SENATE DOCKET, NO. 1021        FILED ON: 1/15/2015

SENATE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 557


The Commonwealth of Massachusetts



Karen E. Spilka


To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
Court assembled:

The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:

An Act to protect access to confidential healthcare.







Karen E. Spilka

Second Middlesex and Norfolk


David Paul Linsky

5th Middlesex


Jason M. Lewis

Fifth Middlesex


Michael O. Moore

Second Worcester


Paul R. Heroux

2nd Bristol


Stephen Kulik

1st Franklin


Jose F. Tosado

9th Hampden


James B. Eldridge

Middlesex and Worcester


Marjorie C. Decker

25th Middlesex


Michael J. Barrett

Third Middlesex


Sal N. DiDomenico

Middlesex and Suffolk


William N. Brownsberger

Second Suffolk and Middlesex


Carolyn C. Dykema

8th Middlesex


Cynthia S. Creem

First Middlesex and Norfolk


Benjamin B. Downing

Berkshire, Hampshire, Franklin and Hampden


Barbara A. L'Italien

Second Essex and Middlesex


Eric P. Lesser

First Hampden and Hampshire


Kenneth J. Donnelly

Fourth Middlesex


Anne M. Gobi

Worcester, Hampden, Hampshire and Middlesex


Steven Ultrino

33rd Middlesex


Sean Garballey

23rd Middlesex


Linda Dorcena Forry

First Suffolk


Daniel J. Ryan

2nd Suffolk


Thomas M. Stanley

9th Middlesex


Brian A. Joyce

Norfolk, Bristol and Plymouth


Carmine L. Gentile

13th Middlesex


Timothy J. Toomey, Jr.

26th Middlesex


Cory Atkins

14th Middlesex


Michael F. Rush

Norfolk and Suffolk


Danielle W. Gregoire

4th Middlesex


Brian R. Mannal

2nd Barnstable


Michelle M. DuBois

10th Plymouth


Denise Provost

27th Middlesex


Mark C. Montigny

Second Bristol and Plymouth


Patricia D. Jehlen

Second Middlesex


Timothy R. Madden

Barnstable, Dukes and Nantucket


SENATE DOCKET, NO. 1021        FILED ON: 1/15/2015

SENATE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 557

By Ms. Spilka, a petition (accompanied by bill, Senate, No. 557) of Karen E. Spilka, David Paul Linsky, Jason M. Lewis, Michael O. Moore and other members of the General Court for legislation to protect access to confidential healthcare.  Financial Services.


The Commonwealth of Massachusetts



In the One Hundred and Eighty-Ninth General Court



An Act to protect access to confidential healthcare.


Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:


Chapter 176O of the General Laws is hereby amended by striking out section 27 and inserting in place thereof the following:-

Section 27. (a) The division shall develop a common summary of payments form to be used by all carriers in the commonwealth that is provided to health care consumers with respect to provider claims submitted to a payer and written in an easily readable and understandable format showing the consumer’s responsibility, if any, for payment of any portion of a health care provider claim; provided that the division shall allow the development of forms to be exchanged through electronic means; and further provided that carriers shall not be obligated to issue a summary of payments form for provider claims that consist solely of requests for co-payment. The division shall consult with stakeholders to develop these forms.

(b) Carriers shall issue common summary of payments forms at the member level for all insureds. Carriers shall permit an insured who is legally authorized to consent to care, or a party legally authorized to consent to care for the insured, to choose his or her preferred method of receiving the common summary of payments form, which shall include, but not be limited to, the following: (1) sending the form to the address of the subscriber; (2) sending the form to the address of the insured dependent; (3) sending the form to an alternate address upon request of the insured; or (4) sending the form through electronic means when available. The preferred method of receipt shall be valid until the insured submits a new preferred method.

(c) Unless specifically requested by the insured, a carrier shall not provide a common summary of payments form if the insured has no liability for payment for any procedure or service, including, but not limited to, the United States Preventive Services Taskforce recommended A and B preventive services.

(d) Carriers shall not identify the descriptions for sensitive health care services in a common summary of payments form. The division shall define by regulation sensitive health care services for purposes of this section. The division shall refer to the National Committee on Vital and Health Statistics and similar regulations in other states, and shall consult with experts in fields including, but not limited to, infectious disease, reproductive and sexual health, domestic violence and sexual assault, and mental health and substance use disorders, in promulgating the regulation.

(e) Carriers shall permit all insureds who are legally authorized to consent to care, or parties legally authorized to consent to care for the insured, to request suppression of summary of payments forms, in which case summary of payments forms shall not be issued unless and until the insured submits a revocation of the request; provided that the insured clearly states orally or in writing that the communication of medical or provider information on the form discloses the receipt of sensitive services that could endanger the insured or limit access to future health services. Carriers shall not require an explanation as to the basis for an insured’s confidential communications request, unless otherwise required by law or court order.

(f) The right to request suppression of summary of payments forms pursuant to subsection (e) shall be communicated in plain language and in a clear and conspicuous manner to all insureds, including insured dependents, in evidence of coverage documents, member privacy communications and on every summary of payments form. 

(g) The division shall promulgate regulations necessary to implement and enforce this section, which shall include reasonable reporting regarding compliance and breaches of confidentiality.

(h) The division, in collaboration with the department of public health, shall develop and implement a plan to educate providers and consumers regarding the rights of insureds to promote compliance with this section. The plan shall include, but not be limited to, staff training and other education for hospitals, community health centers, school-based health centers, physicians, nurses and other licensed health care professionals, as well as administrative staff, which shall include all staff involved in patient registration and education about confidentiality, and billing staff involved in processing of insurance claims.  The plan shall be developed in consultation with groups representing health care insurers, providers, and consumers, including consumer organizations concerned with the provision of sensitive health services.

SECTION 2. Subsections (a), (g), and (h) of Chapter 176O shall take effect 6 months from the effective date of this act.

Subsections (b)-(f) of Section 27 of Chapter 176O shall take effect at such time as each carrier revises its plans subsequent to the promulgation of the regulations described in subsection (g).