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SENATE DOCKET, NO. 1133 FILED ON: 1/15/2025
SENATE . . . . . . . . . . . . . . No. 764
The Commonwealth of Massachusetts
_________________
PRESENTED BY:
Adam Gomez
_________________
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 ensuring prompt access to health care.
_______________
PETITION OF:
NAME:DISTRICT/ADDRESS :Adam GomezHampden 1 of 4
SENATE DOCKET, NO. 1133 FILED ON: 1/15/2025
SENATE . . . . . . . . . . . . . . No. 764
By Mr. Gomez, a petition (accompanied by bill, Senate, No. 764) of Adam Gomez for legislation
to ensure prompt access to health care. Financial Services.
[SIMILAR MATTER FILED IN PREVIOUS SESSION
SEE SENATE, NO. 654 OF 2023-2024.]
The Commonwealth of Massachusetts
_______________
In the One Hundred and Ninety-Fourth General Court
(2025-2026)
_______________
An Act ensuring prompt access to health care.
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 32A of the General Laws, as appearing in the 2022 Official
2Edition, is hereby amended by adding at the end the following new section:-
3 Section 31: Reimbursement of costs for medically appropriate evaluation and
4management services in outpatient settings, including but not limited to office-based and
5hospital-based clinics, in accordance with guidelines developed by the division of insurance,
6shall be part of a basic benefits package offered by the insurer or a third party and shall not
7require a co-payment or deductible; provided, however, that co-payments and deductibles shall
8be required if the applicable plan is governed by the Federal Internal Revenue Code and would
9lose its tax-exempt status as a result of the prohibition on such for these services. 2 of 4
10 SECTION 2. Chapter 32B of the General Laws, as appearing in the 2022 Official
11Edition, is hereby amended by adding at the end the following new section:-
12 Section 30: Reimbursement of costs for medically appropriate evaluation and
13management services in outpatient settings, including but not limited to office-based and
14hospital-based clinics, in accordance with guidelines developed by the division of insurance,
15shall be part of a basic benefits package offered by the insurer or a third party and shall not
16require a co-payment or deductible; provided, however, that co-payments and deductibles shall
17be required if the applicable plan is governed by the Federal Internal Revenue Code and would
18lose its tax-exempt status as a result of the prohibition on such for these services.
19 SECTION 3. Chapter 175 of the General Laws, as appearing in the 2022 Official Edition,
20is hereby amended by inserting after Section 47KK the following section:-
21 Section 47QQ: Reimbursement of costs for medically appropriate evaluation and
22management services in outpatient settings, including but not limited to office-based and
23hospital-based clinics, in accordance with guidelines developed by the division of insurance,
24shall be part of a basic benefits package offered by the insurer or a third party and shall not
25require a co-payment or deductible; provided, however, that co-payments and deductibles shall
26be required if the applicable plan is governed by the Federal Internal Revenue Code and would
27lose its tax-exempt status as a result of the prohibition on such for these services.
28 SECTION 4. Chapter 176A of the General Laws, is hereby amended by inserting after
29Section 8MM the following section:-
30 Section 8RR: Reimbursement of costs for medically appropriate evaluation and
31management services in outpatient settings, including but not limited to office-based- and 3 of 4
32hospital-based clinics, in accordance with guidelines developed by the division of insurance,
33shall be part of a basic benefits package offered by the insurer or a third party and shall not
34require a co-payment or deductible; provided, however, that co-payments and deductibles shall
35be required if the applicable plan is governed by the Federal Internal Revenue Code and would
36lose its tax-exempt status as a result of the prohibition on such for these services.
37 SECTION 5. Chapter 176B of the General Laws, as appearing in the 2022 Official
38Edition, is hereby amended by inserting after Section 4MM the following section:-
39 Section 4RR: Reimbursement of costs for medically appropriate evaluation and
40management services in outpatient settings, including but not limited to office-based and
41hospital-based clinics, in accordance with guidelines developed by the division of insurance,
42shall be part of a basic benefits package offered by the insurer or a third party and shall not
43require a co-payment or deductible; provided, however, that a co-payment and deductible shall
44be required if the applicable plan is governed by the Federal Internal Revenue Code and would
45lose its tax-exempt status as a result of the prohibition on such for these services.
46 SECTION 6. Chapter 176G of the General Laws, as appearing in the 2022 Official
47Edition, is hereby amended by adding at the end the following new section:-
48 Section 34: Reimbursement of costs for medically appropriate evaluation and
49management services in outpatient settings, including but not limited to office-based and
50hospital-based clinics, in accordance with guidelines developed by the division of insurance,
51shall be part of a basic benefits package offered by the insurer or a third party and shall not
52require a co-payment or deductible; provided, however, that a co-payment and deductible shall 4 of 4
53be required if the applicable plan is governed by the Federal Internal Revenue Code and would
54lose its tax-exempt status as a result of the prohibition on such for these services.