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Bill > H2974

MA H2974

To limit retroactive denials of health insurance claims for behavioral health and substance abuse services

summary

Introduced
01/23/2017
In Committee
01/23/2017
Crossed Over
Passed
Dead
12/31/2018

Introduced Session

190th General Court

Bill Summary

For legislation to limit retroactive denials of health insurance claims for behavioral health and substance abuse services. Financial Services.

AI Summary

This bill aims to limit retroactive denials of health insurance claims for behavioral health and substance abuse services. The key provisions are: 1. It prohibits insurers, the Group Insurance Commission, and other entities that manage behavioral health services from imposing retroactive claim denials on providers unless certain conditions are met, such as the claim being submitted fraudulently or the claim payment being subject to adjustment due to expected payment from another payer. 2. It requires insurers and other entities to provide written explanations to providers for any retroactive claim denials and give providers time to address the issue or determine if the claim is eligible for payment by a secondary insurer. 3. It defines "behavioral health" and "retroactive claim denial" for the purposes of the bill. 4. It directs the Division of Medical Assistance to develop an internal process to reconcile claims due to retroactive eligibility changes or duplicate enrollments for MassHealth enrollees, without requiring provider involvement.

Committee Categories

Business and Industry

Sponsors (49)

Michael Brady (D),  Tony Cabral (D),  Dan Cahill (D),  Thomas Calter (D),  James Cantwell (D),  Mike Connolly (D),  Brendan Crighton (D),  Marjorie Decker (D),  Dan Donahue (D),  Michelle DuBois (D),  Jamie Eldridge (D),  Tricia Farley-Bouvier (D),  Kim Ferguson (R),  Dylan Fernandes (D),  Linda Forry (D),  Sean Garballey (D),  Colleen Garry (D),  Carmine Gentile (D),  Solomon Goldstein-Rose (I),  Carlos González (D),  Ken Gordon (D),  Stephen Hay (D),  Jonathan Hecht (D),  Paul Heroux (D),  Natalie Higgins (D),  Donald Humason (R),  Mary Keefe (D),  Kay Khan (D),  Peter Kocot (D),  Barbara L'Italien (D),  Jack Lewis (D),  John Mahoney (D),  Elizabeth Malia (D),  Juana Matias (D),  Thomas McGee (D),  Paul McMurtry (D),  Mike Moore (D),  Frank Moran (D),  Harold Naughton (D),  Jim O'Day (D),  Denise Provost (D),  Dave Rogers (D),  John Rogers (D),  Danny Ryan (D),  José Tosado (D),  Paul Tucker (D),  Steve Ultrino (D),  Aaron Vega (D),  Bud Williams (D), 

Last Action

Accompanied a new draft, see H4315 (on 03/22/2018)
(3 Companion Bills)

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Document Type Source Location
State Bill Page https://malegislature.gov/Bills/190/H2974
Bill https://malegislature.gov/Bills/190/H2974.pdf
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