BULLETIN 2012-03


Commercial Health Insurers, Blue Cross and Blue Shield of Massachusetts, Inc., and

Health Maintenance Organizations Offering or Renewing Insured Health Products in Massachusetts

FROM:Joseph G. Murphy, Commissioner of Insurance
DATE:May 2, 2012
RE:Comprehensive Cancer Centers, Pediatric Hospitals and Pediatric Specialty Units Impacted by Chapter 61 of the Acts of 2012

The Division of Insurance (“Division”) issues this Bulletin to instruct commercial health insurers, Blue Cross and Blue Shield of Massachusetts, Inc. and Health Maintenance Organizations (“Carriers”) regarding compliance with the provisions of Chapter 61 of the Acts of 2012 (“Chapter 61”), which became effective on May 1, 2012.

Chapter 61 amends M.G.L. c. 176J, which, together with regulation 211 CMR 153.00, requires Carriers with limited, regional and tiered network health plans in the small group/individual health insurance market to continue benefits under certain circumstances for a member who is a patient in an active course of medical treatment for a serious disease in a comprehensive cancer center, pediatric hospital, or pediatric specialty unit. The definitions of “comprehensive cancer center”, “pediatric hospital” and “pediatric specialty unit” appearing in 211 CMR 153.02 have the same meaning as those terms are defined in M.G.L. c. 118G, §1, but are limited therein to only those entities in Massachusetts.

The Division has consulted with the Department of Public Health and the Division of Health Care Finance and Policy relative to which facilities are comprehensive cancer centers, pediatric hospitals, or pediatric specialty units pursuant to the definitions in M.G.L. c. 118G § 1. These facilities have been determined to be the following:

Comprehensive Cancer Center:

Dana Farber Cancer Institute

Pediatric Hospital:

Children’s Hospital Boston

Shriners Hospitals for Children - Boston

Shriners Hospitals for Children - Springfield

Pediatric Specialty Unit:

Floating Hospital for Children at Tufts Medical Center

Nashoba Valley Medical Center

Massachusetts Eye and Ear Infirmary

If you have any question about this Bulletin, please contact Kevin P. Beagan, Deputy Commissioner of the Health Care Access Bureau at (617) 521-7323 or kevin.beagan@state.ma.us.