(BOSTON 11/1/2024) — This week, the Massachusetts Senate passed two bills expanding services that must be covered by health insurers in the Commonwealth.
One requires that insurers provide coverage for the treatment of Down syndrome through speech therapy, occupational therapy, physical therapy and applied behavior analysis services. The other requires insurers provide coverage for diagnostic examinations for breast cancer.
“I am proud that the Senate took action this week to help families struggling with expensive medical bills for essential screenings and treatments,” said Senator Michael Moore (D-Millbury). “Under one of these bills, breast cancer screenings will be uniformly covered under public and private insurance in the Commonwealth, ensuring women will not receive unexpected charges for these critical routine tests. Under the other bill, Bay Staters with Down syndrome will be able to access the care, therapy, and services they need to thrive – all under their standard insurance policy. These bills represent a great advancement toward making healthcare accessible to all, and I am hopeful that both of these pieces of legislation will make it to Governor Healey’s desk.”
Requiring Coverage for Breast Cancer Screenings
H.4918, An Act relative to medically necessary breast screenings and exams for equity and early detection, requires health insurance providers, including the Group Insurance Commission (GIC) and MassHealth, to provide coverage for diagnostic examinations for breast cancer, digital breast tomosynthesis screening, and medically necessary and appropriate screening with breast magnetic resonance imaging. Although access to routine preventive screening mammograms is currently covered under the Affordable Care Act, this legislation would go further and require coverage for certain screenings and exams currently not uniformly covered by law.
According to the Massachusetts Department of Public Health (DP), breast cancer was the leading cancer among Massachusetts females between 2016 and 2020, accounting for over 30 per cent of all new cancer diagnoses in the state, afflicting more than 30,000 individuals. 4,010 Massachusetts residents lost their lives to breast cancer in that time period.
According to the American Cancer Society, when breast cancer is localized and detected early, the five year relative survival rate is 99%.
“I am grateful to see this legislation, which I have worked on for nearly a decade, move forward,” said Senate Assistant Majority Leader Joan B. Lovely (D-Salem). “Early detection of breast cancer saves lives. This legislation makes those diagnostic exams used for early detection accessible and affordable, giving women the vital resources needed to catch breast cancer in its earliest stages. With this bill we are bolstering the Commonwealth’s commitment to providing higher quality, more equitable, and more accessible healthcare for women.”
“We know that in the fight against cancer, early detection is absolutely vital for the long-term success of the patients,” said Senate Majority Whip Michael F. Rush (D-Boston). “We also know that for one out of every ten women, initial mammogram screenings are not sufficient to detect possible indicators of breast cancer. This legislation passed by the Senate today ensures that all women in the Commonwealth have access to the digital breast tomosynthesis and MRI screening they need to catch cancer early without facing financial barriers. I’m grateful to Senator Lovely and House Chair James Murphy for their championship on this issue, and to my colleagues in the Senate, particularly President Spilka and Chairman Rodrigues, for their unending support for women’s issues and the fight against breast cancer.”
A previous version of this bill having passed the House of Representatives, the two branches will now reconcile the differences between the bills before sending it to the Governor’s desk.
Requiring Certain Coverage for Down Syndrome Treatment
S.617, An Act relative to applied behavioral analysis therapy, requires health insurance providers to provide coverage for the treatment of Down syndrome through speech therapy, occupational therapy, physical therapy and applied behavior analysis services.
According to UMass Memorial Health, approximately 5,000 people in Massachusetts live with Down syndrome.
According to studies performed by the American Speech-Language-Hearing Association, speech therapy intervention improved decoding skills for word reading and had a positive impact on articulation in children with Down syndrome.
“Every child deserves a fair shot at learning, growing, and thriving in their community—and that includes children with Down syndrome,” said Senate Assistant Majority Whip Julian Cyr (D-Provincetown). “Applied Behavioral Analysis therapy has proven transformative for so many; yet too often, access to this essential support is out of reach for those who need it most. By ensuring insurance coverage for at-home ABA therapy, this legislation will make a powerful difference for families across the Commonwealth, lifting a burden that has existed for too long. It’s about time we make this gold-standard care accessible to all, so every child has the chance to realize their fullest potential.”
Having been passed by the Senate, the bill now goes to the House of Representatives for consideration.
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