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S 793

Relates to vacancies on the council of the arts

2025 Regular Session Introduced by Michelle Hinchey

Protects patients from being blocked from medically necessary out-of-network referrals by prohibiting network-based restrictions and empowering regulators to sanction violators.

SIGNED CHAP.88
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Bill Summary · S 793

Summary — S.793 (2025): "An Act to save lives by preventing unscrupulous medical referral restrictions by profit-driven health care networks" (SIGNED, Chap. 88)

Note on source materials: The package provided includes some unrelated federal amendment language and inconsistent headers. This summary focuses on the enacted Massachusetts legislation (Senate Docket No. 989 / S.793) titled “An Act to save lives by preventing unscrupulous medical referral restrictions by profit-driven health care networks,” which was enacted as Chapter 88 (signed Feb 14, 2025).

Purpose / Intent

To protect patients’ access to medically necessary care by prohibiting health care facilities, providers, and provider groups from using network affiliations or business relationships to unduly restrict referrals or access to out‑of‑network providers when a treating clinician reasonably determines such referral is in the patient’s best interest (or the patient requests it).

Key provisions

  • Amendment to chapter 6D, §11:

    • The relevant regulatory commission (per chapter 6D) may suspend, revoke, or refuse to renew a provider organization’s registration for violations of the new referral-related rules (see below).

  • Amendment to chapter 149, §187(b):

    • Adds a new clause making explicit that a health care professional may refer a patient to an outside, non‑affiliated facility or provider when:
    • the outside provider is not the referring provider’s facility/place of employment, and
    • the referring provider reasonably believes the referral is in the patient’s best interest or is at the patient’s direct request.

  • Amendment to chapter 176O, §16(a):

    • Replaces the prior last sentence with language clarifying that nothing in that section alters third‑party obligations, except:
    • Contracts or obligations that unduly restrict an insured from receiving medically necessary services ordered by treating clinicians are not enforceable.
    • No facility, provider, or provider group may unduly restrict medically necessary services or referrals based solely on network or affiliation status.
    • Any attempt to prohibit or hinder such referrals/services constitutes an unfair method of competition and an unfair or deceptive act in violation of chapter 93A (consumer protection law).

Who is affected

  • Patients/insureds: Greater protection to obtain medically necessary care and out‑of‑network referrals when clinically appropriate or requested.
  • Treating clinicians (physicians, primary care providers, other health professionals): Explicit statutory protection to make referrals they reasonably believe are in the patient’s best interest.
  • Health care facilities, provider organizations, and provider groups: New prohibitions on contractual or operational practices that block medically necessary referrals based solely on network/affiliation; subject to regulatory action and potential Chapter 93A enforcement.
  • Regulator/commission under chapter 6D: Empowered to take registration actions (suspension, revocation, nonrenewal) for violations.

Enforcement and remedies

  • Regulatory: Suspension, revocation, or refusal to renew provider organization registration under chapter 6D for violations.
  • Civil/consumer protection: Violations may constitute unfair or deceptive acts under chapter 93A, enabling civil enforcement (including potential damages/penalties under that statute).

Procedural / timeline notes

  • Legislative passage: Passed both chambers in January 2025; delivered to Governor Feb 12, 2025; signed into law (Chapter 88) Feb 14, 2025.
  • Effective: As an enacted chapter, provisions are law as of the effective date specified in the act (check the act text for a specific effective date if not immediate).

If you want, I can:
- Extract the exact statutory language and compare it line‑by‑line with the prior text of chapters 149, 176O, and 6D; or
- Draft a plain‑language “what this means for patients” explainer or a checklist for provider compliance.

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

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