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S 758

Relates to doula access during emergency situations

2025 Regular Session Introduced by Roxanne Persaud

Insurers must reimburse providers 65% of unpaid co-pays, co-insurance, and deductibles after reasonable collection efforts; claims ≥$250 per service, annual filing, audits.

SUBSTITUTED BY A1019
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Bill Summary · S 758

Summary — S.758 (2025): "Equitable Funding for Health Care Provider Bad Debt"

Note: The bill text provided concerns reimbursement for uncollected patient cost‑sharing (co‑payments, co‑insurance, deductibles). Some metadata in the request (title, sponsors) appears inconsistent with the text; this summary follows the bill language inserted as Section 7A into Chapter 176O of the Massachusetts General Laws.

Purpose

To require health insurance carriers to share financial responsibility for uncollected patient cost‑sharing obligations by reimbursing health care providers for a portion of unpaid co‑payments, co‑insurance and deductibles after providers have made reasonable collection efforts.

Key provisions

  • Adds a new Section 7A to Chapter 176O establishing a reimbursement framework for provider bad debt arising from unpaid cost‑sharing.
  • Mandatory reimbursement: carriers must reimburse providers at least 65% of each unpaid co‑payment, co‑insurance or deductible that meets the criteria below.
  • Definitions: clarifies “co‑payment,” “co‑insurance,” and “deductible” consistent with common health plan meanings; premiums are excluded from the deductible definition.
  • Claim eligibility and thresholds:
    • Claim must derive from wholly or partially uncollected cost‑sharing for a covered service.
    • Each claim must be at least $250 and represent a unique covered service per insured.
  • Provider documentation and collection efforts:
    • Providers must show “reasonable collection efforts” (telephone calls, collection letters, other notifications) with dates and methods of contact.
    • Claims in ongoing payment plans for more than 120 days from first bill are excluded from reimbursement.
    • Providers submit an aggregate reimbursement request by May 1 each year for claims from the prior calendar year, including member identifiers, dates of service, unpaid amounts, amounts collected, and contact attempts.
  • Carrier audit, payment, and dispute process:
    • Carriers may audit eligibility and completeness (eligibility at time of service, coverage, provider logs).
    • Carrier must (a) complete audits and notify disputes within 120 days of receipt, and (b) pay 65% of undisputed amounts within 120 days.
    • Contested claims follow the existing dispute resolution mechanism between carrier and provider.
    • Any amounts collected by providers after carrier reimbursement must be recorded and used as offsets on future submissions.
  • Providers are not prohibited from collecting cost‑sharing at time of service.
  • Regulatory implementation:
    • The state division (presumably Division of Insurance) must promulgate regulations within 90 days consistent with CMS reasonable‑collection rules.
    • If the division fails to promulgate rules, the section is self‑implementing and carriers must follow Medicare bad‑debt documentation standards (CMS Pub. 15‑1 and 15‑2).
    • Carriers must submit annual public reports to the division on reimbursed and denied uncollected cost‑sharing.

Who is affected

  • Health insurance carriers: new reimbursement and reporting obligations; subject to audits and timeframes for payment.
  • Health care providers (hospitals, clinics, physicians): potential reimbursement for certain bad debts but increased administrative documentation and aggregated annual submissions.
  • Insured patients: may see reduced provider‑level financial pressure to collect unpaid cost‑sharing; potential downstream effects on premiums or plan design are possible but not specified in the bill.
  • State regulator: tasked with rulemaking and public reporting oversight.

Procedural/status notes

  • Introduced in the Senate (per file text) and assigned to relevant committees.
  • The provided status indicates the bill was “SUBSTITUTED BY A1019” (i.e., replaced by companion bill A1019). Hearing dates and committee referrals are listed in the legislative actions provided; some dates in the metadata are inconsistent. The text excerpt is truncated near the end; readers should consult A1019 or the full enacted text (if available) for final language and any subsequent modifications.

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

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