the standards outlined in the National Asthma Education and Prevention Program’s Guidelines for the Diagnosis and Management of Asthma and shall include (1) instruction about asthma and asthma triggers, (2) instruction on how and why to take long-term control and quick relief medications, (3) demonstrations concerning correct technique for use of inhalers and spacing devices to dispense medications, and nebulizers, (4) instruction about self-monitoring techniques such as peak flow monitoring and symptom recognition with patients, when appropriate (5) instruction about factors that worsen asthma, how to practice allergen avoidance, and actions enrollees and their family can take to control asthma attacks; and (6) development of a written asthma management individual treatment plan.

As used in this section, "certified asthma health care provider" shall mean a licensed health care professional with expertise in asthma or an individual certified as an asthma educator by a nationally recognized certification program, including but not limited to National Asthma Educator Certification Board.

Nothing in this section shall be construed to require a health maintenance organization to contract with a certified asthma health care provider who is not already under contract with such health maintenance organization.

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.