Healthcare (Insurance)

in committee · Massachusetts · House Jul 29, 2026

H 4616: An Act improving the health insurance prior authorization process

H 4616 requires health insurance companies in Massachusetts to publicly list all medical services, drugs, and procedures needing pre-approval (prior authorization) on their websites. Insurers must also report annual data on approval/denial rates, processing times, and appeal outcomes in a standardized format. The bill prevents insurers from denying coverage for services already approved or denying claims over minor administrative errors (unless fraud is proven), and bans retrospective denials unless fraud occurred. This directly affects insurers, healthcare providers, and patients by making the authorization process more transparent and reducing unexpected coverage denials.

Topics ✓ HealthcareSupports HealthcareRequires insurers to disclose prior auth requirements and prevent unjust denials, improving patient access and protecting rights.95% confidence

Sub-Topics Insurance

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passed · Massachusetts · House Jan 28, 2026

H 4162: An Act to increase access to healthcare for ostomy patients

By Representative Consalvo of Boston, a petition (accompanied by bill, House, No. 4162) of Rob Consalvo relative to insurance coverage for healthcare for ostomy patients. Financial Services.

Topics ✓ HealthcareSupports HealthcareBill explicitly aims to increase healthcare access for ostomy patients via insurance coverage expansion, directly advancing patient access and coverage under healthcare policies.95% confidence

Sub-Topics Insurance

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introduced · Massachusetts · Senate

SD 530: An Act relative to health care non-discrimination

SD 530 (An Act relative to health care non-discrimination) requires health insurance carriers to design payment models (like capitation or global budgets) that fairly account for patient needs, such as age, health conditions, and social factors, rather than using historical costs tied to specific providers. It prohibits carriers from basing payments on provider prices or past spending from subsets of their network. Carriers must report payment model details to the Center for Health Information and Analysis for compliance checks, and violations will be treated as unfair business practices under Chapter 93A. The bill directly affects health insurance companies and healthcare providers participating in these payment arrangements.

Topics ✓ HealthcareSupports HealthcareRequires fair insurance payment models accounting for patient needs, preventing discrimination based on historical provider costs, improving equitable access to care.95% confidence

Sub-Topics Insurance

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introduced · Massachusetts · House

HD 907: An Act to reduce inequities in access to medical procedures

This bill prohibits health insurance companies from reducing payments to healthcare providers for evaluation visits or procedures when multiple covered services (like minor surgery) are provided during the same appointment. It specifically stops insurers from penalizing providers financially for offering comprehensive care in a single visit. The law directly affects doctors, clinics, and hospitals that bill for multiple services per patient encounter. It ensures providers receive full payment for all covered services rendered on the same day, removing a financial barrier to integrated care.

Topics ✓ HealthcareSupports HealthcareBill prohibits insurers from reducing payments for multiple services in one visit, ensuring full provider compensation and improving patient access to comprehensive care without financial penalties.95% confidence

Sub-Topics Insurance

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introduced · Massachusetts · House

HD 951: An Act relative to unilateral contract changes

This bill prohibits health insurance companies from including clauses in contracts with healthcare providers that allow termination without cause or unilateral changes to key terms like payment rates, covered services, or quality policies. It requires insurers to provide written notice of any proposed changes at least 90 days before the contract renewal date, with changes only taking effect after the current contract term ends. The state health insurance commission must also avoid purchasing policies from insurers that violate these rules. The law directly affects healthcare providers (doctors, clinics, hospitals) and insurers by increasing contract stability and transparency.

Topics ✓ HealthcareSupports HealthcareProhibits insurers from unilateral contract changes affecting payment rates/services, protecting provider stability and patient access to consistent care.85% confidence ✓ Labor & EmploymentSupports Labor & EmploymentProtects healthcare providers' payment stability and contract terms from unilateral insurer changes, advancing workers' rights in employment agreements.90% confidence

Sub-Topics Insurance

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introduced · Massachusetts · House

HD 1256: An Act relative to uncollected co-pays, co-insurance and deductibles

This bill requires health insurance carriers to reimburse healthcare providers 65% of unpaid patient co-pays, co-insurance, and deductibles after providers make documented reasonable collection efforts (e.g., 120+ days of contact attempts). It directly affects healthcare providers who struggle to collect these patient payments, particularly for claims over $250 per unique service. Providers must submit annual aggregated requests by May 1 with documentation of collection efforts, and carriers must pay within 120 days of receiving valid submissions. The law aims to reduce provider financial strain from uncollected patient costs while referencing CMS guidelines for collection standards.

Topics ✓ HealthcareSupports HealthcareRequiring insurers to reimburse providers for unpaid patient costs prevents service cuts and maintains access to care, directly supporting healthcare delivery.90% confidence

Sub-Topics Insurance

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introduced · Massachusetts · House

HD 1608: An Act relative to health insurance and incarcerated individuals

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.

Topics ✓ Criminal JusticeSupports Criminal JusticeBill mandates health insurance coverage for incarcerated individuals' medically necessary care, including waiving fees for non-preferred providers. This improves correctional health care access, aligning with criminal justice reform goals to enhan...90% confidence ✓ HealthcareSupports HealthcareMandates insurers cover medically necessary care for incarcerated individuals with insurance, waiving co-pays and extra fees, expanding healthcare access for this population.95% confidence

Sub-Topics Corrections Insurance

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introduced · Massachusetts · House

HD 1818: An Act relative to parental choice for medically fragile students

This bill requires health insurance policies (including group plans, hospital services, and health maintenance contracts) to cover medically necessary treatments for students with disabilities, as specified in their individual education plans or similar federal special education documents. It directly affects students with disabilities whose care is outlined in these plans and their families, ensuring insurers cannot deny coverage based on disability. The law mandates that all qualifying insurance policies issued or renewed after January 1, 2024, provide equal coverage for these treatments without discrimination. It applies broadly to all relevant insurance products under Massachusetts law, aligning with existing federal special education requirements.

Topics ✓ EducationSupports EducationMandates insurance coverage for medically necessary treatments per IEPs, directly enabling educational access for students with disabilities by removing coverage barriers.95% confidence ✓ HealthcareSupports HealthcareMandates insurance coverage for medically necessary treatments for students with disabilities, preventing denial based on disability - directly expands health coverage access.95% confidence

Sub-Topics Special Education Student Health Hospitals Insurance

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introduced · Massachusetts · House

HD 1913: An Act to address barriers to HIV prevention medication

HD 1913 requires health insurance plans covering HIV prevention medication (pre-exposure prophylaxis, or PrEP) to provide full coverage without out-of-pocket costs. It applies to Commonwealth employee health insurance, state health plans, and accident/sickness insurance policies. The bill eliminates cost-sharing (like copays or deductibles), removes prior authorization requirements, and prohibits denying coverage based on the prescriber's type or location. It ensures access to PrEP drugs and required monitoring services (like lab tests or counseling) as defined by federal health agencies. This directly affects individuals seeking HIV prevention medication through these specific insurance programs.

Topics ✓ HealthcareSupports HealthcareEliminates cost barriers for PrEP coverage, expanding access to HIV prevention medication under insurance plans per bill's full coverage mandate.95% confidence

Sub-Topics Insurance

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introduced · Massachusetts · House

HD 1929: An Act providing insurance coverage for biennial echocardiograms for persons under the age of 18

This bill requires all health insurance plans sold in Massachusetts - including state employee group plans, individual policies, and hospital service agreements - to cover biennial echocardiograms (heart screenings) and concussion analysis for children aged 5 to 18. It directly affects insurers and policyholders by mandating this specific preventive care coverage for youth. The key provision adds new requirements to multiple chapters of state law, ensuring consistent coverage across all medical insurance types in the commonwealth. The policy change focuses on making these screenings accessible without out-of-pocket costs for families.

Topics ✓ HealthcareSupports HealthcareMandates insurance coverage for preventive pediatric heart screenings, expanding access to essential healthcare services for children.95% confidence

Sub-Topics Hospitals Insurance Primary Care

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