This bill establishes a public health insurance option in Massachusetts, creating a state-run plan available through the Commonwealth Connector. It will directly affect eligible individuals (residents not offered employer-sponsored coverage with 50+ employees) and small groups (1-50 employees) starting January 1, 2027, with large groups (51+ employees) added by July 1, 2027. The plan must meet the same quality and affordability standards as private plans approved by the Connector, use Medicare-based payment rates for providers, and cover all costs through premiums. It will operate alongside existing private plans but will be administered by the Connector, with providers automatically participating unless they opt out.
HD 1608 requires health insurance carriers to cover all medically necessary care for incarcerated individuals who have health insurance through themselves or their family. If the individual or family cannot pay co-pays or deductibles, the insurance company can seek reimbursement from the Department of Corrections instead. The bill also mandates that insurers waive extra fees for using non-preferred medical providers while the person is incarcerated. This directly affects incarcerated people with health insurance, their insurers, and the Department of Corrections.
This bill requires health insurance plans covering commonwealth employees (under group insurance) and Medicaid enrollees to cover biomarker testing - tests analyzing tissue or blood to identify biological markers for guiding treatment - when supported by medical evidence like FDA approvals, clinical guidelines, or CMS determinations. Insurers must approve or deny prior authorization requests within 72 hours (24 hours in emergencies), with automatic approval if no response is given. The bill also mandates coverage without unnecessary disruptions, such as multiple biopsies, to ensure continuous patient care.
This bill prohibits health insurance carriers from lowering reimbursement rates for doctors' evaluation/management or procedural services solely because the provider also billed other covered services (like minor surgery) on the same day. It directly affects medical providers and insurers by voiding any contract terms allowing such payment reductions. The key provision ensures providers aren't penalized financially for delivering multiple covered services during a single patient visit, promoting fair payment for comprehensive care.
This bill requires most health insurance plans in Massachusetts to set a separate yearly maximum out-of-pocket limit specifically for prescription drugs (including specialty drugs). This limit cannot exceed the federal minimum annual deductible for high-deductible health plans (as defined in the Internal Revenue Code). It applies to all policies covering prescription drugs delivered, issued, or renewed after January 1, 2025, directly affecting patients who use prescription medications. The limit includes standard drug costs like copays and coinsurance, as defined under federal law.
This bill (HD 3215) modifies Massachusetts health insurance regulations to increase enrollment in affordable health plan networks. It creates exemptions for insurance carriers if most members are in single-rate regions, subsidized coverage (Chapter 176Q), or if 80%+ income comes from government programs. The bill also requires carriers to include entire provider groups in networks on an "all-or-nothing" basis, rather than selectively adding providers to select or tiered networks. These changes primarily affect health insurance carriers operating in Massachusetts, aiming to simplify network requirements for certain plans and improve access to providers for enrollees.
By Representative Lewis of Framingham, a petition (accompanied by bill, House, No. 1246) of Jack Patrick Lewis that the Commonwealth Connector Authority provide for a public health insurance option. Financial Services.
By Representative Decker of Cambridge, a petition (accompanied by bill, House, No. 1136) of Marjorie C. Decker and others relative to the health insurance prior authorization process. Financial Services.
