Breast cancer accounts for 30 per cent of new cancer diagnoses, approximately 5,000 residents live with Down syndrome
(BOSTON—10/29/2024) This week the Massachusetts Senate passed two bills expanding services that must be covered by health insurers in the state.
One requires that insurers provide coverage for the treatment of Down syndrome through speech therapy, occupational therapy, physical therapy and applied behavior analysis services. The other requires insurers provide coverage for diagnostic examinations for breast cancer.
“I firmly believe that insurance coverage should never be a barrier to seeking and receiving comprehensive and evidence-based medical treatment,” said Senator Cindy F. Friedman (D-Arlington), Senate Chair of the Joint Committee on Health Care Financing. “One bill passed by the Senate today requires insurance coverage for therapies to treat individuals with a singular diagnosis of Down syndrome, helping to reduce financial stressors for families and ensure these individuals receive necessary interventions to help them thrive. The other bill passed by the Senate covers breast cancer screenings and diagnostic examinations, removing the financial barriers that could otherwise prevent early detection and treatment of beatable cases of breast cancer. The Massachusetts Senate will continue to work to address challenges to equitable health care access to ensure we can improve the lives of those who stand to benefit the most from these life-changing treatments.”
Requiring Coverage for Breast Cancer Screenings
H.4918, An Act relative to medically necessary breast screenings and exams for equity and early detection, requires health insurance providers, including the Group Insurance Commission (GIC) and MassHealth, to provide coverage for diagnostic examinations for breast cancer, digital breast tomosynthesis screening, and medically necessary and appropriate screening with breast magnetic resonance imaging. Although access to routine preventive screening mammograms is currently covered under the Affordable Care Act, this legislation would go further and require coverage for certain screenings and exams currently not uniformly covered by law.
According to the Massachusetts Department of Public Health (DP), breast cancer was the leading cancer among Massachusetts females between 2016 and 2020, accounting for over 30 per cent of all new cancer diagnoses in the state, afflicting more than 30,000 individuals. 4,010 Massachusetts residents lost their lives to breast cancer in that time period.
According to the American Cancer Society, when breast cancer is localized and detected early, the five year relative survival rate is 99%.
A previous version of this bill having passed the House of Representatives, the two branches will now reconcile the differences between the bills before sending it to the Governor’s desk.
Requiring Certain Coverage for Down Syndrome Treatment
S.617, An Act relative to applied behavioral analysis therapy, requires health insurance providers to provide coverage
for the treatment of Down syndrome through speech therapy, occupational therapy, physical therapy and applied behavior analysis services.
According to UMass Memorial Health, approximately 5,000 people in Massachusetts live with Down syndrome.
According to studies performed by the American Speech-Language-Hearing Association, speech therapy intervention improved decoding skills for word reading and had a positive impact on articulation in children with Down syndrome.
Having been passed by the Senate, the bill now goes to the House of Representatives for consideration.
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