Bill > H788

This bill requires licensed health insurance companies in Massachusetts that provide behavioral health coverage, including those working with behavioral health management firms or third-party administrators (entities that manage payments and services for others), to report specific data to the Health Policy Commission's Office of Patient Protection. This data includes details on denied behavioral health services, the reasons for denial (but no patient-identifying information), and all denied medication requests. It also mandates the disclosure of provider network sizes for outpatient, inpatient, and clinic services, including the number of providers, how long they've been affiliated, the number of patients seen, and the last payment date. Furthermore, insurance companies and third-party administrators must annually file their payment rates for each CPT code (a standardized medical code for services and procedures) and disclose any geographic sampling used for provider payments. The Office of Patient Protection will create a public system for insured individuals to report unsuccessful attempts to schedule appointments, and insurance companies must also make public the terms of their contracts with third-party administrators, including payment, bonus, and incentive structures. These reports, which will not contain identifying information about patients or providers, are to be filed quarterly, with the first report due within 90 days of the law's effective date.