Healthcare

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 1564: An Act providing insurance coverage for Alfi’s syndrome

This bill requires health insurance plans to cover diagnosis and treatment for Alfi's syndrome (a genetic condition also known as 9p deletion syndrome) on the same terms as coverage for physical conditions. It mandates no annual or lifetime dollar limits for this care, prohibits restrictions on the number of visits to Alfi's syndrome providers, and requires coverage for specified services including habilitative/rehabilitative care, pharmacy care, psychiatric care, psychological care, and therapeutic care. The law applies to all health plans offered through the state group insurance commission and ensures coverage isn't subject to lower limits than those for physical health conditions. It does not affect existing benefits or school-based services provided under individualized education plans.

Topics ✓ HealthcareSupports HealthcareMandates comprehensive insurance coverage for Alfi's syndrome including mental health services, no coverage limits, and prohibits visit restrictions, expanding patient access and protecting rights.95% confidence

Sub-Topics Prescription Drugs

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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 1587: An Act to prevent medical debt by restoring health safety net eligibility levels

HD 1587 expands eligibility for the health safety net program to cover uninsured or underinsured patients earning up to 400% of the federal poverty level (FPL), directly affecting low-to-moderate income residents who previously faced gaps in care. It establishes that patients earning between 200%-400% FPL may have a deductible, while those below 200% FPL have full coverage. The bill also mandates retroactive eligibility for 180 days prior to an application. Additionally, it creates a task force to study the Health Safety Net Trust Fund's financing, including hospital payments and reimbursements, with a report due to the legislature within one year.

Topics ✓ HealthcareSupports HealthcareExpands health safety net coverage to 400% FPL, provides full coverage below 200% FPL, and enables retroactive eligibility for uninsured patients.95% confidence

Sub-Topics Hospitals

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introduced · Massachusetts · House

HD 2059: An Act relative to opioid use disorder treatment and rehabilitation coverage

HD 2059 requires Massachusetts health insurance plans to cover medications for opioid use disorder (like naloxone and buprenorphine) without prior authorization, prescriptions, or cost-sharing (deductibles, copays). It directly affects Commonwealth employees (via group insurance), Medicaid patients, and private insurance holders in Massachusetts. The bill mandates coverage as both a medical benefit (when administered at treatment facilities) and pharmacy benefit, with facilities reimbursed at standard rates to prevent balance billing. It also specifies that cost-sharing may still apply if a plan would lose tax-exempt status under IRS rules.

Topics ✓ Criminal JusticeSupports Criminal JusticeMandates opioid treatment coverage as rehabilitation, directly advancing criminal justice reform by reducing recidivism through accessible medical care.90% confidence ✓ HealthcareSupports HealthcareMandates insurance coverage for opioid treatment without cost-sharing, expanding access to critical care and aligning with healthcare access indicators.95% confidence

Sub-Topics Drug Policy Prescription Drugs Substance Abuse

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introduced · Massachusetts · House

HD 2117: An Act advancing health care research and decision-making centered on patients and people with disabilities

This bill (HD 2117) requires Massachusetts healthcare agencies (Division of Medical Assistance and Health Policy Commission) to use patient-centered research standards when making coverage and treatment decisions. It mandates that research must prioritize outcomes valued by patients and people with disabilities, include analysis of diverse patient subgroups, and follow rigorous scientific practices. Crucially, it prohibits agencies from using "dollars-per-quality adjusted life year" or similar cost-effectiveness metrics to deny coverage or set payment rates. The bill also requires clear appeals processes for physicians to override coverage denials. These changes directly affect how state healthcare decisions are made, aiming to ensure patient perspectives shape coverage policies.

Topics ✓ Budget & TaxesSupports Budget & TaxesProhibits cost-effectiveness metrics (e.g., dollars-per-QALY) in healthcare decisions, removing fiscal constraints and enabling increased government healthcare spending.85% confidence ✓ HealthcareSupports HealthcareMandates patient-centered research standards for coverage decisions, prioritizes patient-valued outcomes, and prohibits cost-based metrics like QALYs that could limit access.95% confidence

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introduced · Massachusetts · House

HD 1660: An Act authorizing pharmacists to provide opioid use disorder treatment

This bill requires Massachusetts insurers to cover opioid use disorder treatment provided by pharmacists at rates comparable to other nonphysician health providers. It mandates coverage under group insurance (Chapter 32A), Medicaid plans (Chapter 118E), private health insurance policies (Chapter 175), and hospital service plans (Chapter 176A). Pharmacists must be reimbursed for this service if it aligns with their scope of practice and would be covered if provided by a physician or nurse practitioner. The policy directly affects patients seeking opioid treatment and pharmacists who can now deliver this care with guaranteed insurance reimbursement.

Topics ✓ HealthcareSupports HealthcareMandates insurer coverage for pharmacist-provided opioid treatment under multiple insurance frameworks, expanding access to substance use disorder care.95% confidence

Sub-Topics Healthcare Workforce Hospitals Substance Abuse

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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 · Senate

SD 993: An Act to ensure timely health care cost reporting and protecting not-for-profit patient care

This bill (SD 993) requires health care providers to submit cost reports on time and blocks for-profit companies from taking over non-profit hospitals. It amends reporting rules to make submission mandatory ("shall" instead of "may") and adds a requirement for the state center to define "just cause" for reporting exemptions. Crucially, it prohibits for-profit entities from obtaining licenses to operate acute-care hospitals if they acquire a non-profit hospital after April 1, 2024, through sales, mergers, or similar transactions. The bill directly affects hospitals seeking new licenses or renewals and health care providers responsible for cost reporting.

Topics ✓ HealthcareSupports HealthcareMandates timely cost reporting and prohibits for-profit hospital takeovers, protecting non-profit community care and patient access per bill title and summary.95% confidence

Sub-Topics Hospitals

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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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