HOUSE DOCKET, NO. 4570        FILED ON: 11/2/2021

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 4268

The Commonwealth of Massachusetts

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PRESENTED BY:

William C. Galvin

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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 fair and equitable compensation for medical services.

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PETITION OF:

HOUSE DOCKET, NO. 4570        FILED ON: 11/2/2021

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 4268

The Commonwealth of Massachusetts

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In the One Hundred and Ninety-Second General Court
(2021-2022)

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An Act relative to fair and equitable compensation for medical services.

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

Section 16 of chapter 176O of the General Laws is hereby amended by striking out subsection (c) and inserting in place thereof the following subsections:

(c) Carriers are prohibited from reducing the payment of a negotiated rate for evaluation and management or procedural services under a participating provider agreement that are furnished by a participating provider and that are otherwise covered services solely because the provider also billed other health care services, including but not limited to minor surgery, on the same day as the evaluation and management or procedural services. Any provision of a provider agreement that allows for a reduction in reimbursement as prohibited by this subsection shall be void.

(d) With respect to an insured enrolled in a health benefit plan under which the carrier or utilization review organization only provides administrative services, the obligations of a carrier or utilization review organization created by this section and related to payment shall be limited to recommending to the third party payor that coverage should be authorized.