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