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SD 2480

An Act defining financial responsibility for uncollected co-pays, co-insurance and deductibles

194th Legislature (2025-2026) Introduced by Barry Finegold

Requires insurers to reimburse providers 65% of uncollected patient cost-sharing after reasonable collection efforts, shifting bad debt risk from providers to insurers.

House concurred
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Bill Summary · SD 2480

Summary of Senate Bill SD 2480: An Act defining financial responsibility for uncollected co-pays, co-insurance and deductibles

Overview and purpose

  • Bill number: SD 2480 (Senate Docket No. 758)
  • Title: An Act defining financial responsibility for uncollected co-pays, co-insurance and deductibles
  • Sponsor: Senator Barry R. Finegold
  • Status: House concurred (as of current information)
  • Introduced: February 27, 2025
  • Objective: Establish an equitable funding mechanism to address health care provider bad debt from uncollected patient cost-sharing (co-pays, co-insurance, and deductibles) after reasonable collection efforts.

Key provisions

  • New section added: Section 7A to Chapter 176O of the General Laws (Equitable Funding for Health Care Provider Bad Debt)
    • Carrier obligation: A health insurer/carrier must reimburse a health care provider not less than 65% of each uncollected patient obligation (co-pay, coinsurance, deductible) after reasonable collection efforts.
    • Definitions:
    • Co-payment: fixed dollar amount owed by insured for services.
    • Co-insurance: percentage of the allowed amount owed after any co-payment.
    • Deductible: amount due before the plan pays, excluding premium portions.
    • Eligibility and submission for reimbursement:
    • The claim must derive from uncollected cost-sharing under the insured’s plan.
    • Reimbursement requests relate to claims of at least $250 per unique service per insured.
    • Providers must demonstrate reasonable collection efforts and document that the claim remains unpaid and not under a >120-day payment plan from the first bill.
    • Annual aggregate submission due by May 1 each year for the prior calendar year, including details of collection attempts, insured identity, service date, unpaid amount, amounts collected, and contact methods.
    • Insured eligibility confirmation may be verified; service must be a covered benefit; carriers may audit.
    • Carriers must pay 65% of undisputed amounts within 120 days of receipt; disputes are handled via the existing carrier-provider dispute resolution process.
    • Any amounts collected after reimbursement must be recorded as an offset to future submissions.
    • No prohibition at time of service: Carriers may not prohibit providers from collecting the patient’s cost-sharing at the time of service.
  • Regulatory framework (Section 2):
    • The state division (of Insurance/Health Care Regulation) must issue regulations within 90 days aligning with CMS guidelines on reasonable collection efforts (CMS rules for bad debt collection).
    • If the division fails to issue regulations, the act is self-implementing, applying CMS HIM-15 (Pub. 15-1 and 15-2) methodologies.
    • Annual reporting requirement: carriers must provide the division with total uncollected cost-sharing reimbursed and denied; the report must be publicly available.

Affected parties

  • Health care providers: May recover a portion (65%) of uncollected patient cost-sharing after meeting criteria and submitting documentation.
  • Health insurance carriers: Responsible for reimbursing eligible provider claims at 65% and conducting/allowing audits; must implement dispute resolution processes and annual reporting.
  • Insured patients: Affected indirectly, as the policy sets expectations for how cost-sharing is collected and how bad debt is handled.

Procedural and timeline notes

  • Regulations: Division required to issue rules within 90 days of enactment; default federal CMS-based process if regulations are not issued.
  • Annual cycle: May 1 deadline for aggregate reimbursement requests.
  • Payment timeline: Carriers to pay undisputed amounts within 120 days of receipt of the request.
  • Audit and dispute: Carriers may audit; disputes resolved under existing carrier-provider dispute resolution processes.

Potential impact

  • Clarifies financial responsibility for patient cost-sharing that remains uncollected.
  • Shifts some bad debt risk from providers to carriers, potentially improving provider cash flow.
  • Introduces formal documentation, reporting, and regulatory alignment with CMS guidelines.
  • Public reporting may increase transparency around uncollected cost-sharing and reimbursement outcomes.

Compiled from official sources — confirm details with the bill’s official record.

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