Bill > S674

This bill aims to address out-of-network billing in Massachusetts. The key provisions are: 1. The Center for Health Information and Analysis (CHIA) will calculate the "noncontracted commercial rates" for emergency and non-emergency services provided by out-of-network healthcare providers. These rates will be used to determine the payment to providers when patients receive care from out-of-network providers. 2. The bill defines key terms like "emergency health care services," "in-network contracted rate," and "noncontracted commercial rate for emergency/non-emergency services." 3. It requires health insurance carriers to reimburse out-of-network providers at the noncontracted commercial rates for emergency and non-emergency services, and prohibits providers and carriers from billing patients for any amount beyond the applicable copay, coinsurance, or deductible. 4. The Division of Insurance must establish and implement the noncontracted commercial rates by July 31, 2022, based on a prior report and recommendations from the Secretary of Health and Human Services. The overall goal is to protect patients from surprise out-of-network medical bills and improve transparency around healthcare provider reimbursement rates.

Budget and Finance, Business and Industry, Health and Social Services

https://malegislature.gov/Bills/192/S674