Section 33: Federally-defined preventive services
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/ma/part-i/title-iv/chapter-32a/33A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Section 33.
(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)immunizations with routine use in children, adolescents and adults that currently have a recommendation from the Advisory Committee on Immunization Practices of the federal Centers for Disease Control and Prevention with respect to the individual involved;
(iii)with respect to infants, children and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the federal Health Resources and Services Administration; and
(iv)with respect to women, such additional preventive care and screenings not described in clause
(i)as provided for in comprehensive guidelines supported by the federal Health Resources and Services Administration; provided, however, that ''federally-defined preventive services'' shall include all other preventive services not subject to cost-sharing, as required by established federal regulatory and sub-regulatory guidance issued on or before July 1, 2023.
(b)The commission shall provide to an active or retired employee of the commonwealth who is insured under the group insurance commission coverage for federally-defined preventive services.
(c)(1) Coverage provided pursuant to this section shall not be subject to any cost-sharing, including, but not limited to, co-payments, co-insurance or any deductible, as required by established federal regulatory and sub-regulatory guidance issued on or before July 1, 2023.
(2)Benefits for an enrollee pursuant to this section shall be the same for the enrollee's covered spouse and covered dependents.
(d)Nothing in this section shall prohibit:
(i)coverage for items and services in addition to those recommended by the United States Preventive Services Task Force, the Advisory Committee on Immunization Practices of the federal Centers for Disease Control and Prevention or the federal Health Resources and Services Administration; or
(ii)denying coverage for items or services not recommended by the United States Preventive Services Task Force, the Advisory Committee on Immunization Practices of the federal Centers for Disease Control and Prevention or the federal Health Resources and Services Administration.
(e)If a recommendation pursuant to subsection
(a)is changed during a plan year, a carrier shall not be required to make changes to the health plan during the plan year.