Amendment ID: S3116-12

Amendment 12

Direct Primary Care

Mr. Moore moves that the proposed new draft be amended by inserting after section __ the following sections:-

SECTION __. Chapter 32A of the General Laws, as appearing in the 2022 Official Edition, is hereby amended by adding the following section:-

“Section 35. 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 __. Chapter 32B of the General Laws, as so appearing, is hereby amended by adding 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 __. 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 inserting in place thereof the following 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 words:- “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 __. Section 19 of said chapter 94C, as so appearing, shall be amended by inserting in line 6 of paragraph (a) after the word “prescription”, the following words:- “or practitioner who dispenses the controlled substance.”

SECTION __. Chapter 118E of the General Laws, as so appearing, is hereby amended by inserting 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 __. Chapter 175 of the General Laws, as so appearing, is hereby amended by inserting after section 47QQ the following section:

“Section 47QQ1/2. 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 __. Chapter 176A of the General Laws, as so appearing, is hereby amended by adding 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 __. Chapter 176B of the General Laws, as so appearing, is hereby amended by adding 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 __. Chapter 176G of the General Laws, as so appearing, is hereby amended by adding 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 __. Chapter 176I of the General Laws, as so appearing, 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 __. 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.