Bill > H1343

This bill introduces a comprehensive healthcare insurance regulation that prevents health insurance carriers from denying payment for covered health care services solely because a patient's referral comes from a provider outside the carrier's network. The bill amends multiple chapters of Massachusetts state law, including sections related to state employee insurance (Chapter 32A and 32B), Medicaid (Chapter 118E), and various insurance regulations (Chapters 175, 176A, 176B, 176G, and 176I). Additionally, the bill makes some modifications to controlled substance prescription regulations in Chapter 94C, which appears to allow more flexibility for practitioners in dispensing medications. The key provision across most sections is a clear prohibition on network-based payment denials, meaning that if a health service is covered under a patient's plan, the insurance carrier cannot refuse payment simply because the referring provider is not in their network. This change aims to provide patients with greater freedom in choosing healthcare providers and reduce potential barriers to receiving necessary medical care. The amendments will become effective for all contracts entered into, renewed, or amended one year after the bill's effective date.

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https://malegislature.gov/Bills/194/H1343