WeVote
Log In

Bill

Bill

S 3069

An Act ensuring access to healthcare and medically necessary food for children

194th Legislature (2025-2026)

Expands and standardizes coverage of medically necessary food for children under 18 with food protein allergies, with no higher out-of-pocket costs.

Referred to the committee on Senate Ways and Means
0
WeVote Research Nonpartisan
Bill Summary · S 3069

Overview

S 3069, an Act ensuring access to healthcare and medically necessary food for children, proposes to expand and standardize coverage across multiple Massachusetts health care and insurance frameworks for medically necessary food products for individuals under 18 with food protein allergies. The bill definesMedically Necessary Food and requires certain payers to cover such products without increasing patient cost sharing. It also prohibits certain administratively burdensome requirements (like referrals) for this coverage. The measure includes implementation deadlines and a regulatory rulemaking step.

Purpose and intent

  • Ensure access to medically necessary food for children with food protein allergies and related eosinophilic disorders.
  • Guarantee coverage for medically necessary food by health plans, hospital service plans, managed care plans, and preferred provider contracts, without raising out-of-pocket costs for beneficiaries.
  • Remove barriers such as referral requirements and misclassification of coverage (e.g., treating medically necessary food as durable medical equipment).

Key provisions and changes

  • Definition of Medically Necessary Food (applies to under-18s):
    • Includes low protein modified foods, amino acid preparations, modified fats, or nutritional formulas, whether prescription-based or not.
    • Conditions for coverage include physician or qualified professional prescription/ recommendation, and use for dietary management of food protein allergies or related therapeutic needs.
    • Excludes:
    • Foods intended for general disease risk reduction or weight loss.
    • Gluten-free foods used for celiac disease/non-celiac gluten sensitivity management.
    • Foods marketed for diabetes management.
    • Coverage parameters emphasize medical supervision and dietary management, including home use in appropriate cases.
  • Coverage requirements (applicable to multiple insurance contexts):
    • Carriers must cover medically necessary food from network suppliers for persons under 18 with a food protein allergy.
    • Patient cost sharing cannot be increased to meet compliance.
    • No requirement for referral from primary care for specialty care related to medically necessary food (immunologists, etc.).
    • Do not categorize medically necessary food coverage as durable medical equipment.
  • Applicability across multiple chapters:
    • Chapter 32A (Massachusetts Group Health Insurance)
    • Chapter 175 (Insurance, including plans and certificates of insurance)
    • Chapter 176A (Hospital service plans)
    • Chapter 176B (Medical service agreements)
    • Chapter 176G (Health maintenance organizations)
    • Chapter 176I (Preferred provider organization contexts)
    • For each, similar definitions and coverage requirements mirror the general framework above.
  • Rulemaking:
    • Within 6 months after enactment, the Division of Insurance must promulgate necessary rules and regulations to implement and enforce the act’s provisions.

Who would be affected

  • Insured individuals under 18 diagnosed with food protein allergies (including related eosinophilic disorders) seeking medically necessary food.
  • Health insurers, hospital service plans, medical service agreements, HMOs, and related carriers operating under the cited General Laws.
  • Healthcare providers who prescribe or order medically necessary food and pharmacists involved in dispensing such products.
  • Division of Insurance, which would regulate and implement the new requirements through rules.

Procedural and timeline aspects

  • Effective scope: Provisions apply to policies, plans, and contracts issued, delivered, or renewed within Massachusetts, with a consistent coverage mandate for medically necessary foods under 18.
  • Rulemaking deadline: Division of Insurance must issue implementing regulations within 6 months of enactment.
  • Legislative status: Reported favorably by the Senate Health Care Financing Committee and amended with a new draft (Senate 3069) after referral from Senate No. 691; estimated cost greater than $100,000.

Summary of potential impact

  • Increases access to medically necessary food for low-protein or specialized nutrition needs in children, reducing financial barriers.
  • Standardizes coverage across major types of health coverage in the Commonwealth, promoting consistency for families.
  • Reduces administrative hurdles (no referrals where not required, no reclassification as equipment) that can delay or complicate access.
  • Introduces a regulatory framework to ensure enforcement and uniform application across plans.

If you’d like, I can tailor this into a one-page briefing with a plain-language summary for stakeholders (families, providers, insurers) or provide a comparison to current Massachusetts practice.

Compiled from official sources — confirm details with the bill’s official record.

Sign in to ask a question.