An Act to enhance analysis of state health mandates and costs

194th Legislature (2025-2026) Introduced by Bruce Tarr

Requires CHIA evaluation of any proposed state health-mandate regulation using a broadened mandate definition to assess costs, coverage, and market impact before adoption.

House concurred

Purpose and intent

The bill seeks to strengthen, standardize, and formalize how the Commonwealth analyzes health insurance mandates and their associated costs.

It expands definitions of what counts as a mandated health benefit and requires more rigorous evaluation by the Center for Health Information and Analysis (CHIA) before state health mandates are adopted or regulators impose new requirements.

Key provisions

Section 1 – Amendments to the health-mandate framework (Massachusetts General Laws, ch. 3, §38C)

Replaces subsection (a) of §38C with a broader definition of a “mandated health benefit proposal.” A proposal qualifies if it:

Requires coverage for specific services, drugs, diseases, or providers (including pharmacies);
Requires reimbursement for certain services, drugs, diseases, or providers;
Prohibits or limits cost sharing or deductibles for health services, drugs, diseases, or providers;
Mandates specific payment rates for services or drugs, or requires increases in existing payment rates;
Restricts or limits utilization management or medical-necessity determinations (e.g., prior authorizations, concurrent/retrospective reviews, step therapy);
Includes any other provision that would increase health care costs or health insurance coverage for plans offered to Commonwealth employees or within various Massachusetts health-plan structures (state employee plans, Medicaid-related plans, marketplace/insurer plans, HMOs, etc.).

The defined scope explicitly covers a wide array of plans and insurers connected to state programs and Commonwealth employees.

Section 2 – New CHIA-triggered evaluation mechanism (MGL ch. 12C, new §25: Evaluation of regulatory changes)

Creates a new requirement that any state agency or statutorily created board that proposes adding a mandated health benefit by regulation, rule, bulletin, or other guidance must seek review and evaluation by CHIA pursuant to §38C.

CHIA’s evaluation is intended to compile a formal report on the proposed regulation's anticipated costs and impact on health insurance coverage and health care spending.

The section mirrors the broadened definition of “mandated health benefit” used in §38C, ensuring consistency between statutory analysis and regulatory proposals.

Who is affected

State agencies and boards that propose new or enhanced health mandates through regulation.

CHIA (Center for Health Information and Analysis), which would perform formal analyses and issue reports on proposed mandates.

Insurers, third-party administrators, health plans, and providers within Massachusetts’ public and regulated private health coverage ecosystems, given the broadened scope of what constitutes a mandated health benefit.

Procedural and timeline aspects

Status: House concurred on February 27, 2025.

Legislative path: Referred to the House Committee on Health Care Financing (as of the latest actions).

The bill establishes a procedural requirement for CHIA evaluation before implementing proposed mandates (regulatory or legislative), potentially adding a review step to policymaking.

Potential impact

Increased transparency and evidence-based decision-making on health mandates and their costs.

Potentially slower adoption of new mandates due to mandated CHIA reviews, but with more robust cost and market impact data.

Improved budget forecasting for Commonwealth health programs and for private plans serving Massachusetts residents.

Clarity for legislators, regulators, and stakeholders about the financial and utilization effects of proposed health-mandate changes.

Bill