Bill
S 810
Prohibits insurers from lowering E/M or procedure payments when same-day services are billed; ASO carriers/UROs limited to recommending coverage, not binding payment decisions.
An Act to reduce inequities in access to medical procedures — incorporated as Chapter 106 (signed into law 3/7/2025)
Note on source materials
- The bill text provided here is a Massachusetts bill (Senate No. 810 / SD 831) presented by Sen. Jacob R. Oliveira and Sen. James B. Eldridge and titled “An Act to reduce inequities in access to medical procedures.”
- The prompt included inconsistent metadata (a different title referencing New York City election notices and a separate list of sponsors). This summary is based on the actual statutory text included in the filing (amendments to Mass. Gen. Laws ch. 176O, §16).
Purpose
- Prevent insurance carriers from reducing payment for evaluation & management (E/M) or procedural services solely because a participating provider billed additional health care services (e.g., minor surgery) on the same day; and
- Clarify payment-authorization responsibilities for carriers or utilization review organizations (UROs) that serve in an administrative-only role for self-funded/third‑party plans.
Key provisions (amendments to G.L. c.176O, §16)
1. Prohibition on payment reductions for same-day services (new subsection (c))
- Carriers may not reduce the negotiated payment rate for E/M or procedural services furnished by a participating provider solely because the provider also billed other services on the same day.
- Any contract provision that permits such a reduction is declared void.
Who is affected
- Participating providers (physicians, surgeons, clinics) who bill combinations of E/M, procedural services, and same‑day ancillary/minor surgical services.
- Health insurance carriers and utilization review organizations operating in Massachusetts.
- Employers or third‑party payors that sponsor self-funded plans (ASO plans), since carriers/UROs in those arrangements will have a limited role.
- Patients may be affected indirectly through provider access, billing/claims handling, and potential impacts on plan administration.
Likely impacts
- Providers: reduces contractual and payer practices that “down‑pay” E/M or procedural services when additional same‑day services are billed; may increase appropriate reimbursement and reduce claim denials or refund recoupments.
- Carriers/UROs: restricts a common cost‑management practice; for ASO arrangements, limits liability/obligation to recommendation rather than authorization.
- Employers/third‑party payors: may need to review contractual arrangements and consider how recommendations from administrative carriers/UROs are implemented.
- Patients: may experience improved access to multi-part same‑day care if providers are no longer financially penalized for billing all services rendered.
Procedural / timeline status
- Filed (Senate Docket No. 831) 1/14/2025; introduced 2/27/2025.
- Passed both chambers (Senate and House) and delivered to the Governor.
- Signed into law as Chapter 106 on 3/7/2025 — the amendments are enacted.
Practical next steps for stakeholders
- Providers: review participating provider agreements for prohibited clauses and consult billing teams about same‑day service coding and appeals.
- Carriers/UROs: revise claim-edit rules and contract language to comply; update policies for ASO plan recommendations.
- Employers / plan sponsors: confirm how carrier recommendations will be handled in their third‑party payer arrangements.
For verification
- Because the prompt contained conflicting metadata (title and named sponsors inconsistent with the bill text), stakeholders should consult the official Massachusetts session laws (Chapter 106 of 2025) or the Massachusetts Legislature online bill status page for the authoritative enacted text and legislative history.
Compiled from official sources — confirm details with the bill’s official record.
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