Massachusetts 2025-2026 Regular Session

Massachusetts House Bill H1267 Compare Versions

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

Old	New	Differences
1	1	1 of 1
2	2	HOUSE DOCKET, NO. 951 FILED ON: 1/14/2025
3	3	HOUSE . . . . . . . . . . . . . . . No. 1267
4	4	The Commonwealth of Massachusetts
5	5	_________________
6	6	PRESENTED BY:
7	7	Frank A. Moran
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 :DATE ADDED:Frank A. Moran17th Essex1/14/2025 1 of 3
16	16	HOUSE DOCKET, NO. 951 FILED ON: 1/14/2025
17	17	HOUSE . . . . . . . . . . . . . . . No. 1267
18	18	By Representative Moran of Lawrence, a petition (accompanied by bill, House, No. 1267) of
19	19	Frank A. Moran for legislation to further regulate health insurance contracts. Financial Services.
20	20	The Commonwealth of Massachusetts
21	21	_______________
22	22	In the One Hundred and Ninety-Fourth General Court
23	23	(2025-2026)
24	24	_______________
25	25	An Act relative to unilateral contract changes.
26	26	Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
27	27	of the same, as follows:
28	28	1 SECTION 1. Section 15 of chapter 176O of the General Laws is hereby amended by
29	29	2striking out subsection j and inserting in place thereof the following new subsection:-
30	30	3 (j) No carrier shall make a contract with a health care provider which includes a provision
31	31	4permitting termination without cause. A carrier shall provide a written statement to a provider of
32	32	5the reason or reasons for such provider's involuntary disenrollment. No carrier shall make a
33	33	6contract with a health care provider which includes a provision permitting the carrier to make a
34	34	7unilateral change to any material term or condition of such contract, including, but not limited to,
35	35	8changes to underlying fee schedules, payment terms, carrier policies or procedures, definitions of
36	36	9covered services or covered sites of services, policies associated with utilization review, quality
37	37	10management and improvement, credentialing or covered preventive health services, other than a
38	38	11change expressly required by law, unless the effective date of such unilateral change is after the
39	39	12end of the then-current term of such contract, and notice of such change was provided, in
40	40	13writing, to the health care provider more than 90 days before the date by which the health care 2 of 3
41	41	14provider must provide notice of termination or non-renewal to the carrier under such contract.
42	42	15Nothing herein shall prohibit a carrier and a health care provider from entering into a mutually-
43	43	16agreeable amendment to such contract.
44	44	17 SECTION 3. Section 4 of chapter 32A of the General Laws is hereby amended by
45	45	18inserting after the first paragraph the following new paragraph:-
46	46	19 The commission shall not purchase a policy providing health insurance benefits from an
47	47	20insurance company whose contract with a healthcare provider under said policy includes a
48	48	21provision permitting termination without cause. The commission shall not purchase a policy
49	49	22providing health insurance benefits from an insurance company whose contract with a healthcare
50	50	23provider under said policy includes a provision permitting the carrier to make a unilateral change
51	51	24to any material term or condition of such contract, including, but not limited to, changes to
52	52	25underlying fee schedules, payment terms, carrier policies or procedures, definitions of covered
53	53	26services or covered sites of services, policies associated with utilization review, quality
54	54	27management and improvement, credentialing or covered preventive health services, other than a
55	55	28change expressly required by law, unless the effective date of such unilateral change is after the
56	56	29end of the then-current term of such contract, and notice of such change was provided, in
57	57	30writing, to the health care provider more than 90 days before the date by which the health care
58	58	31provider must provide notice of termination or non-renewal to the carrier under such contract.
59	59	32Nothing herein shall prohibit an insurance company and a health care provider from entering into
60	60	33a mutually-agreeable amendment to such contract.
61	61	34 SECTION 4. Section 4A of chapter 32A of the General Laws is hereby amended by
62	62	35inserting at the end of the first paragraph the following:- 3 of 3
63	63	36 The commission shall not enter into such service-type contracts if said contract includes a
64	64	37provision permitting the termination without cause of a healthcare provider. The commission
65	65	38shall not enter into such service-type contracts if said contract includes a provision permitting the
66	66	39carrier to make a unilateral change to any material term or condition of such contract, including,
67	67	40but not limited to, changes to underlying fee schedules, payment terms, carrier policies or
68	68	41procedures, definitions of covered services or covered sites of services, policies associated with
69	69	42utilization review, quality management and improvement, credentialing or covered preventive
70	70	43health services, other than a change expressly required by law, unless the effective date of such
71	71	44unilateral change is after the end of the then-current term of such contract, and notice of such
72	72	45change was provided, in writing, to the health care provider more than 90 days before the date by
73	73	46which the health care provider must provide notice of termination or non-renewal to the carrier
74	74	47under such contract. Nothing herein shall prohibit an insurance company and a health care
75	75	48provider from entering into a mutually-agreeable amendment to such contract.