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S 818

Relates to cannabis showcase event permits

2025 Regular Session Introduced by Michelle Hinchey and 1 co-sponsor

The bill removes PCP referrals or prior authorizations for specified specialty gynecologic and maternity care, enabling direct access within in-network providers.

SIGNED CHAP.112
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Bill Summary · S 818

Summary — S. 818 (An Act relative to eliminating the PCP referral requirement for specialty gynecological care)

Purpose

S. 818 removes the requirement that an insured patient obtain a referral or prior authorization from a primary care provider (PCP) before receiving specified specialty gynecological and maternity care. The change is intended to improve timely access to obstetric, gynecologic, midwifery and related family-practitioner services without a PCP gatekeeper step.

Key provisions

  • Amends subsection (g) of section 15 of chapter 176O of the General Laws by replacing the first sentence to prohibit health carriers from requiring referrals or PCP prior authorizations for specialty care provided by:
    • Obstetricians and gynecologists,
    • Certified nurse‑midwives (CNMs),
    • Family practitioners participating in the carrier’s network, for the following categories:
    • Annual preventive gynecologic examinations, including any subsequent obstetric/gynecologic services that the specialist determines are medically necessary as a result of the exam.
    • Preventive gynecologic and menstrual-health conditions, explicitly including abnormal uterine bleeding, dysmenorrhea, and pelvic pain.
    • Maternity care.
    • Medically necessary evaluations and resulting health care services for acute or emergency gynecological conditions.

Who is affected

  • Insured individuals in Massachusetts seeking gynecologic, menstrual-health, maternity, acute or emergency gynecologic care.
  • Health carriers/insurers operating in Massachusetts (they may no longer impose PCP referral/prior-authorization barriers for the enumerated services).
  • Providers: obstetricians, gynecologists, certified nurse‑midwives, and family practitioners (in-network) who may receive patients directly without PCP referrals.
  • Primary care providers may see a reduction in administrative referral responsibilities for these services.

Potential impacts and considerations

  • Expected to improve patient access and reduce delays for preventive, maternity and urgent gynecologic care.
  • May reduce administrative burdens on patients and PCPs (fewer referral/authorization steps).
  • Could shift utilization patterns for insurers; potential cost implications depend on use and insurer policy reactions (e.g., utilization management tools other than PCP referrals).
  • Maintains in‑network requirement; out-of-network access/coverage not altered by this language.

Procedural status and timeline (as provided)

  • Filed: Senate docketed 1/14/2025.
  • Introduced/Read: listed as introduced 3/3/2025.
  • Passed Legislature: recorded as passed both chambers (Senate and House/Assembly) in February–March 2025.
  • Delivered to Governor: 3/20/2025.
  • Enacted: Signed into law as Chapter 112 on 3/20/2025.

Sponsors and related legislation

  • Presented and petitioned in the provided text by Senator Pavel M. Payano; petition also lists Rebecca L. Rausch.
  • Companion bill: H.418 / A.418.
  • Related/replace entry: SD 822.

Note: Some metadata provided in the source (sponsor names and duplicate action entries) contained inconsistencies. The summary above follows the statutory amendment language and the final enactment status reported in the provided materials.

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

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