Bill
S 692
The bill requires insurers and public/private health plans to cover and reimburse patient navigation services provided by certified community health workers to improve access to ca
Summary — Senate Bill No. 692 (2025)
(Note: the materials provided contain conflicting metadata. The bill text filed as Senate Docket No. 1141 / Senate No. 692 is a Massachusetts bill to expand coverage of patient navigation by community health workers. The header information you supplied (title about the town of Massena issuing bonds to cover pension contributions) does not match the attached bill text. This summary addresses the actual bill text included in your packet.)
Purpose
- To expand access to patient navigation services by requiring coverage and reimbursement for community health worker–delivered patient navigation across state-regulated public and private health plans, with the aim of improving timely access to quality health care.
Key provisions
- New statutory insertion: Chapter 118E, section 10R.
- Definitions:
- “Community health worker” — a frontline worker who links patients, providers, social services and community resources to facilitate access to physical, behavioral and preventive care and services addressing social determinants of health.
- “Patient navigation services” — enumerated services provided by community health workers, including:
1. Chronic disease prevention, screening and disease‑progression mitigation (e.g., cancer).
2. Screening for nonclinical and social needs and referrals to appropriate services/agencies.
3. Group and individual health education to prevent illness and promote healthy behaviors.
4. Health coaching, navigation, advocacy and transition‑of‑care supports.
5. Addressing cultural/language/health‑literacy barriers to understanding treatment.
6. Diagnosis‑related education for treatment and self‑management, including adherence support.
7. Other services approved by the Division of Insurance.
- Coverage requirement: The Division of Insurance and insurers/health plans under contract (including HMOs, behavioral health management firms, and third‑party administrators for Medicaid managed care organizations or primary care clinician plans) must provide coverage for patient navigation services to improve access to screening, follow‑up and treatment.
- Reimbursement conditions: Payment is required for individuals who have completed a national patient navigation certification/credential program or another certification/training approved by the Executive Office of Health and Human Services (EOHHS).
- Federal funding and authorization: EOHHS must seek any necessary federal authorizations and seek to maximize federal financial participation for these benefits.
- Implementation/regulation: The Office of Medicaid must promulgate regulations or guidance to implement the section.
- Effective date: Applies to all contracts entered into, renewed, or amended on or after January 1, 2026.
Who is affected
- Patients who would receive navigation supports (Medicaid enrollees and members of private plans subject to the Division’s contracts).
- Community health workers (who must meet certification/training standards to be reimbursed).
- Insurers, HMOs, behavioral health firms, Medicaid MCOs, primary care clinician plans, and third‑party administrators that contract under the Division of Insurance.
- EOHHS and the Office of Medicaid (rulemaking and federal coordination responsibilities).
Legislative/procedural status (as provided)
- Filed as Senate Docket No. 1141 / Senate No. 692 (presented by Senator Brendan P. Crighton).
- Read twice and referred to Committee on Finance (2/24/2025); hearing scheduled 10/08/2025 (Gardner Auditorium).
- Materials also show other committee referrals and docketing activity; verify current status with the legislative clerk.
Recommendation
- Confirm which bill you intend to track (the Massena bonds item in your header appears to be a different measure). If you want a summary of the Massena bond/pension measure, please provide the correct bill text or docket.
Compiled from official sources — confirm details with the bill’s official record.
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