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S 902

Relates to the sale, manufacture, and distribution of vapor products

2025 Regular Session Introduced by Monica Martinez

Cap health care charges at 200% of Medicare; ban balance billing beyond payor payments, lowering patient costs and reshaping provider-payor contracts in Massachusetts.

REFERRED TO HEALTH
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WeVote Research Nonpartisan
Bill Summary · S 902

Summary — S.902 (2025): "An Act lowering health care prices for patients"

Note: The bill text filed for S.902 addresses limits on what health care providers may charge patients and payors. (There is an apparent mismatch between an initial short title referencing vapor products and the full text, which clearly concerns health care pricing; this summary follows the bill text.)

Purpose

To limit what health care providers, hospitals, and provider organizations may charge, bill, or collect for health care services by capping allowed charges at 200% of the amount Medicare pays for the same service. The stated aim is to lower health care prices for patients.

Key provisions

  • Charge cap: A health care provider, hospital, or provider organization “shall not charge, bill, or collect payment for health care services at a rate that exceeds 200 percent of the amount paid by Medicare for the service.”
  • Covered entities:
    • “Health care provider” — any person or organization that furnishes, bills, or is paid for health care services.
    • “Hospital” — hospitals licensed under G.L. c.111 §51, the UMass Medical School teaching hospital, and psychiatric facilities licensed under G.L. c.19 §19.
    • “Provider organization” — organizations that represent providers in contracting with carriers (includes physician orgs, PHOs, IPAs, networks, ACOs, labs, imaging facilities, etc.).
  • Balance billing prohibition: Providers, hospitals, and provider organizations must accept payment under the cap and may not balance bill a person for amounts in excess of what a payor pays under this section, except for applicable copayments, coinsurance, and deductibles.
  • Anti‑cost‑shifting: Entities are prohibited from recouping amounts above the capped charges by increasing charges to other health plans or payors.
  • Enforcement: The Department (presumably the Department of Public Health or another designated department) may promulgate regulations to monitor and ensure compliance. The Attorney General has concurrent authority to review and monitor compliance.

Who would be affected

  • All providers, hospitals, and provider organizations operating in Massachusetts that bill for health care services.
  • Patients, including insured and potentially uninsured individuals, who receive services from these entities — particularly those facing high out‑of‑network bills or balance billing.
  • Health insurers and other payors (private plans, Medicaid/Medicare supplemental arrangements) because contractual payments and negotiations could change.
  • State regulators and the Attorney General, who gain enforcement responsibilities.

Potential impacts and considerations

  • Likely to reduce maximum billed rates and patient responsibility where providers previously charged far above Medicare rates, especially for out‑of‑network or uninsured care.
  • Could reduce provider and hospital revenues depending on current charge structures and payer mixes.
  • May affect contract negotiations between providers and private insurers; could alter network participation incentives.
  • Administrative burden for providers and payors to map services to Medicare fee amounts and implement billing changes.
  • Legal and federal issues (e.g., ERISA preemption for employer-sponsored plans, interaction with federal law) could arise; bill text does not address federal preemption or detailed dispute processes.

Procedural status & timeline (as provided)

  • Filed: Senate docketed Jan 16, 2025. Introduced in Senate and read twice: Mar 6, 2025.
  • Referred to committee(s): Referred to Health (entry shows REFERRED TO HEALTH on 1/8/2025); also referenced to Health Care Financing and Committee on Energy and Natural Resources in actions — records show some conflicting committee referrals.
  • Hearing scheduled: July 1, 2025, 1:00–3:30 PM in Gardner Auditorium.
  • Sponsors/cosponsors: Presented by Senator Pavel M. Payano; listed primary sponsors Tim Sheehy and Monica Martinez; Andy Kim listed as cosponsor.
  • Related/companion legislation: Companion HR 4038, A.4593 (companion), replaces SD 1569; prior-session bills S.6376 and S.9012 are related.

Notes

  • The bill text sets a bright-line cap (200% of Medicare) but does not specify implementation details such as: how to match specific services to Medicare payment codes, dispute resolution for coding/payment disagreements, or explicit penalties for noncompliance beyond regulatory oversight.
  • Because the bill text and procedural history contain some inconsistent entries (titles, committee referrals, sponsors), stakeholders should consult the official legislative docket and committee staff for definitive status and bill language during hearings.

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

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