Bill
S 842
Massachusetts hospitals must adopt statewide uniform charity care policies with income-based tiers up to 400% FPL and pause collections during financial aid applications.
Purpose
- Establish statewide minimum standards requiring Massachusetts acute hospitals to adopt uniform, accessible financial assistance (charity care) policies to reduce medical debt for low- and moderate‑income patients and to protect patients during hospital billing and collections.
Main definitions added
- Creates Section 69B in Chapter 118E and defines: “charity care,” “debt buyer” (excludes buyers who purchase to forgive debt), “eligible person,” “financial assistance policy,” “hospital” (acute hospital and outpatient facilities under common control), “medical hardship” (household income ≤600% FPL with out‑of‑pocket medical costs >10% of gross household income), and “medically necessary services.”
Key provisions
- Hospitals must adopt, implement and maintain a financial assistance policy covering emergency and medically necessary services available at any time after services are provided (including during collections).
- Eligibility and discounts for the patient responsibility portion of hospital bills:
- ≤200% of Federal Poverty Level (FPL), or qualifying medical hardship: free care (100% discount).
- 201–300% FPL: 75% discount.
- 301–350% FPL: 50% discount.
- 351–400% FPL: 25% discount.
- Prohibitions on eligibility considerations: hospitals may not consider a person’s immigration status, the total cost of services, or contract language with payors that would limit offering assistance (such contract provisions are void).
- Notice and access requirements:
- Written and verbal notice of the policy during intake/registration and at discharge.
- Prominent public posting of policy in languages spoken by the lesser of 1,000 people or 5% of the community served, in admissions, EDs, and billing areas.
- Make the policy, a plain‑language summary, and a uniform application available on hospital websites, patient portals, and billing statements in required languages.
- Billing statements must prominently state (in English and the second most spoken language in the service area) that patients may qualify for free or discounted care and provide contact information.
- Application and appeals:
- Hospitals must notify applicants that they may disregard bills while their financial assistance application is pending and must provide notice of approvals/denials and an appeals process.
- Administrative development (text truncated in provided document):
- The bill tasks the Executive Office and Health Policy Commission, in consultation with other state offices and stakeholders, to develop a uniform application form, plain‑language summary, and regulations to implement the policy.
Who is affected
- Patients: Low‑ and moderate‑income residents (particularly those up to 400% FPL and those meeting the medical hardship test) will gain stronger protections and predictable discounts or free care.
- Hospitals: Required to create/maintain policies, perform eligibility determinations, change billing/notice practices, and pause collections during application review.
- Collections industry/debt buyers: The bill defines debt buyers and implies constraints on collections while assisting patients; debt buyers who buy to forgive debt are excluded from the definition.
- Insurers/providers: Contract clauses that restrict hospital charity care are voided.
Procedural history and notes
- Presented in the Massachusetts General Court by Senator Joanne M. Comerford (filed 1/16/2025); introduced to the Senate 3/4/2025.
- Referred to relevant committees; hearing scheduled 5/12/2025; placed on Senate calendar 4/28/2025; listed as accompanying S.857 on 6/16/2025.
- Data provided also includes entries (committees, sponsors) that appear to reference federal proceedings (e.g., Committee on Foreign Relations, U.S. sponsors). These entries conflict with the Massachusetts provenance of the bill and may reflect a data conflation; the core bill text summarized above is the Massachusetts State Senate bill (No. 842 / Section 69B of Chapter 118E).
Potential impact
- Would substantially expand and standardize hospital financial assistance, reduce patient medical debt and unexpected collections, improve language access and transparency, and limit contract or administrative barriers that previously restricted charity care. Implementation details (uniform application, timelines, enforcement) depend on regulations to be developed by state agencies (text truncated in provided copy).
Compiled from official sources — confirm details with the bill’s official record.
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