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HOUSE DOCKET, NO.                 FILED ON: 4/2/2014

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 4024

 

 

The Commonwealth of Massachusetts

 

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In the Year Two Thousand Fourteen

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An Act related to collection of health care co-insurance and deductibles .

 

              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. (a) Notwithstanding any general or special law to the contrary, there shall be a special commission on the recovery of uncollected co-payments, co-insurance and deductibles due from patients for covered services, as required under a carrier’s health benefit plan.

              (b) The commission shall be within the executive office of health and human services, consisting of the secretary of health and human services, who shall serve as chair, the commissioner of insurance or a designee,  the Senate chair of the Joint Committee on Financial Services, the House chair of the Joint Committee on Financial Services, Senate chair of the Joint Committee on Health Care Financing, the House chair of the Joint Committee on Health Care Financing, and 9 members to be appointed by the Governor, 1 of whom shall be a representative of the Massachusetts Association of Health Plans, Inc., 1 of whom shall be a representative of Association Industries of Massachusetts, Inc., 1 of whom shall be a representative of Blue Cross and Blue Shield of Massachusetts, Inc., 1of whom shall be a representative of the Massachusetts Hospital Association, Inc., 1 of whom shall be a representative of the Massachusetts Medical Society,  1 of whom shall be a representative of the Massachusetts Association of Behavioral Health Systems, 1 of whom shall be a representative of the Home Care Alliance of Massachusetts, 1 of whom shall be a representative of the Association for Behavioral Healthcare, and 1 of whom shall be a representative of the Massachusetts League of Community Health Centers, Inc.

              The commission shall adopt rules and establish procedures it considers necessary for the conduct of its business. The commission may expend funds as may be appropriated or made available for its purposes. No action of the commission shall be considered official unless approved by a majority vote of the commission.

              (c) The commission shall conduct an examination and review of: (i) the means and ability of healthcare providers to determine, collect and monitor co-payments, co-insurance and deductibles that are owed from patients who are insured by a carrier as defined under Section 1 of Chapter 176O; (ii) the trend in the amount of uncollected co-payments, co-insurance and deductible payments that result in bad debt to healthcare providers, after healthcare providers have made reasonable collection efforts for the amount owed, over the most recent three years; (iii) the resources  that healthcare providers utilize to monitor and collect co-payments, co-insurance and deductibles from patients; (iv) the ability of and steps necessary for carriers to develop a process to collect such amounts if the collection were to be shifted from healthcare providers to carriers; and (v) an analysis  of the variety of co-payments, co-insurance and deductibles used by carriers.

              (d) The commission shall make recommendations to reduce or eliminate provider bad debt arising from the establishment of patient co-payments, co-insurance and deductibles by carriers. In developing recommendations, the commission shall consider shifting collection responsibility to carriers; establishing a process for carriers to reimburse  providers for the amount of unpaid co-payments, co-insurance and deductibles, as certified annually by providers; requiring carriers to make available to providers access to timely, accurate information about the amount of an individual insured’s unmet deductibles and annual out-of-pocket maximums; and limiting the amount of co-pays, deductibles and co-insurance that can be included in health benefit plans.

              (d) In making its investigation, the commission may consult with healthcare providers, carriers and such other individuals or organizations with expertise in the collection of co-payments, co-insurance and deductibles from patients. The commission shall use data and recommendations gathered in the course of these consultations as a basis for its findings and recommendations.

              (e) The commission shall hold its first meeting no later than July 1, 2014 and shall file a report of its findings and recommendations, including any proposed legislative or regulatory changes needed to implement said findings and recommendations, with the joint committee on financial services and the clerks of the senate and the house of representatives no later than December 17, 2014.

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