Massachusetts 2025-2026 Regular Session

Massachusetts Senate Bill S758 Compare Versions

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

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1	1	1 of 1
2	2	SENATE DOCKET, NO. 2480 FILED ON: 1/17/2025
3	3	SENATE . . . . . . . . . . . . . . No. 758
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 defining financial responsibility for 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 4
16	16	SENATE DOCKET, NO. 2480 FILED ON: 1/17/2025
17	17	SENATE . . . . . . . . . . . . . . No. 758
18	18	By Mr. Finegold, a petition (accompanied by bill, Senate, No. 758) 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. 643 OF 2023-2024.]
23	23	The Commonwealth of Massachusetts
24	24	_______________
25	25	In the One Hundred and Ninety-Fourth General Court
26	26	(2025-2026)
27	27	_______________
28	28	An Act defining financial responsibility for 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 not less than 65 per cent of each co-payment, co-insurance or
36	36	6deductible amount due under an insured’s health benefit plan which is unpaid after reasonable
37	37	7collection efforts have been made by the health care provider pursuant to subsection (c).
38	38	8 (b) As used in this section, the following words shall have the following meanings unless
39	39	9the context clearly requires otherwise: 2 of 4
40	40	10 “Co-payment”, 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.
42	42	12 “Co-insurance”, a percentage of the allowed amount, after a co-payment, if any, that an
43	43	13insured is required to pay for covered services received under a health benefit plan for health
44	44	14care services provided and billed by a healthcare provider.
45	45	15 “Deductible”, a specific dollar amount that an insured is required to pay for covered
46	46	16services before the carrier’s health benefit plan becomes obligated to pay for covered health care
47	47	17services provided and billed by a healthcare provider; provided, however, that such deductible
48	48	18shall not include any portion of premiums paid by an insured.
49	49	19 (c) Reimbursement for uncollected co-payment, co-insurance or deductible amounts due,
50	50	20each of which is hereinafter referred to as a claim, under an insured’s health benefit plan for
51	51	21covered services rendered shall be deemed an uncollectible bad debt, and a health care provider
52	52	22may submit a request for reimbursement to the carrier under the following conditions:
53	53	23 (1) The claim shall be derived from the wholly or partially uncollected co-payment, co-
54	54	24insurance or deductible amounts under an insured’s health benefit plan;
55	55	25 (2) The reimbursement requested by the health care provider shall be for a claim where
56	56	26the co-payment, co-insurance or deductible amount was not less than$250 and each claim
57	57	27reflected a unique covered service under the health benefit plan per insured;
58	58	28 (3) The health care provider shall have made reasonable collection efforts for each claim
59	59	29filed for reimbursement under this section, including documentation that the claim has remained
60	60	30partially or fully unpaid and is not subject to an on-going payment plan for more than 120 days 3 of 4
61	61	31from the date the first bill was mailed and which may include such efforts as telephone calls,
62	62	32collection letters or any other notification method that constitutes a genuine and continuous
63	63	33effort to contact the member; provided, however, that said documentation shall include the date
64	64	34and method of contact;
65	65	35 (4) On or before May 1 of each year, the health care provider shall submit an aggregate
66	66	36request for reimbursement representing all claims that meet the criteria under this section in the
67	67	37prior calendar year. The request for reimbursement shall include documentation of the attempt to
68	68	38collect on any claims, the name and identification number of the insured, the date of service, the
69	69	39unpaid co-payment, co-insurance or deductible, the amount that was collected, if any, and the
70	70	40date and general method of contact with the insured. For the purposes of this section, an insured
71	71	41co-payment, co-insurance or deductible amount due shall be determined based on the date that
72	72	42the service is rendered; provided, however, that a carrier shall not prohibit reimbursement if the
73	73	43insured is no longer covered by the plan on the date that the request is made.
74	74	44 (5) Nothing in this section shall prevent the carrier from conducting an audit of the
75	75	45request for reimbursement of unpaid co-payment, co-insurance or deductible amounts to verify
76	76	46that the insured was eligible for coverage at the time of service, that the service was a covered
77	77	47health benefit under the applicable health benefit plan and, from the provider’s internal log, that
78	78	48reasonable efforts were made to contact the insured following the criteria outlined in this section.
79	79	49The carrier shall complete any such audit of the submitted report from the health care provider
80	80	50and notify the health care provider of any disputes as to the request for reimbursement within
81	81	51120 days of receipt of the request for reimbursement from the health care provider. The carrier
82	82	52shall pay the health care provider 65 per cent of the undisputed amounts as submitted by the
83	83	53health care provider in the request for reimbursement in accordance with this section within 120 4 of 4
84	84	54days of receipt of such requests from the health care provider. Any dispute regarding contested
85	85	55claims shall be subject to a dispute resolution process applicable to the arrangement between the
86	86	56carrier and the health care provider; and
87	87	57 (6) Any amounts attributable to co-payment, co-insurance or deductible amount collected
88	88	58by a health care provider after reimbursement has been made by the carrier pursuant to this
89	89	59section shall be recorded by the health care provider and reported as an offset to future
90	90	60submissions to such carrier.
91	91	61 (d) No carrier shall prohibit a health care provider from collecting the amount of the
92	92	62insured’s co-payment, co-insurance or deductible, if any, at the time of service.
93	93	63 SECTION 2. The division shall promulgate regulations within 90 days of the effective
94	94	64date of this act that are consistent with the rules developed by the federal centers for Medicare
95	95	65and Medicaid services for reasonable collection efforts required by a health care provider prior to
96	96	66submission of a request of reimbursement to a carrier. Notwithstanding the foregoing, in the
97	97	67event that the division fails to promulgate such regulations, the provisions of section 1 shall be
98	98	68self-implementing and carriers shall make applicable payments to health care providers in
99	99	69accordance with the provisions of section 1 utilizing the same process adopted by the federal
100	100	70centers for Medicare and Medicaid services's reasonable collection efforts for bad debt, as
101	101	71documented in the most recent Medicare Provider Reimbursement Manual, CMS Pub. 15-1 and
102	102	7215-2 (HIM-15) in effect within 90 days of enactment. The division shall further require each
103	103	73carrier to provide the division an annual report showing the total number and amount of
104	104	74uncollected co-payments, co-insurances and deductibles that are reimbursed, as well as those that
105	105	75are denied. The report shall be made publicly available on the division’s website.