WeVote
Log In

Bill

Bill

SD 3071

An Act providing insurance coverage for the medically necessary treatment of port-wine stains

194th Legislature (2025-2026) Introduced by Patrick O'Connor

Requires insurance coverage for medically necessary early treatments of port-wine stains in individuals 18 or younger, not cosmetic-only, with CHIA review.

House concurred
0
WeVote Research Nonpartisan
Bill Summary · SD 3071

Summary: SD 3071 — An Act providing insurance coverage for the medically necessary treatment of port-wine stains

Purpose and intent

  • Establish a mandated health benefit to require insurance coverage for medically necessary treatment of port-wine stains (PWS) in individuals 18 years of age or younger.
  • Focus on treatments that prevent or address functional impairments, medical complications, or significant psychosocial distress, rather than cosmetic-only procedures.

Key provisions

Definitions

  • Port-wine stains (PWS): Capillary malformations diagnosed as nevus flammeus, Sturge-Weber syndrome, or Klippel-Trénaunay syndrome.
  • Medically necessary treatment: Medical interventions aimed at preventing or addressing vision, oral function, physical mobility impairments, inflammation, bleeding, infection, lesion hypertrophy, or substantial psychosocial distress (especially in pediatric patients).
  • Early intervention treatment: Includes topical, intralesional, or systemic therapies; FDA-approved laser treatments; surgery or other procedures to treat or prevent health complications related to PWS.

Coverage requirements (Section 1)

  • All applicable insurance products and plans (including:
    • Individual and group accident and sickness insurance plans (Chapter 175),
    • Medical service agreements (Chapter 176B),
    • Group Health Maintenance Organization plans (Chapter 176G),
    • Group Insurance Commission offerings (Chapter 32A)) shall provide coverage for medically necessary early intervention treatments for PWS in individuals 18 or younger.
  • Cosmetic-only treatment is not covered unless it also meets the medically necessary criteria defined in subsection (a).
  • No policy may impose deductibles, coinsurance, or coverage limits on PWS treatments that are more restrictive than those for other medically necessary services.

Effective date (Section 2)

  • The act applies to contracts that take effect or are renewed on or after January 1, 2026.

Oversight, analysis, and reporting (Section 3)

  • The Center for Health Information and Analysis (CHIA) shall conduct a review of the mandated coverage proposal for medically necessary treatment and early intervention of PWS in individuals 18 and under.
  • The review will consider preventable/addressable functional impairments, medical complications, and psychosocial distress, and exclude treatments solely for cosmetic purposes unless medically necessary.
  • CHIA must evaluate the impact on all applicable health plans and Medicaid managed care arrangements, including related insurers and administrative entities.
  • CHIA must file its review with the clerks of the House and Senate and relevant committees no later than January 1, 2026.

Affected parties

  • Individuals under 18 with PWS and their families.
  • Private insurers, HMOs, and the Group Insurance Commission offering plans in Massachusetts.
  • Medicaid managed care organizations and related health care contractors.

Legislative status and timeline

  • Introduced: July 17, 2025 (Senate Docket No. 3071; Senate No. 2599).
  • House concurred: September 8, 2025.
  • Additional procedural actions noted: Rules suspended and referral to the Financial Services Committee in August 2025; initial concurrent referral on July 17, 2025.

Impact at a glance

  • Expands insurance coverage to include medically necessary treatments for PWS in minors, reducing financial barriers to early intervention.
  • Requires alignment of cosmetic and medical criteria to avoid coverage gaps.
  • Introduces a formal, data-driven review by CHIA to assess broader system impacts before or around the date of applicability.

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

Sign in to ask a question.