HOUSE DOCKET, NO. 1776        FILED ON: 1/15/2025

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 1343

The Commonwealth of Massachusetts

_________________

PRESENTED BY:

Thomas P. Walsh

_________________

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.

_______________

PETITION OF:

HOUSE DOCKET, NO. 1776        FILED ON: 1/15/2025

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 1343

[SIMILAR MATTER FILED IN PREVIOUS SESSION
SEE HOUSE, NO. 1160 OF 2023-2024.]

The Commonwealth of Massachusetts

_______________

In the One Hundred and Ninety-Fourth General Court
(2025-2026)

_______________

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 thereof

Section 31. 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 9 of chapter 94C of the General Laws, as so appearing, is hereby amended by striking the following words in lines 31-32 of paragraph (b):- “in a single dose or in a quantity” and;

By striking in line 35 the words, “essential for the treatment of a patient” and add the words, “which is for a legitimate medical purpose by a practitioner acting in the usual course of his professional practice.” and;

By striking in lines 35-39 the words, “The amount or quantity of any controlled substance dispensed under this subsection shall not exceed the quantity of a controlled substance necessary for the immediate and proper treatment of the patient until it is possible for the patient to have a prescription filled by a pharmacy.”; and

By striking in lines 91-93 of paragraph (e) the lines “and shall be except from the requirement that such dispensing be in a single dose or as necessary for immediate and proper treatment under subsection (b).

SECTION 4. Section 19 of said chapter 94C shall be amended by inserting in line 6 of paragraph (a) after the word “prescription” “or practitioner who dispenses the controlled substance.”

SECTION 5. Section 118E of the General Laws of the General Laws is hereby amended by adding after Section 13C 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 6. Chapter 175 of the General Laws is hereby amended by adding the following new section:

Section 47QQ. 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 176A of the General Laws of the General Laws is hereby amended by adding at the end the following new section:

Section 39. 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 176B of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by inserting at the end thereof the following new section:

Section 26. 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. Chapter 176G of the General Laws of the General Laws is hereby amended by adding at the end the following new section:

Section 34. 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 10. Chapter 176I of the General Laws of the General Laws is hereby amended by adding at the end the following new section:

Section 14. 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 11. Section’s 1-2 and 5-10 of this Act shall be effective for all contracts which are entered into, renewed, or amended one year after its effective date.