Bill
H 4335
Mandates state group plans and regulated insurers cover medically necessary cognitive rehabilitation after acquired brain injury, with parity and no lifetime or unreasonable annual
Status & procedural history
- Bill number: H.4335
- Introduced: April 9, 2025; printed/reported July 31, 2025
- Committees: Referred to the Committee on Medical, Military, Public and Municipal Affairs (initially); reported from the Committee on Financial Services (July 31, 2025) and referred to the Committee on Health Care Financing.
- Sponsor/committee report language appears in bill text (committee on Financial Services recommended passage).
Purpose
- Require state group health coverage and regulated health insurers to cover medically necessary services for persons who sustain an acquired brain injury (ABI), and to define covered services, provider qualifications, and certain utilization-review and parity requirements.
Key definitions (selected)
- Acquired brain injury (ABI): any brain injury occurring after birth (examples listed: stroke, traumatic brain injury, tumors, infections, metabolic/endocrine causes, toxins, hypoxia).
- Cognitive rehabilitation therapy (CRT), cognitive communication therapy, neurocognitive/neurobehavioral/neurophysiological/neuropsychological therapies and testing, neurofeedback therapy, functional rehabilitation and remediation, community reintegration services, post‑acute residential treatment — each are defined in the bill.
Major provisions and changes
- Coverage mandate for state group plans: Chapter 32A (Group Insurance Commission) plans for active and retired Commonwealth employees must cover medically necessary treatment related to ABI. Covered services explicitly include CRT, cognitive communication therapy, neurocognitive therapy, neurobehavioral/neurophysiological/neuropsychological/psychophysiological testing and treatment, neurofeedback, functional rehabilitation, community reintegration, post‑acute residential treatment, inpatient, outpatient/day treatment, and home/community‑based treatment.
- Insurance code amendment: The bill inserts a parallel section (Section 47AAA) into Chapter 175 (state insurance laws), applying the same definitions and (based on the text pattern) similar coverage requirements to regulated health benefit plans/issuers (text truncated in the copy but structure mirrors the Chapter 32A section).
- Limits and parity:
- Prohibits lifetime limits and “unreasonable” annual limits on days or sessions of the enumerated services.
- Benefits may not be subject to greater deductibles, coinsurance, copays, or out‑of‑pocket limits than other benefits provided by the plan/commission.
- A plan may not deny coverage solely because services are delivered at a non‑hospital facility; any limitations must be separately stated by the commission.
- Preauthorization and utilization review: The Commissioner of Insurance must require plan issuers to provide adequate training for personnel who authorize or review utilization of these services — in consultation with the Brain Injury Association of Massachusetts.
- Provider qualifications: Individual practitioners and facilities must possess customary licenses, accreditation, training and experience for acute and post‑acute brain injury rehabilitation services; bill cites regulation by the Executive Office of Health & Human Services and CARF “Medical Rehabilitation with a Brain Injury Specialty Program” accreditation as examples.
Who is affected
- Directly affected: active and retired Commonwealth employees insured under the Group Insurance Commission; health benefit plan issuers and their enrollees regulated under Massachusetts insurance law (Chapter 175); providers delivering ABI rehabilitation services.
- Stakeholders: persons with ABI and families, rehabilitation providers, state insurers, the Brain Injury Association of Massachusetts, and potentially employers/self‑funded ERISA plans (not addressed in the bill; federal preemption may limit application to some employer plans).
Potential impacts and considerations
- Access: Expands and clarifies coverage for a broad set of rehabilitation services intended to support recovery and community reintegration after ABI; requires parity of cost‑sharing and bans lifetime/unreasonable annual caps.
- Cost: Mandated coverage expansion may increase insurer and state plan expenditures; the bill does not include specific fiscal offsets or appropriations.
- Provider standards: Accreditation and credential requirements aim to assure quality but could influence network availability and provider participation.
- Implementation: Requires insurer training and regulatory oversight; details of “unreasonable” limits and how benefits are “separately stated” will affect implementation and appeals.
Note
- The available bill text includes a truncated duplicate indicating similar language will be placed into Chapter 175; the full Chapter 175 insert should be consulted to confirm exact scope and any differences. Federal ERISA rules may limit the bill’s reach with respect to self‑funded employer plans.
Compiled from official sources — confirm details with the bill’s official record.
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