Bill > S603

This bill aims to address the issue of equitable provider reimbursement for non-network providers in the state's Medicaid (MassHealth) program. The key provisions are: 1. It defines important terms, such as "Emergency Services," "Managed Care Organization," "Network," and "Non-network Provider." 2. It requires that non-network providers must accept the Medicaid rate for the same or similar services, while allowing managed care organizations to deny payment for unapproved services provided by non-network providers. Non-network providers cannot bill the insured beyond any applicable copayment, coinsurance, or deductible. 3. It establishes rules for reimbursement of emergency and non-emergency services provided by non-participating providers. It prohibits non-participating providers from billing the patient beyond any applicable cost-sharing, except in cases where the patient is informed of their rights and obligations and provides written consent to continue services at their own expense. The overall goal of the bill is to ensure that non-network providers are reimbursed at equitable rates and that patients do not face higher out-of-pocket costs when receiving care from non-participating providers, particularly in emergency situations.

Health and Social Services

https://malegislature.gov/Bills/190/S603