HOUSE DOCKET, NO. 2582        FILED ON: 1/17/2019

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 1121

The Commonwealth of Massachusetts

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PRESENTED BY:

Thomas P. Walsh

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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 relative to direct primary care.

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PETITION OF:

HOUSE DOCKET, NO. 2582        FILED ON: 1/17/2019

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 1121

The Commonwealth of Massachusetts

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In the One Hundred and Ninety-First General Court
(2019-2020)

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An Act relative to direct primary care.

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

SECTION 1. Chapter 32A of the General Laws is hereby amended by adding at the end the following new section:

Section 28: a carrier may not deny payment for any health care service covered under an enrollee’s health plan based solely on the basis that the enrollee’s referral was made by a provider who is not a member of the carrier’s provider network

SECTION 2. Chapter 32B of the General Laws is hereby amended by adding at the end the following new section:

Section 30: a carrier may not deny payment for any health care service covered under an enrollee’s health plan based solely on the basis that the enrollee’s referral was made by a provider who is not a member of the carrier’s provider network

SECTION 3. Section 118E of the General Laws of the General Laws is hereby amended by adding at the end the following new section:

Section 13C½.: a carrier may not deny payment for any health care service covered under an enrollee’s health plan based solely on the basis that the enrollee’s referral was made by a provider who is not a member of the carrier’s provider network

SECTION 4. Section 47BB of chapter 175 of the General Laws, as most recently added by Section 158 of Chapter 224 of the Acts of 2012, of the General Laws is hereby amended by striking subsections (a)-(d) and adding at the end of the existing paragraph the following new paragraph:

A carrier may not deny payment for any health care service covered under an enrollee’s health plan based solely on the basis that the enrollee’s referral was made by a provider who is not a member of the carrier’s provider network

SECTION 5. Chapter 176A of the General Laws of the General Laws is hereby amended by adding at the end the following new section:

Section 38: a carrier may not deny payment for any health care service covered under an enrollee’s health plan based solely on the basis that the enrollee’s referral was made by a provider who is not a member of the carrier’s provider network

SECTION 6. Chapter 176B of the General Laws, as appearing in the 2014 Official Edition, is hereby amended by inserting at the end thereof the following new section:

Section 25: a carrier may not deny payment for any health care service covered under an enrollee’s health plan based solely on the basis that the enrollee’s referral was made by a provider who is not a member of the carrier’s provider network

SECTION 7. Chapter 176G of the General Laws of the General Laws is hereby amended by adding at the end the following new section:

Section 33: a carrier may not deny payment for any health care service covered under an enrollee’s health plan based solely on the basis that the enrollee’s referral was made by a provider who is not a member of the carrier’s provider network

SECTION 8. Chapter 176I of the General Laws of the General Laws is hereby amended by adding at the end the following new section:

Section 13: a carrier may not deny payment for any health care service covered under an enrollee’s health plan based solely on the basis that the enrollee’s referral was made by a provider who is not a member of the carrier’s provider network

SECTION 9. The provisions this Act shall be effective for all contracts which are entered into, renewed, or amended one year after its effective date.