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H 1375

An Act prohibiting surprise outside billing

194th Legislature (2025-2026) Introduced by Kim Ferguson and 5 co-sponsors

The bill would create a commission to study and recommend policies to prevent surprise outside billing, including bundled service pricing and potential prohibitions.

Accompanied a study order, see H5066
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Bill Summary · H 1375

Summary: H.1375 – An Act prohibiting surprise outside billing

Overview

H.1375, introduced February 27, 2025, would establish a temporary commission to study and recommend policy options aimed at addressing and preventing “surprise outside billing” in Massachusetts. Rather than immediate rate-setting or prohibitions, the bill creates a dedicated body to evaluate bundled-service billing models and to propose legislation or regulations designed to curb surprise charges from out-of-network providers.

Purpose and intent

  • Main goal: Explore and assess policies that require bundled packages of services (including fees for all relevant physicians) to limit or prevent surprise outside billing for patients.
  • Seek to learn from other states’ approaches and to develop comprehensive recommendations for state action.
  • Potential outcomes include prohibiting surprise outside billing, ensuring patients are held harmless by insurers, and extending any applicable regulations to all provider types (including HMOs and PPOs).

Key provisions

Section 1–2: Establishment and governance

  • Creates a commission to study and provide recommendations on policies to address surprise outside billing.
  • The commission is chaired by the chairs of the joint committee on health care financing (house and senate), with additional members appointed by:
    • Speaker of the House
    • President of the Senate
    • House minority leader
    • Senate minority leader
    • Director of the Health Policy Commission (or designee)
    • Commissioner of the Department of Public Health (or designee)
    • Executive Director of the Center for Health Information and Analysis (or designee)

Section 3: Scope of review

  • The commission will consider the effectiveness of policies that require hospitals and other health care providers to sell bundled packages of services that include fees for all relevant physicians (e.g., anesthesiologists, pathologists, radiologists).
  • Will evaluate similarities to laws in other states.
  • Will develop recommendations on:
    • Prohibiting surprise outside billing
    • Requiring insurers to hold members harmless
    • Extending regulations across all providers, including HMOs and PPOs

Section 4: Reporting

  • The commission must report findings, recommendations, and drafted legislation to specified House/Senate committees and clerks within 12 months of passage.

Who is affected

  • Hospitals and other health care providers that currently bill for bundled services with separate physician fees.
  • Physicians who practice in hospital or out-of-network settings (e.g., anesthesiologists, pathologists, radiologists).
  • Health insurers (including carriers and plans offered by HMOs and PPOs).
  • Massachusetts patients who could otherwise face surprise charges from out-of-network clinicians in in-network settings.

Procedural timeline and status

  • Introduced: February 27, 2025
  • Referred to Health Care Financing (02/27/2025)
  • Senate concurred (04/03/2025); Discharged to the Committee on Financial Services (03/31/2025)
  • Hearing: Scheduled for July 15, 2025, from 10:00 AM to 1:00 PM (A-2)
  • Related action: HD 2242 (replaces) noted in related bills
  • Notable: The current form emphasizes study and recommendation rather than immediate regulatory action; any substantive prohibitions or mandates would rely on subsequent drafted legislation arising from the commission’s report.

Next steps

  • The commission would convene, gather data, hear testimony, and prepare a report with legislative recommendations within 12 months.
  • Policymakers and stakeholders should monitor the hearing and any subsequent committee actions for updates on proposed statutory changes stemming from the commission’s findings.

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

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