Massachusetts 2025-2026 Regular Session

Massachusetts Senate Bill S762 Compare Versions

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

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2	2	SENATE DOCKET, NO. 2182 FILED ON: 1/17/2025
3	3	SENATE . . . . . . . . . . . . . . No. 762
4	4	The Commonwealth of Massachusetts
5	5	_________________
6	6	PRESENTED BY:
7	7	Cindy F. Friedman
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 streamlining notice and disclosure.
13	13	_______________
14	14	PETITION OF:
15	15	NAME:DISTRICT/ADDRESS :Cindy F. FriedmanFourth Middlesex 1 of 4
16	16	SENATE DOCKET, NO. 2182 FILED ON: 1/17/2025
17	17	SENATE . . . . . . . . . . . . . . No. 762
18	18	By Ms. Friedman, a petition (accompanied by bill, Senate, No. 762) of Cindy F. Friedman
19	19	relative to disclosure of insurance allowed amounts for admissions, procedures or services by
20	20	healthcare providers. Financial Services.
21	21	The Commonwealth of Massachusetts
22	22	_______________
23	23	In the One Hundred and Ninety-Fourth General Court
24	24	(2025-2026)
25	25	_______________
26	26	An Act relative to streamlining notice and disclosure.
27	27	Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
28	28	of the same, as follows:
29	29	1 SECTION 1. Chapter 111 of the General Laws, as appearing in the 2022 Official Edition,
30	30	2is hereby amended by striking section 228, as amended by section 25 of chapter 260 of the acts
31	31	3of 2020, and replacing it with the following section:-
32	32	4 Section 228. (a)(1) Upon scheduling an admission, procedure or service for a patient or
33	33	5prospective patient for a condition that is not an emergency medical condition, as defined in
34	34	6section 1 of chapter 176O, or upon request by a patient or prospective patient, a health care
35	35	7provider shall disclose whether the health care provider is participating in the patient’s health
36	36	8benefit plan; provided, however, that if a patient or prospective patient schedules a series of
37	37	9admissions, procedures or services as part of a continued course of treatment, the health care
38	38	10provider does not need to affirmatively make this disclosure for subsequent admissions,
39	39	11procedures or services for that course of treatment so long as the initial disclosure to the patient
40	40	12was documented; provided further, that if the health care provider’s status as participating in the 2 of 4
41	41	13patient’s health benefit plan changes during a continued course of treatment, the health care
42	42	14provider shall inform a patient of this change in status.
43	43	15 (2) If the health care provider is participating in the patient’s or prospective patient’s
44	44	16health benefit plan, the health care provider shall provide the patient’s health insurance carrier
45	45	17with a good faith estimate of the expected billing and diagnostic codes for any admission,
46	46	18procedure or service; provided, however, that a participating health care provider shall also
47	47	19inform the patient or prospective patient that the patient or prospective patient may obtain
48	48	20additional information about any applicable out-of-pocket costs pursuant to section 23 of chapter
49	49	21176O. A health insurance carrier shall then provide the patient with the estimated amount the
50	50	22insured will be responsible to pay for a proposed admission, procedure or service in the form of a
51	51	23notification in clear and understandable language as required under the Public Health Service
52	52	24Act section 2799B –6, as added by Section 112 of Title I of Division BB of the Consolidated
53	53	25Appropriations Act of 2021 as codified at 42 USC section 300gg-136. The health insurance
54	54	26carrier must provide the patient with the estimated amount the insured will be responsible to pay
55	55	27for a proposed admission, procedure or service within 3 business days if their admission,
56	56	28procedure or service is scheduled at least 10 days in advance, or within 1 business day if there
57	57	29are fewer than 10 days before the admission, procedure or service.
58	58	30 (3) If the health care provider is not participating in the patient’s or prospective patient’s
59	59	31health benefit plan, or the patient is uninsured or otherwise not using their health benefit plan, the
60	60	32health care provider shall provide patients with relevant cost information regarding the scheduled
61	61	33admission, procedure or service, including a good faith estimate of the charge amount and the
62	62	34amount of any facility fees for the admission, procedure or service; provided further that the
63	63	35provider shall inform the patient or prospective patient that the patient or prospective patient will 3 of 4
64	64	36be responsible for the amount of the charge and the amount of any facility fees for the admission,
65	65	37procedure or service not covered through the patient’s health benefit plan and shall inform the
66	66	38patient or prospective patient that the patient or prospective patient may be able to obtain the
67	67	39admission, procedure or service at a lower cost from a health care provider who participates in
68	68	40the patient’s or prospective patient’s health benefit plan. A good faith estimate under this section
69	69	41shall be furnished to a patient no more than 1 business day after the day the appointment was
70	70	42scheduled if the appointment was scheduled at least 3 business days before the admission,
71	71	43procedure or service and within 3 business days of scheduling if the appointment is made at least
72	72	4410 business days in advance. Providers may comply with this section through compliance with
73	73	45notice requirements for providers under the in Public Health Service Act section 2799B–6, as
74	74	46added by Section 112 of Title I of Division BB of the Consolidated Appropriations Act of 2021,
75	75	47as implemented under 45 CFR section 149.610(c).
76	76	48 (b) If a health care provider that does not participate in the patient’s health benefit plan,
77	77	49or is providing care to a patient that does not have insurance or is not using their health benefit
78	78	50plan, fails to provide the required notifications under this section, the provider shall not bill the
79	79	51insured except for any applicable copayment, coinsurance or deductible that would be payable if
80	80	52the insured received the service from a participating health care provider under the terms of the
81	81	53insured’s health benefit plan.
82	82	54 (c) The commissioner shall implement and enforce this section and impose penalties for:
83	83	55(i) non-compliance consistent with the department’s authority to regulate health care providers;
84	84	56provided, however, that the penalty for non-compliance shall not exceed $5,000 in each instance;
85	85	57provided further that the department shall not impose a penalty if a provider has been subject to a
86	86	58penalty by the Centers for Medicare and Medicaid Services for the same violation; and (ii) non- 4 of 4
87	87	59compliance consistent with the department’s authority to regulate health insurance carriers;
88	88	60provided, however, that the penalty for non-compliance shall not exceed $5,000 in each instance;
89	89	61provided further that the department shall not impose a penalty if a health insurance carrier has
90	90	62been subject to a penalty by the Centers for Medicare and Medicaid Services or Massachusetts
91	91	63division of insurance for the same violation. A health care provider and health insurance carrier
92	92	64that violates any provision of this section or the rules and regulations adopted pursuant to this
93	93	65subsection shall be liable for penalties as provided in this subsection.
94	94	66 SECTION 2. Subsection 2(a)(2) shall take effect upon the effective date of regulations
95	95	67implementing 42 USC section 300gg-136.