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H 4338

Building codes

2025-2026 Regular Session Introduced by Brandon Cox and 2 co-sponsors

Mass. H.4338 bars insurers from lowering negotiated payments for evaluation/management or procedures when other same-day services are billed, protecting provider revenue.

Referred to Committee on Labor, Commerce and Industry
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Bill Summary · H 4338

Summary of Massachusetts H.4338: An Act to reduce inequities in access to medical procedures

Overview

H.4338, introduced July 31, 2025, seeks to reduce inequities in access to medical procedures by restricting certain payer reimbursement practices. The bill amends Chapter 176O of the General Laws to prohibit insurance carriers from reducing negotiated payments for evaluation and management (E&M) or procedural services when the provider also bills for other health care services on the same day. It also clarifies the duties of carriers or utilization review organizations in plans where they provide only administrative services.

Key Provisions

  • Section 16(c): Prohibits carriers from reducing the payment of a negotiated rate for E&M or procedural services under a participating provider agreement solely because the provider also billed other health care services (including minor surgery) on the same day. Any contract provision that allows such a reduction is void. This ensures that the presence of on-the-same-day bundled services cannot be used to justify lowering reimbursement for the E&M or procedural services.

  • Section 16(d): For insureds enrolled in health benefit plans where the carrier or utilization review organization provides only administrative services, the carrier’s or UR’s payment-related obligations are limited to recommending to the third-party payor that coverage should be authorized. This clarifies the payer’s administrative role in such plans.

Affected Parties

  • Providers (physicians, specialists, and other participating providers) who deliver E&M and procedural services under negotiated agreements with carriers.
  • Insurance carriers and utilization review organizations operating under Massachusetts health plans.
  • Insured patients enrolled in plans where carriers/URs provide administrative services.
  • Providers and payers may need to adjust provider agreements to ensure compliance with the new prohibitions.

Legislative Status and Timeline

  • Introduced: July 31, 2025.
  • Current status: Reported favorably by the Committee on Financial Services and referred to the Committee on Health Care Financing.
  • Related actions: New draft of House Petition 1162 accompanying H.4338 was filed on July 31, 2025.
  • Filing date: July 25, 2025.

Practical Impact

  • Aims to reduce payment inequities by preventing downward adjustments to negotiated rates based on the billing of other services on the same day.
  • Could improve access to care by stabilizing provider reimbursement, potentially encouraging physicians to offer comprehensive services without fear of reduced payments.
  • May necessitate revisions to provider agreements and internal payer policies to ensure alignment with the statute.

Notes

  • The bill amends Section 16 of Chapter 176O, which governs certain health insurance payment practices in Massachusetts.
  • The text emphasizes protections against penalizing providers for offering multiple services in a single encounter.

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

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