Chapter 176G

Section 4J. (a) For the purposes of this section, the following words shall have the following meanings: ''Prosthesis'', an artificial appliance used to replace a lost natural structure; provided, however, that prosthesis shall include, but not be limited to, artificial arms, leg…

Section 4JJ. (a) For the purposes of this section, ''psychiatric collaborative care model'' shall mean the evidence-based, integrated behavioral health service delivery method in which a primary care team consisting of a primary care provider and a care manager provides structure…

Section 4K. A health maintenance contract shall provide coverage for a newborn hearing screening test to be performed before the newborn infant is discharged from the hospital or birthing center to the care of the parent or guardian, pursuant to regulations of the department of p…

Section 4KK. (a) For the purposes of this section, the following terms shall have the following meanings unless the context clearly requires otherwise: ''Community-based acute treatment'', 24–hour clinically managed mental health diversionary or step-down services for children an…

Section 4L. Any group health maintenance contract shall provide coverage for hospice services as defined in section 57D of chapter 111 during the life of the patient, to terminally ill patients with a life expectancy of six months or less; provided, however, that such services ar…

Section 4LL. An individual or group health maintenance contract that is issued or renewed within or without the commonwealth shall provide benefits on a nondiscriminatory basis for medically necessary emergency services programs, as defined in section 1 of chapter 175.

Section 4M. (a) A health maintenance contract issued or renewed within or without the commonwealth shall provide mental health benefits on a nondiscriminatory basis to residents of the commonwealth and to all members or enrollees having a principal place of employment in the comm…

Section 4MM. (a) For the purpose of this section, the following words shall have the following meanings unless the context clearly requires otherwise: ''Licensed mental health professional,'' a licensed physician who specializes in the practice of psychiatry, a licensed psycholog…

Section 4N. Any individual or group health maintenance contract that 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 reside…

Section 4NN. (a) For the purposes of this section, ''federally-defined preventive services'' shall mean: (i) evidence-based items or services that currently have a rating of ''A'' or ''B'' in the recommendations of the United States Preventive Services Task Force; (ii) immunizati…

Section 4O. (a) Any individual or group health maintenance contract that is issued, renewed or delivered within or without the commonwealth and that provides benefits for outpatient services shall provide to residents of the commonwealth and to persons having a principal place of…

Section 4OO. (a) For the purposes of this section, the following words shall have the following meaning unless the context clearly requires otherwise: ''Directly or indirectly cause impairment of fertility'', to cause circumstances where a disease or the necessary treatment for a…

Section 4P. Any individual or group health maintenance contract shall provide for the coverage of patient care services furnished pursuant to qualified clinical trials as defined in, and subject to the requirements and limitations of, section 110L of chapter 175.

Section 4PP. An individual or group health maintenance contract that is issued or renewed within or without the commonwealth shall provide coverage for postpartum depression and major depressive disorder screenings conducted pursuant to section 247 of chapter 111.

Section 4Q. Any group health maintenance contract, except contracts providing supplemental coverage to Medicare or to other government programs, delivered, issued or renewed by agreement within or without the commonwealth shall provide to a member or enrollee coverage for the cos…

Section 4QQ. (a) An individual or group health maintenance contract that is issued or renewed within or without the commonwealth shall provide coverage for the provision of medically necessary pasteurized donor human milk and donor human milk-derived products; provided, however, …

Section 4RR. Any individual or group health maintenance contract that is issued or renewed within or without the commonwealth shall provide coverage for universal postpartum home visiting services, in accordance with operational standards set by the department of public health pu…

Section 4S. (a) Individual and group health maintenance contracts shall provide coverage for prosthetic devices and repairs. If prosthetic devices are covered as a durable medical equipment benefit, coverage shall be provided under the same terms and conditions that apply to othe…

Section 4SS. (a) As used in this section, the following words shall, unless the context clearly requires otherwise, have the following meanings:— ''Cost sharing'', a deductible, coinsurance, copayment and any maximum limitation on the application of such a deductible, coinsurance…

Section 4T. A health maintenance contract, except certificates which provide stand-alone dental services, supplemental coverage to Medicare or other governmental programs, shall provide, as benefits to all individuals or to group members having a principal place of employment wit…

Section 4TT. (a) An individual or group health maintenance contract that is issued or renewed within or without the commonwealth shall provide coverage for prescribed, ordered or dispensed opioid antagonists, as defined in section 19B of chapter 94C and used in the reversal of ov…

Section 4U. No individual or group health maintenance contract shall restrict or discontinue coverage for medically necessary hypodermic syringes or needles, notwithstanding section 27 of chapter 94C. The term ''medical necessity'' shall be construed in accordance with the guidel…

Section 4UU. An individual or group health maintenance contract that is issued or renewed within or without the commonwealth shall provide coverage for the provision of services by a recovery coach licensed or otherwise authorized to practice under chapter 111J, regardless of the…

Section 4V. (a) As used in this section the following words shall, unless the context clearly requires otherwise, have the following meanings:— ''Actuary'', a person who is a member of American Academy of Actuaries and meets the academy's professional qualification standards for …

Section 4VV. (a) As used in this section, the following words shall have the following meanings unless the context clearly requires otherwise: ''Brand name drug'', a drug that is: (i) produced or distributed pursuant to an original new drug application approved under 21 U.S.C. 35…

Section 4W. A health maintenance contract issued or renewed within or without the commonwealth that covers a child under the age of 18 shall provide coverage for the cost of treating cleft lip and cleft palate for the child. The coverage shall include benefits for medical, dental…

Section 4X. Any individual or group health maintenance contract that provides coverage for cancer chemotherapy treatment shall provide coverage for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells on a basis not less favora…

Section 4Y. An individual or group health maintenance contract that is issued or renewed shall provide coverage for abuse deterrent opioid drug products listed on the formulary, compiled pursuant to subsection (b) of section 13 of chapter 17, on a basis not less favorable than no…

Section 4Z. For the purposes of this section the term ''substance abuse treatment'' shall include: early intervention services for substance use disorder treatment; a substance use disorder evaluation, as defined in section 511/2 of chapter 111; outpatient services including medi…

Section 5. (a) As used in this section, the following words shall have the following meanings:- ''Attending physician'', the emergency physician or consultant physician who actively treats the emergency medical condition of a member at an emergency facility. ''Emergency medical c…

Section 5A. (a) In the event of the granting of a judgment absolute of divorce or of separate support to which a member of a group health maintenance contract is a party, the person who was the spouse of said member prior to the issuance of such judgment shall be and remain eligi…

Section 6. A health maintenance organization may enter into contractual arrangements with any other person or company for the provision, to the health maintenance organization, of health services, insurance, reinsurance and administrative, marketing, underwriting or other service…

Section 6A. A health maintenance organization may only enter into a group health maintenance contract with an employer if the group health maintenance contract is offered by that employer to all full-time employees who live in the commonwealth; provided, however, the employer sha…

Section 6B. (a) For the purposes of this section, the following words shall have the following meanings unless the context clearly requires otherwise: ''Behavioral health services'', as defined in section 1 of chapter 175, or ''services''. ''Provider'', (i) a mental health clinic…

Section 8. Public dissemination of any promotional material, evidence of coverage, health maintenance contract or any other statement with respect to a health maintenance organization, which is untrue, deceptive or misleading, shall constitute an unfair and deceptive practice und…

Section 9. The provisions of sections 1 to 14K, inclusive, and sections 48 to 68, inclusive, of chapter ninety-three, and chapter ninety-three A shall be applicable to the ownership, organization, operation and health care services provided by a health maintenance organization as…