MA H1165

Requires all health insurance plans in Massachusetts to cover the cost of enteral formulas (specialized nutrition delivered orally or via tube feeding) for home use when prescribed by a physician

Coverage applies to patients who are or will become malnourished, or who have disorders that if untreated would cause chronic physical or intellectual disability or death

Covered conditions include inherited diseases of amino acid or organic acid metabolism, eosinophilic gastrointestinal disorders, Crohn's Disease, gastroesophageal reflux with failure to thrive, chronic intestinal pseudo-obstruction, and multiple severe food allergies

Applies to Group Insurance Commission plans for state employees, individual and group accident/sickness policies, hospital service plans, medical service agreements, and HMO contracts

Distinguishes medically necessary enteral formulas prescribed for specific diseases from elective nutritional supplements, which would not be covered