Massachusetts 2023-2024 Regular Session

Massachusetts Senate Bill S721 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. 890 FILED ON: 1/18/2023
3	3	SENATE . . . . . . . . . . . . . . No. 721
4	4	The Commonwealth of Massachusetts
5	5	_________________
6	6	PRESENTED BY:
7	7	John C. Velis
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 unilateral contract changes.
13	13	_______________
14	14	PETITION OF:
15	15	NAME:DISTRICT/ADDRESS :John C. VelisHampden and Hampshire 1 of 4
16	16	SENATE DOCKET, NO. 890 FILED ON: 1/18/2023
17	17	SENATE . . . . . . . . . . . . . . No. 721
18	18	By Mr. Velis, a petition (accompanied by bill, Senate, No. 721) of John C. Velis for legislation
19	19	relative to unilateral contract changes. Financial Services.
20	20	[SIMILAR MATTER FILED IN PREVIOUS SESSION
21	21	SEE SENATE, NO. 733 OF 2021-2022.]
22	22	The Commonwealth of Massachusetts
23	23	_______________
24	24	In the One Hundred and Ninety-Third General Court
25	25	(2023-2024)
26	26	_______________
27	27	An Act relative to unilateral contract changes.
28	28	Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
29	29	of the same, as follows:
30	30	1 SECTION 1. Section 13F of chapter 118E of the General Laws, as appearing in the 2022
31	31	2Official Edition, is hereby amended by inserting at the end the following new paragraph:-
32	32	3 The division shall not make a contract with a health care provider which includes a
33	33	4provision permitting termination without cause. The division shall provide a written statement to
34	34	5a provider of the reason or reasons for such provider's involuntary disenrollment. The division
35	35	6shall not make a contract with a health care provider which includes a provision permitting the
36	36	7division to make a unilateral change to any material term or condition of such contract,
37	37	8including, but not limited to, changes to underlying fee schedules, payment terms, carrier
38	38	9policies or procedures, definitions of covered services or covered sites of services, policies
39	39	10associated with utilization review, quality management and improvement, credentialing or 2 of 4
40	40	11covered preventive health services, other than a change expressly required by law, unless the
41	41	12effective date of such unilateral change is after the end of the then-current term of such contract,
42	42	13and notice of such change was provided, in writing, to the health care provider more than 90
43	43	14days before the date by which the health care provider must provide notice of termination or non-
44	44	15renewal to the division under such contract. Nothing herein shall prohibit the division and a
45	45	16health care provider from entering into a mutually-agreeable amendment to such contract.
46	46	17 SECTION 2. Section 15 of chapter 176O of the General Laws, as appearing in the 2018
47	47	18Official Edition, is hereby amended by striking out subsection j and inserting in place thereof the
48	48	19following new subsection:-
49	49	20 (j) No carrier shall make a contract with a health care provider which includes a provision
50	50	21permitting termination without cause. A carrier shall provide a written statement to a provider of
51	51	22the reason or reasons for such provider's involuntary disenrollment. No carrier shall make a
52	52	23contract with a health care provider which includes a provision permitting the carrier to make a
53	53	24unilateral change to any material term or condition of such contract, including, but not limited to,
54	54	25changes to underlying fee schedules, payment terms, carrier policies or procedures, definitions of
55	55	26covered services or covered sites of services, policies associated with utilization review, quality
56	56	27management and improvement, credentialing or covered preventive health services, other than a
57	57	28change expressly required by law, unless the effective date of such unilateral change is after the
58	58	29end of the then-current term of such contract, and notice of such change was provided, in
59	59	30writing, to the health care provider more than 90 days before the date by which the health care
60	60	31provider must provide notice of termination or non-renewal to the carrier under such contract.
61	61	32Nothing herein shall prohibit a carrier and a health care provider from entering into a mutually-
62	62	33agreeable amendment to such contract. 3 of 4
63	63	34 SECTION 3. Section 4 of chapter 32A of the General Laws, as appearing in the 2018
64	64	35Official Edition, is hereby amended by inserting after the first paragraph the following new
65	65	36paragraph:-
66	66	37 The commission shall not purchase a policy providing health insurance benefits from an
67	67	38insurance company whose contract with a healthcare provider under said policy includes a
68	68	39provision permitting termination without cause. The commission shall not purchase a policy
69	69	40providing health insurance benefits from an insurance company whose contract with a healthcare
70	70	41provider under said policy includes a provision permitting the carrier to make a unilateral change
71	71	42to any material term or condition of such contract, including, but not limited to, changes to
72	72	43underlying fee schedules, payment terms, carrier policies or procedures, definitions of covered
73	73	44services or covered sites of services, policies associated with utilization review, quality
74	74	45management and improvement, credentialing or covered preventive health services, other than a
75	75	46change expressly required by law, unless the effective date of such unilateral change is after the
76	76	47end of the then-current term of such contract, and notice of such change was provided, in
77	77	48writing, to the health care provider more than 90 days before the date by which the health care
78	78	49provider must provide notice of termination or non-renewal to the carrier under such contract.
79	79	50Nothing herein shall prohibit an insurance company and a health care provider from entering into
80	80	51a mutually-agreeable amendment to such contract.
81	81	52 SECTION 4. Section 4A of chapter 32A of the General Laws as appearing in the 2018
82	82	53Official Edition, is hereby amended by inserting at the end of the first paragraph the following:-
83	83	54 The commission shall not enter into such service-type contracts if said contract includes a
84	84	55provision permitting the termination without cause of a healthcare provider. The commission 4 of 4
85	85	56shall not enter into such service-type contracts if said contract includes a provision permitting the
86	86	57carrier to make a unilateral change to any material term or condition of such contract, including,
87	87	58but not limited to, changes to underlying fee schedules, payment terms, carrier policies or
88	88	59procedures, definitions of covered services or covered sites of services, policies associated with
89	89	60utilization review, quality management and improvement, credentialing or covered preventive
90	90	61health services, other than a change expressly required by law, unless the effective date of such
91	91	62unilateral change is after the end of the then-current term of such contract, and notice of such
92	92	63change was provided, in writing, to the health care provider more than 90 days before the date by
93	93	64which the health care provider must provide notice of termination or non-renewal to the carrier
94	94	65under such contract. Nothing herein shall prohibit an insurance company and a health care
95	95	66provider from entering into a mutually-agreeable amendment to such contract.