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H 5381

An Act relative to provider choice

194th Legislature (2025-2026)

The act strengthens patients’ right to choose their healthcare providers by improving network access, transparency, and protections against surprise or out-of-network billing.

Pending new draft of H2384
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Bill Summary · H 5381

Summary of H 5381 (Massachusetts, 194th Legislature): An Act Relative to Provider Choice

Note: The bill text and final details may be revised as it moves through the legislative process. This summary reflects the information available from the latest action history.

Purpose and Intent

  • The bill is titled “An Act relative to provider choice,” and its central aim is to enhance or codify patients’ ability to choose healthcare providers within certain licensed systems or under specific health coverage arrangements in Massachusetts.
  • It is positioned within the realm of health care access and consumer choice, seeking to remove or reduce barriers that limit where or with whom a patient can receive care.

Key Provisions and Changes (as generally anticipated in provider-choice legislation)

Because the specific bill text is not provided in the action history, the following points reflect common elements of provider-choice bills and the typical direction such measures take. Readers should verify the exact language once a complete draft is available.

  • Provider Selection Rights

    • Establish or reinforce patient rights to choose medical providers (e.g., clinicians, hospitals, or specialists) within approved networks or plans.
    • Potentially clarifies that patients may seek care outside traditional networks under certain conditions, with corresponding protections for cost-sharing or coverage.

  • Network Adequacy and Access

    • Provisions to ensure networks (e.g., in health insurance or managed care) maintain adequate access to a broad range of providers, including primary care and specialty services.
    • May require insurers or health care organizations to maintain sufficient provider-to-enrollee ratios and geographic access standards.

  • Transparency and Information

    • Requirements for clearer information about provider networks, in-network vs. out-of-network costs, and patient rights.
    • Possible mandates for consumer-friendly disclosures about coverage, referral processes, and out-of-network billing.

  • Cost and Billing Protections

    • Protections related to out-of-network billing or balance billing, including caps or prohibitions in certain contexts (emergency care, certain facilities, or specific plans).
    • Potential alignment with state protections against surprise medical bills.

  • Implementation and Oversight

    • Establishment or empowerment of state agencies or designated bodies to monitor compliance, handle complaints, and enforce the act.
    • Possible reporting or biennial reviews to assess effectiveness and access improvements.

Who Would Be Affected

  • Patients/Consumers
    • Benefit from expanded provider choice, clearer information, and protection against unexpected or excessive out-of-network charges.
  • Insurers and Health Plans
    • May need to modify network design, disclosure practices, and claims processing to comply with new requirements.
  • Hospitals and Providers
    • Could face changes in network participation rules, contract negotiations, and reporting obligations.
  • State Regulatory Agencies
    • Expected to administer the new provisions, enforce compliance, and handle enforcement actions or penalties as defined.

Procedural and Timeline Aspects

  • Reported by Committee
    • The bill was reported from the House Committee on Health Care Financing on April 28, 2026.
  • Pending New Draft
    • A note indicates a pending new draft of H 2384, suggesting ongoing revisions or consolidation with related measures before a final vote.
  • Next Steps
    • After reporting, the bill typically proceeds to the House floor for debate and a vote, then to the Senate (where it would undergo its own committee process and potential amendments), and finally to the Governor for signature or veto.
  • Effective Date
    • Any enacted provisions would specify an effective date, either on enactment or with a staged implementation (e.g., one year after passage). The exact timeline would be defined in the final text.

Additional Considerations

  • The current action history indicates ongoing drafting and refinement. To provide a precise, clause-by-clause summary, the final bill text should be consulted when available.
  • Stakeholders may seek clarifications on how “provider choice” interacts with managed care networks, cost-sharing structures, emergency care coverage, and out-of-network protections.

If you’d like, I can incorporate the exact statutory language from the final enacted version (once available) and produce a line-by-line comparison to current Massachusetts statutes.

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

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