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H 4935

An Act to strengthen the control of contagious and infectious diseases in the Commonwealth

194th Legislature (2025-2026) Introduced by Mindy Domb and 1 co-sponsor

Designate contagious diseases as heightened public health importance so insurers must cover prevention, diagnosis, and treatment with no cost sharing or utilization review.

Reporting date extended to Thursday, December 31, 2026
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Bill Summary · H 4935

Summary of Bill H. 4935 (194th Legislature, Massachusetts)

Purpose and intent

  • The bill, titled An Act to strengthen the control of contagious and infectious diseases in the Commonwealth, aims to reduce or eliminate patient cost sharing and utilization review for health care services related to contagious or infectious diseases designated as heightened public health importance.
  • It designates certain contagious or infectious diseases as heightened public health importance and requires insurers, public programs, and health plans to cover related prevention, diagnosis, and treatment services without cost sharing or utilization review.

Key provisions and changes

  • Designation of heightened public health importance (Chapter 111, new Section 7A):

    • The Public Health Commissioner can designate contagious/infectious diseases as heightened public health importance.
    • After designation, the commissioner must notify relevant state bodies and ensure enforcement coordination across programs.
    • A publicly accessible list of designated diseases must be maintained and reviewed annually; removals trigger notices.
    • Effective date: cost-sharing and utilization-review prohibitions take effect 30 days after designation.

  • Cost sharing and utilization review prohibitions (applies to multiple coverage types):

    • Health plans and programs subject to listed chapters must cover without cost sharing or utilization review any health care service for prevention, diagnosis, or treatment of the designated diseases.
    • Cost sharing (copays, coinsurance, deductibles) and utilization review restrictions do not apply if the plan is governed by the Federal Internal Revenue Code and such prohibition would cause loss of tax-exempt status.

  • Coverage universe by program/category:

    • Chapter 32A (group health insurance, and active/retired Commonwealth employees): 17AA requires no cost sharing or utilization review for designated diseases (with tax-exemption caveat).
    • Chapter 118E (Massachusetts medical assistance/MA programs): 10AA requires no cost sharing or utilization review.
    • Chapter 175 (individual and group accident and sickness insurance): 47AAA requires no cost sharing or utilization review.
    • Chapter 176A (hospital service plans): 8EEE requires no cost sharing or utilization review.
    • Chapter 176B (subscription certificates under medical service agreements): 4EEE requires no cost sharing or utilization review.
    • Chapter 176G (health maintenance organizations): 4WW requires no cost sharing or utilization review.
    • Chapter 176I (preferred provider contracts): Section 14 requires no cost sharing or utilization review.

Who is affected

  • Insurers, health plans, and medical benefit/program providers operating in Massachusetts, including:
    • State group health insurance for active/retired employees
    • Medicaid/MASS health programs
    • Individual and group health insurance policies
    • Hospital service organizations, HMOs, and preferred provider organizations
  • Consumers/patients seeking care for designated diseases will face no cost-sharing or utilization-review barriers for eligible services, subject to tax-status exceptions.

Procedural and timeline aspects

  • Designation process and designation list management (by the Commissioner of Public Health) with annual review.
  • Upon designation, enforcement coordination occurs across several state entities (secretary of health and human services, group insurance commission, division of insurance) and notification to insurers and providers.
  • The cost-sharing and utilization-review prohibitions become effective 30 days after designation.

Practical impact

  • If a contagious or infectious disease is designated, patients would generally pay no out-of-pocket costs (e.g., copays, coinsurance, deductibles) for prevention, diagnosis, or treatment services related to that disease, across many major types of health coverage.
  • Plans must balance prohibitions with federal tax-exemption rules to avoid jeopardizing status.

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

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