Massachusetts 2023-2024 Regular Session

Massachusetts Senate Bill S643 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	1 of 1
2	2	SENATE DOCKET, NO. 1297 FILED ON: 1/19/2023
3	3	SENATE . . . . . . . . . . . . . . No. 643
4	4	The Commonwealth of Massachusetts
5	5	_________________
6	6	PRESENTED BY:
7	7	Barry R. Finegold
8	8	_________________
9	9	To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
10	10	Court assembled:
11	11	The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:
12	12	An Act relative to uncollected co-pays, co-insurance and deductibles.
13	13	_______________
14	14	PETITION OF:
15	15	NAME:DISTRICT/ADDRESS :Barry R. FinegoldSecond Essex and Middlesex 1 of 5
16	16	SENATE DOCKET, NO. 1297 FILED ON: 1/19/2023
17	17	SENATE . . . . . . . . . . . . . . No. 643
18	18	By Mr. Finegold, a petition (accompanied by bill, Senate, No. 643) of Barry R. Finegold for
19	19	legislation to require certain healthcare carriers to share accountability with providers for
20	20	uncollectible patient obligations after insurance. Financial Services.
21	21	[SIMILAR MATTER FILED IN PREVIOUS SESSION
22	22	SEE SENATE, NO. 670 OF 2021-2022.]
23	23	The Commonwealth of Massachusetts
24	24	_______________
25	25	In the One Hundred and Ninety-Third General Court
26	26	(2023-2024)
27	27	_______________
28	28	An Act relative to uncollected co-pays, co-insurance and deductibles.
29	29	Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
30	30	of the same, as follows:
31	31	1 SECTION 1. Chapter 176O of the General Laws is hereby amended by inserting after
32	32	2section 7 the following new section:-
33	33	3 Section 7A. Equitable Funding for Health Care Provider Bad Debt
34	34	4 (a) Notwithstanding any other provision of the general laws to the contrary, a carrier shall
35	35	5reimburse a health care provider no less than sixty-five percent (65%) of each co-payment, co-
36	36	6insurance and/or deductible amount due under an insured’s health benefit plan which are unpaid
37	37	7after reasonable collection efforts have been made by the health care provider pursuant to
38	38	8subsection (c) of this section. 2 of 5
39	39	9 (b) As used in this section, the following words shall have the following meanings: a “co-
40	40	10payment” is defined as a fixed dollar amount that is owed by an insured as required under a
41	41	11health benefit plan for health care services provided and billed by a healthcare provider. A “co-
42	42	12insurance” is defined as a percentage of the allowed amount, after a co-payment, if any, that an
43	43	13insured must pay for covered services received under a health benefit plan for health care
44	44	14services provided and billed by a healthcare provider. A “deductible” is defined as a specific
45	45	15dollar amount that an insured must pay for covered services before the carrier’s health benefit
46	46	16plan becomes obligated to pay for covered health care services provided and billed by a
47	47	17healthcare provider; provided, however, that “deductible” does not include any portion of
48	48	18premiums paid by an insured.
49	49	19 (c) Reimbursement for uncollected co-payment, co-insurance and/or deductible amounts
50	50	20due (each a “claim”) under an insured’s health benefit plan for covered services rendered shall be
51	51	21deemed an uncollectible bad debt, and a health care provider may submit a request for
52	52	22reimbursement to the carrier under the following conditions:
53	53	23 (1) The claim must be derived from the wholly or partially uncollected co-payment, co-
54	54	24insurance and/or deductible amounts under an insured’s health benefit plan;
55	55	25 (2) The reimbursement requested by the health care provider should be for a claim where
56	56	26the co-payment, co-insurance, or deductible amount was at least two hundred and fifty dollars
57	57	27($250), and each claim reflected a unique covered service under the health benefit plan per
58	58	28insured;
59	59	29 (3) The health care provider must have made reasonable collection efforts for each claim
60	60	30filed for reimbursement under this section, such efforts including documentation that the claim 3 of 5
61	61	31has remained partially or fully unpaid and is not subject to an on-going payment plan for more
62	62	32than one hundred twenty (120) days from the date the first bill was mailed; provided, however,
63	63	33that such efforts may include telephone calls, collection letters, or any other notification method
64	64	34that constitutes a genuine and continuous effort to contact the member; and provided further, that
65	65	35such documentation shall include the date and method of contact;
66	66	36 (4) On or before May 1 of each year, the health care provider shall submit an aggregate
67	67	37request for reimbursement representing all claims that meet the criteria under this section in the
68	68	38prior calendar year. The request for reimbursement shall include documentation of the attempt to
69	69	39collect on the claim(s), the name and identification number of the insured, the date of service, the
70	70	40unpaid co-payment, co-insurance, or deductible, the amount that was collected, if any, and the
71	71	41date and general method of contact with the insured. For the purposes of this section, an insured
72	72	42co-payment, co-insurance, and/or deductible amount due shall be determined based on the date
73	73	43that the service is rendered; provided, however, that a carrier shall not prohibit reimbursement if
74	74	44the insured is no longer covered by the plan on the date that the request is made.
75	75	45 (5) Nothing in this section shall prevent the carrier from conducting an audit of the
76	76	46request for reimbursement of unpaid co-payment, co-insurance, and/or deductible amounts to
77	77	47verify that the insured was eligible for coverage at the time of service, that the service was a
78	78	48covered health benefit under the applicable health benefit plan, and to verify from the provider’s
79	79	49internal log that reasonable efforts were made to contact the insured following the criteria
80	80	50outlined in this section. The carrier must complete any such audit of the submitted report from
81	81	51the health care provider and notify the health care provider of any disputes as to the request for
82	82	52reimbursement within one hundred and twenty (120) days of receipt of the request for
83	83	53reimbursement from the health care provider. The carrier shall pay the health care provider sixty- 4 of 5
84	84	54five percent (65%) of the undisputed amounts as submitted by the health care provider in the
85	85	55request for reimbursement in accordance with this section within 120 days of receipt of such
86	86	56requests from the health care provider. Any dispute regarding contested claims shall be subject to
87	87	57a dispute resolution process applicable to the arrangement between the carrier and the health care
88	88	58provider; and
89	89	59 (6) Any amounts attributable to co-payment, co-insurance, or deductible amount
90	90	60collected by a health care provider after reimbursement has been made by the carrier pursuant to
91	91	61this section shall be recorded by the health care provider and reported as an offset to future
92	92	62submissions to such carrier.
93	93	63 (d) No carrier shall prohibit a health care provider from collecting the amount of the
94	94	64insured’s co-payment, co-insurance, and/or deductible, if any, at the time of service.
95	95	65 SECTION 2. The division shall promulgate regulations within ninety (90) days of the
96	96	66effective date of this act that are consistent with the rules developed by the Centers for Medicare
97	97	67& Medicaid Services for reasonable collection efforts required by a health care provider prior to
98	98	68submission of a request of reimbursement to a carrier. Notwithstanding the foregoing, in the
99	99	69event that the division fails to promulgate such regulations, the provisions of section 1 shall be
100	100	70self-implementing, and carriers shall make applicable payments to health care providers in
101	101	71accordance with the provisions of section 1 utilizing the same process adopted by the Centers for
102	102	72Medicare & Medicaid Services' reasonable collection efforts for bad debt, as documented in the
103	103	73most recent Medicare Provider Reimbursement Manual, CMS Pub. 15-1 and 15-2 (HIM-15) in
104	104	74effect within 90 days of the effective date of this Act. The division shall further require each
105	105	75carrier to provide the division an annual report showing the total number and amount of 5 of 5
106	106	76uncollected co-payments, co-insurances, and deductibles that are reimbursed as well as those that
107	107	77are denied. The report shall be made publicly available on the division’s website.