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SENATE DOCKET, NO. 1297 FILED ON: 1/19/2023
SENATE . . . . . . . . . . . . . . No. 643
The Commonwealth of Massachusetts
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PRESENTED BY:
Barry R. Finegold
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To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
Court assembled:
The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:
An Act relative to uncollected co-pays, co-insurance and deductibles.
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PETITION OF:
NAME:DISTRICT/ADDRESS :Barry R. FinegoldSecond Essex and Middlesex 1 of 5
SENATE DOCKET, NO. 1297 FILED ON: 1/19/2023
SENATE . . . . . . . . . . . . . . No. 643
By Mr. Finegold, a petition (accompanied by bill, Senate, No. 643) of Barry R. Finegold for
legislation to require certain healthcare carriers to share accountability with providers for
uncollectible patient obligations after insurance. Financial Services.
[SIMILAR MATTER FILED IN PREVIOUS SESSION
SEE SENATE, NO. 670 OF 2021-2022.]
The Commonwealth of Massachusetts
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In the One Hundred and Ninety-Third General Court
(2023-2024)
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An Act relative to uncollected co-pays, co-insurance and deductibles.
Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
of the same, as follows:
1 SECTION 1. Chapter 176O of the General Laws is hereby amended by inserting after
2section 7 the following new section:-
3 Section 7A. Equitable Funding for Health Care Provider Bad Debt
4 (a) Notwithstanding any other provision of the general laws to the contrary, a carrier shall
5reimburse a health care provider no less than sixty-five percent (65%) of each co-payment, co-
6insurance and/or deductible amount due under an insured’s health benefit plan which are unpaid
7after reasonable collection efforts have been made by the health care provider pursuant to
8subsection (c) of this section. 2 of 5
9 (b) As used in this section, the following words shall have the following meanings: a “co-
10payment” is defined as a fixed dollar amount that is owed by an insured as required under a
11health benefit plan for health care services provided and billed by a healthcare provider. A “co-
12insurance” is defined as a percentage of the allowed amount, after a co-payment, if any, that an
13insured must pay for covered services received under a health benefit plan for health care
14services provided and billed by a healthcare provider. A “deductible” is defined as a specific
15dollar amount that an insured must pay for covered services before the carrier’s health benefit
16plan becomes obligated to pay for covered health care services provided and billed by a
17healthcare provider; provided, however, that “deductible” does not include any portion of
18premiums paid by an insured.
19 (c) Reimbursement for uncollected co-payment, co-insurance and/or deductible amounts
20due (each a “claim”) under an insured’s health benefit plan for covered services rendered shall be
21deemed an uncollectible bad debt, and a health care provider may submit a request for
22reimbursement to the carrier under the following conditions:
23 (1) The claim must be derived from the wholly or partially uncollected co-payment, co-
24insurance and/or deductible amounts under an insured’s health benefit plan;
25 (2) The reimbursement requested by the health care provider should be for a claim where
26the co-payment, co-insurance, or deductible amount was at least two hundred and fifty dollars
27($250), and each claim reflected a unique covered service under the health benefit plan per
28insured;
29 (3) The health care provider must have made reasonable collection efforts for each claim
30filed for reimbursement under this section, such efforts including documentation that the claim 3 of 5
31has remained partially or fully unpaid and is not subject to an on-going payment plan for more
32than one hundred twenty (120) days from the date the first bill was mailed; provided, however,
33that such efforts may include telephone calls, collection letters, or any other notification method
34that constitutes a genuine and continuous effort to contact the member; and provided further, that
35such documentation shall include the date and method of contact;
36 (4) On or before May 1 of each year, the health care provider shall submit an aggregate
37request for reimbursement representing all claims that meet the criteria under this section in the
38prior calendar year. The request for reimbursement shall include documentation of the attempt to
39collect on the claim(s), the name and identification number of the insured, the date of service, the
40unpaid co-payment, co-insurance, or deductible, the amount that was collected, if any, and the
41date and general method of contact with the insured. For the purposes of this section, an insured
42co-payment, co-insurance, and/or deductible amount due shall be determined based on the date
43that the service is rendered; provided, however, that a carrier shall not prohibit reimbursement if
44the insured is no longer covered by the plan on the date that the request is made.
45 (5) Nothing in this section shall prevent the carrier from conducting an audit of the
46request for reimbursement of unpaid co-payment, co-insurance, and/or deductible amounts to
47verify that the insured was eligible for coverage at the time of service, that the service was a
48covered health benefit under the applicable health benefit plan, and to verify from the provider’s
49internal log that reasonable efforts were made to contact the insured following the criteria
50outlined in this section. The carrier must complete any such audit of the submitted report from
51the health care provider and notify the health care provider of any disputes as to the request for
52reimbursement within one hundred and twenty (120) days of receipt of the request for
53reimbursement from the health care provider. The carrier shall pay the health care provider sixty- 4 of 5
54five percent (65%) of the undisputed amounts as submitted by the health care provider in the
55request for reimbursement in accordance with this section within 120 days of receipt of such
56requests from the health care provider. Any dispute regarding contested claims shall be subject to
57a dispute resolution process applicable to the arrangement between the carrier and the health care
58provider; and
59 (6) Any amounts attributable to co-payment, co-insurance, or deductible amount
60collected by a health care provider after reimbursement has been made by the carrier pursuant to
61this section shall be recorded by the health care provider and reported as an offset to future
62submissions to such carrier.
63 (d) No carrier shall prohibit a health care provider from collecting the amount of the
64insured’s co-payment, co-insurance, and/or deductible, if any, at the time of service.
65 SECTION 2. The division shall promulgate regulations within ninety (90) days of the
66effective date of this act that are consistent with the rules developed by the Centers for Medicare
67& Medicaid Services for reasonable collection efforts required by a health care provider prior to
68submission of a request of reimbursement to a carrier. Notwithstanding the foregoing, in the
69event that the division fails to promulgate such regulations, the provisions of section 1 shall be
70self-implementing, and carriers shall make applicable payments to health care providers in
71accordance with the provisions of section 1 utilizing the same process adopted by the Centers for
72Medicare & Medicaid Services' reasonable collection efforts for bad debt, as documented in the
73most recent Medicare Provider Reimbursement Manual, CMS Pub. 15-1 and 15-2 (HIM-15) in
74effect within 90 days of the effective date of this Act. The division shall further require each
75carrier to provide the division an annual report showing the total number and amount of 5 of 5
76uncollected co-payments, co-insurances, and deductibles that are reimbursed as well as those that
77are denied. The report shall be made publicly available on the division’s website.