MASSACHUSETTS GENERAL LAWS
Mandating that Certain Health Benefits Be Provided By Commercial Insurers, Blue Cross and Blue Shield and Health Maintenance Organizations

Listings are for informational purposes only. Please refer to the appropriate
sections of the law for specific mandated benefit provisions

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  1. Services and supplies.
  2. Mandated providers and provider contracting
  3. Eligibility
  4. Confidentiality
  5. Continuation of coverage
  6. Other
I. Services and supplies

 		REGULATORY CITATIONS

 
 COMMERCIAL
INSURER
 		BLUE CROSS AND
BLUE SHIELD
 		HMO 1

 
Coverage for Autismc. 175 § 47AA See also Bulletin 2010-15c. 176A § 8DD; c. 176B § 4DD See also Bulletin 2010-15c. 176G § 4V See also Bulletin 2010-15
Bone marrow transplants for
treatment of breast cancer		c. 175 § 47R
(105 CMR 240.00)		c. 176A § 8O; c. 176B § 4O
(105 CMR 240.00)		c. 176G § 4F
(105 CMR 240.00)
Cardiac rehabilitationc. 175 § 47D
(105 CMR 143.00)		c. 176A § 8G; c. 176B § 4F
(105 CMR 143.00)		c. 176G § 4
(105 CMR 143.00)
Chiropractic servicesn/a, but see p. 3 on
" nondiscrimination"		c. 176B § 4Ln/a
Cleft Palate and Cleft Lip

c. 175 § 47BB

See c. 234 of the Acts of 2012

c. 176A § 8EE; c. 176B § 4EE

See c. 234 of the Acts of 2012

c. 176G § 4W

See c. 234 of the Acts of 2012

Clinical trials (to treat cancer)c. 175 § 110L
See also Bulletin 02-13		c. 176A § 8X; c. 176B § 4X
See also Bulletin 02-13		c. 176G § 4P
See also Bulletin 02-13
Contraceptive servicesc. 175 § 47W
See also Bulletin 02-09		c. 176A § 8W; c. 176B § 4W
See also Bulletin 02-09		c. 176G §4O
See also Bulletin 02-09
Cytologic screening (Pap smear)c. 175 § 47Gc. 176A § 8Jc. 176G § 4
Diabetes-related services
and supplies		c. 175 § 47N
See also
Bulletin 00-05		c. 176A § 8P; c. 176B § 4S
See also
Bulletin 00-05		c. 176G § 4H
See also
Bulletin 00-05
Early Intervention servicesc. 175 § 47Cc. 176A § 8B; c. 176B § 4Cc. 176G § 4
Hearing Aids For Children

c. 175 § 47X(f)

See c. 233 of the Acts of 2012

c. 176A § 8Y(f); c. 176B § 4EE

See c. 233 of the Acts of 2012

c. 176G § 4N

See c. 233 of the Acts of 2012

Hearing screening for newbornsc. 175 § 47C
(c. lll § 67F)		c. 176A § 8B; c. 176B § 4C
(c. lll § 67F)		c. 176G § 4K
(c. lll § 67F)
Home health carec. 175 § 110(K)c. 176A § 8Ic. 176G § 4C
Hormone Replacement Therapy (HRT)c. 175 § 47W
See also Bulletin 02-09		c. 176A § 8W; c. 176B § 4W
See also Bulletin 02-09		c. 176G §4O
See also Bulletin 02-09
Hospice carec. 175 § 47S
(105 CMR 141.00)		c. 176A § 8R; c. 176B § 4Q
(105 CMR 141.00)		c. 176G § 4L
(105 CMR 141.00)
Human leukocyte antigen testingc. 175 § 47Vc. 176A § 8V; c. 176B § 4Vc. 176G § 4N
Hypodermic syringes or needlesc. 175 § 47Yc. 176A § 8CC; c. 176B § 4CC.c. 176G § 4U
Infertility treatment
(does not apply to a diocese
See St. 1987, c. 394, § 5 and St. 1993, c. 110, § 248		c. 175 § 47H
(211 CMR 37.00)		c. 176A § 8K; c. 176B § 4J
(211 CMR 37.00)		c. 176G § 4
(211 CMR 37.00)
Lead poisoning screeningc. 175 § 47Cc. 176A § 8B; c. 176B § 4Cc. 176G § 4
Low protein food product for
inherited amino acid and organic
acid diseases (PKU)		c. 175 § 47Ic. 176A § 8L; c. 176B § 4Kc. 176G § 4D
Mammographyc. 175 §§ 47G and 110(L)c. 176A § 8Jc. 176G § 4
Maternity health care
(including minimum maternity stay)		c. 175 § 47F
(105 CMR 130.660)		c. 176A § 8H; c. 176B § 4H
(105 CMR 130.660)		c. 176G §§ 4, 4I
(105 CMR 130.660)
Mental health care 3c. 175 § 47Bc. 176A § 8A; c. 176B § 4Ac. 176G § 4M
Nonprescription enteral formulasc. 175 § 47Ic. 176A § 8L; c. 176B § 4Kc. 176G § 4D
Off-label uses of prescription
drugs to treat cancer		c. 175 §§ 47K, 47Lc. 176A § 8N; c. 176B § 4Nc. 176G § 4E
Off-label uses of prescription
drugs to treat HIV/AIDS		c. 175 §§ 47O, 47Pc. 176A § 8Q; c. 176B § 4Pc. 176G § 4G
Oral Cancer Therapyc. 175 § 47DDc. 176A § 8FF; c. 176B § 4FFc. 176G § 4X
Preventive care for children up
to age six (including specific
newborn testing)		c. 175 § 47Cc. 176A § 8B; c. 176B §4Cc. 176G § 4
Prosthetic Devicesc. 175 §47Zc. 176A §8AA;
c. 176B § 4AA		c. 176G § 4S
Scalp hair prostheses for
cancer patients		c. 175 § 47Tc. 176A § 8T; c. 176B § 4Rc. 176G § 4J
Speech, hearing and language disordersc. 175 § 47Xc. 176A § 8Y; c. 176B § 4Yc. 176G § 4N
Telemedicine Services

c. 175 § 47BB

See Section 158 of c. 224 of the Acts of 2012

n/an/a

II. Providers
REGULATORY CITATIONS

 
(1) Mandated coverage

 		COMMERCIAL
INSURER
 		BLUE CROSS AND
BLUE SHIELD
 		HMO

 
Certified nurse midwivesc. 175 § 47Ec. 176B § 4Gn/a
Certified registered nurse anesthetistsc. 175 § 47Qc. 176A § 8S; c. 176B § 4Tc. 176G § 4
Nurse practitionersc. 175 § 47Qc. 176A § 8S; c. 176B § 4Tc. 176G § 4
Mental health providers:
Licensed psychiatrists, psychologists, independent clinical social workers, mental health counselors, and nurse mental health clinical specialists.		c. 175 § 47Bc. 176A § 8A; c. 176B § 4Ac. 176G § 4M

(2) Nondiscrimination (re: providers)

Chiropractors		c. 175 § 108Dc. 176B § 7
see also "chiropractic services" - p. 1		n/a
Dentistsc. 175 § 108Bc. 176B § 4n/a
Nurse Midwivessee "certified nurse midwives" abovec. 176B § 7
see also "certified nurse midwives" above		see "certified nurse midwives" above
Nurse Practitionersc. 176Rc. 176Rc. 176R
Optometristsc. 175 § 108(8)(D)
c. 175 § 110(F)		c. 176B § 4n/a
Physician Assistants

c. 176S

See Section 216 of c. 224 of the Acts of 2012

c. 176S

See Section 216 of c. 224 of the Acts of 2012

c. 176S

See Section 216 of c. 224 of the Acts of 2012

Podiatristsc. 175 § 110(I)c. 176B § 4c. 176G § 1
(See "nondiscriminatory")

(3) Contracting

Good faith communication
(a.k.a. "gag rule" prohibition) See also c. 176I §2 for preferred provider arrangements		c. 175 § 108(11)
c. 175 § 110(M)
 		c. 176B § 7c. 176G § 6
Pharmacy freedom of choice:
any willing provider		c. 176D § 3B
(211 CMR 44.00)		c. 176D § 3B
(211 CMR 44.00)		c. 176D § 3B
(211 CMR 44.00)
Provider protection re:
48/96- hour maternity stay		St. 1995, c. 218 § 9St. 1995, c. 218 § 9St. 1995, c. 218 § 9
Prompt payment of claims
See also c. 176I § 2 for insured preferred provider plans		See " other"c. 176B § 7 See also " other"c. 176G § 6

III. Eligibility
REGULATORY CITATIONS

 
(1) EligibilityCOMMERCIAL
INSURER
 		BLUE CROSS AND
BLUE SHIELD
 		HMO

 
Dependent coverage: newborn infants
children of dependents adopted children		c. 175 § 47Cc. 176A § 8B; c. 176B § 4Cc. 176G § 4
Eligibility as a Dependent
[See "Bulletin 2008-01]
 		c. 175 § 108.2.(a)(3)
c. 175 § 110(P)
 		c. 176A § 8BB; c. 176B § 4BBc. 176G § 4T
(2) Nondiscrimination (re: insureds)
Blind or deaf personsc. 175 § 108Ac. 176A § 8C; c. 176B § 4Dn/a
Diethylstilbestrol exposurec. 175 § 108Cc. 176A § 8E; c. 176B § 4En/a
Victims of domestic abusec. 175 § 108Gc. 176A § 3A; c. 176B § 5Ac. 176G § 19
Genetic testing/genetic information: use prohibited in health insurance
See also c. 176I § 4A for insured preferred provider plans		c. 175 § 108Hc. 176A § 3B; c. 176B § 5Bc. 176G § 24
Genetic testing/genetic information: limits on use for long-term care and disability income insurancec. 175 § 108In/an/a

IV. Confidentiality
REGULATORY CITATIONS

 
Confidentiality of mental health information 3
(See also "Mental health care" on page 2, including footnote)		c. 175 § 108Ec. 176A § 8A1/2; c. 176B § 4B
c. 176A § 14B; c. 176B § 20		c. 176G § 4B
Insurance information and
privacy protection		c. 175Ic. 175Ic. 175I

V. State-mandated
Continuation of Health Coverage
REGULATORY CITATIONS

 
 COMMERCIAL
INSURER
 		BLUE CROSS AND
BLUE SHIELD
 		HMO

 
Continuation of Coverage:   
(1) Following Divorce or
Separation		c. 175 § 110Ic. 176A § 8F; c. 176B § 6Bc. 176G § 5A
(2) Following Separation
from Employment		   
Employee after termination due to plant closing or partial closingc. 175 § 110D
c. 175 § 110G		c. 176A § 8D; c. 176B § 6Ac. 176G § 4A
Group member after leaving insured groupc. 175 § 110D
c. 175 § 110G		c. 176A § 8D; c. 176B § 6An/a
(3) For small employer group (with 2-19 employees): Continuation of coverage provisions similar to COBRAc. 176J § 9


 		c. 176J § 9


 		c. 176J § 9


 
(4) Disabled adult childrenc. 175 § 108 2(a)(3)c. 176A §8(d); c. 176B § 6(c)n/a

VI. Other
REGULATORY CITATIONS

 
Alternative dental coverage
option		c. 175 § 110Kn/ac. 176G § 11A
Coordination of benefits211 CMR 38.00211 CMR 38.00211 CMR 38.00
Emergency services provided to insureds for emergency medical conditions
See also Bulletin 2000-14 and M.G.L. c. 176I §§ 1 and 3(b) for insured preferred provider plans		M.G.L. c. 175 § 47UM.G.L. c. 176A § 8U and
M.G.L. c. 176B § 4U		M.G.L. c. 176G § 5
Prompt payment of claims
See also c. 176I § 2 for insured preferred provider plans		c. 175 §§ 108 and 110c. 176A § 8 See also "provider contracting"See "provider contracting"

 

1 In many cases, c.176G refers the reader to the citation listed in the commercial insurer column.
2 Mental health parity for certain biologically-based mental disorders is required for policies issued or renewed on or after January 1, 2001; Chapter 256 of the Acts of 2008 [applies to fully-insured health plans issued or renewed within or without the Commonwealth on or after July 1, 2009] amends M.G.L.c.175, §§47B and 108E; M.G.L. c.176A, §8A; M.G.L.c.176B, §4A; and M.G.L.c.176G, §§4B by adding eating disorders, post traumatic stress disorders, substance abuse disorders [including the treatment of alcoholism], and autism to the list of "biologically-based mental disorders" defined within these statutes. Chapter 256 makes no changes to the requirements for medically necessary services to be covered for the required biologically-based and non-biologically based mental health disorders.