1 of 1
SENATE DOCKET, NO. 2182 FILED ON: 1/17/2025
SENATE . . . . . . . . . . . . . . No. 762
The Commonwealth of Massachusetts
_________________
PRESENTED BY:
Cindy F. Friedman
_________________
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 streamlining notice and disclosure.
_______________
PETITION OF:
NAME:DISTRICT/ADDRESS :Cindy F. FriedmanFourth Middlesex 1 of 4
SENATE DOCKET, NO. 2182 FILED ON: 1/17/2025
SENATE . . . . . . . . . . . . . . No. 762
By Ms. Friedman, a petition (accompanied by bill, Senate, No. 762) of Cindy F. Friedman
relative to disclosure of insurance allowed amounts for admissions, procedures or services by
healthcare providers. Financial Services.
The Commonwealth of Massachusetts
_______________
In the One Hundred and Ninety-Fourth General Court
(2025-2026)
_______________
An Act relative to streamlining notice and disclosure.
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. Chapter 111 of the General Laws, as appearing in the 2022 Official Edition,
2is hereby amended by striking section 228, as amended by section 25 of chapter 260 of the acts
3of 2020, and replacing it with the following section:-
4 Section 228. (a)(1) Upon scheduling an admission, procedure or service for a patient or
5prospective patient for a condition that is not an emergency medical condition, as defined in
6section 1 of chapter 176O, or upon request by a patient or prospective patient, a health care
7provider shall disclose whether the health care provider is participating in the patient’s health
8benefit plan; provided, however, that if a patient or prospective patient schedules a series of
9admissions, procedures or services as part of a continued course of treatment, the health care
10provider does not need to affirmatively make this disclosure for subsequent admissions,
11procedures or services for that course of treatment so long as the initial disclosure to the patient
12was documented; provided further, that if the health care provider’s status as participating in the 2 of 4
13patient’s health benefit plan changes during a continued course of treatment, the health care
14provider shall inform a patient of this change in status.
15 (2) If the health care provider is participating in the patient’s or prospective patient’s
16health benefit plan, the health care provider shall provide the patient’s health insurance carrier
17with a good faith estimate of the expected billing and diagnostic codes for any admission,
18procedure or service; provided, however, that a participating health care provider shall also
19inform the patient or prospective patient that the patient or prospective patient may obtain
20additional information about any applicable out-of-pocket costs pursuant to section 23 of chapter
21176O. A health insurance carrier shall then provide the patient with the estimated amount the
22insured will be responsible to pay for a proposed admission, procedure or service in the form of a
23notification in clear and understandable language as required under the Public Health Service
24Act section 2799B –6, as added by Section 112 of Title I of Division BB of the Consolidated
25Appropriations Act of 2021 as codified at 42 USC section 300gg-136. The health insurance
26carrier must provide the patient with the estimated amount the insured will be responsible to pay
27for a proposed admission, procedure or service within 3 business days if their admission,
28procedure or service is scheduled at least 10 days in advance, or within 1 business day if there
29are fewer than 10 days before the admission, procedure or service.
30 (3) If the health care provider is not participating in the patient’s or prospective patient’s
31health benefit plan, or the patient is uninsured or otherwise not using their health benefit plan, the
32health care provider shall provide patients with relevant cost information regarding the scheduled
33admission, procedure or service, including a good faith estimate of the charge amount and the
34amount of any facility fees for the admission, procedure or service; provided further that the
35provider shall inform the patient or prospective patient that the patient or prospective patient will 3 of 4
36be responsible for the amount of the charge and the amount of any facility fees for the admission,
37procedure or service not covered through the patient’s health benefit plan and shall inform the
38patient or prospective patient that the patient or prospective patient may be able to obtain the
39admission, procedure or service at a lower cost from a health care provider who participates in
40the patient’s or prospective patient’s health benefit plan. A good faith estimate under this section
41shall be furnished to a patient no more than 1 business day after the day the appointment was
42scheduled if the appointment was scheduled at least 3 business days before the admission,
43procedure or service and within 3 business days of scheduling if the appointment is made at least
4410 business days in advance. Providers may comply with this section through compliance with
45notice requirements for providers under the in Public Health Service Act section 2799B–6, as
46added by Section 112 of Title I of Division BB of the Consolidated Appropriations Act of 2021,
47as implemented under 45 CFR section 149.610(c).
48 (b) If a health care provider that does not participate in the patient’s health benefit plan,
49or is providing care to a patient that does not have insurance or is not using their health benefit
50plan, fails to provide the required notifications under this section, the provider shall not bill the
51insured except for any applicable copayment, coinsurance or deductible that would be payable if
52the insured received the service from a participating health care provider under the terms of the
53insured’s health benefit plan.
54 (c) The commissioner shall implement and enforce this section and impose penalties for:
55(i) non-compliance consistent with the department’s authority to regulate health care providers;
56provided, however, that the penalty for non-compliance shall not exceed $5,000 in each instance;
57provided further that the department shall not impose a penalty if a provider has been subject to a
58penalty by the Centers for Medicare and Medicaid Services for the same violation; and (ii) non- 4 of 4
59compliance consistent with the department’s authority to regulate health insurance carriers;
60provided, however, that the penalty for non-compliance shall not exceed $5,000 in each instance;
61provided further that the department shall not impose a penalty if a health insurance carrier has
62been subject to a penalty by the Centers for Medicare and Medicaid Services or Massachusetts
63division of insurance for the same violation. A health care provider and health insurance carrier
64that violates any provision of this section or the rules and regulations adopted pursuant to this
65subsection shall be liable for penalties as provided in this subsection.
66 SECTION 2. Subsection 2(a)(2) shall take effect upon the effective date of regulations
67implementing 42 USC section 300gg-136.