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December 06, 2025 Clouds | 28°F
The 194th General Court of the Commonwealth of Massachusetts
  1. General Laws
  2. Part I ADMINISTRATION OF THE GOVERNMENT
  3. Title II EXECUTIVE AND ADMINISTRATIVE OFFICERS OF THE COMMONWEALTH
  4. Chapter 6D HEALTH POLICY COMMISSION
  5. Section 12 Negotiation of network contracts by unregistered provider or provider organization prohibited

Section 12

Section 12: Negotiation of network contracts by unregistered provider or provider organization prohibited

[ Subsection (a) effective until April 8, 2025. For text effective April 8, 2025, see below.]

  Section 12. (a) No provider or provider organization may negotiate network contracts with any carrier or third-party administrator except for a provider or provider organizations which are registered under this chapter and regulations promulgated under this chapter; provided, however, that nothing in this chapter shall require a provider or provider organization with a patient panel of 15,000 or fewer or which represents providers who collectively receive, less than $25,000,000 in annual net patient service revenue from carriers or third-party administrators to be registered if such provider or provider is not a risk-bearing provider organization.

[ Subsection (a) as amended by 2024, 343, Sec. 23 effective April 8, 2025. For text effective until April 8, 2025, see above.]

  (a) No provider or provider organization may negotiate network contracts with any carrier or third-party administrator except for a provider or provider organizations which are registered under this chapter and regulations promulgated under this chapter; provided, however, that nothing in this chapter shall require a provider or provider organization with a patient panel of 15,000 or fewer or which represents providers who collectively receive, less than $25,000,000 in annual net patient service revenue from payers to be registered if such provider or provider is not a risk-bearing provider organization.

  (b) Nothing in this chapter shall require a carrier to negotiate a network contract with a registered provider organization or with a registered provider or provider organization for all providers that are part of, or represented by, a registered provider organization.