Bill
A 7239
Bill A 7239 requires Medicare and Medicaid managed care to cover certain out-of-network services, enhancing access and reducing costs for beneficiaries needing specialized care.
Bill Number: A 7239
Title: Requires Medicare and Medicaid managed care providers to provide coverage for certain out-of-network health care
Status: Referred to Health
Introduced: March 21, 2025
Classification: Bill
Bill A 7239 aims to enhance healthcare access for beneficiaries of Medicare and Medicaid managed care by mandating coverage for specific out-of-network healthcare services. The intent is to ensure that patients can receive necessary medical care without facing prohibitive out-of-pocket costs when their preferred providers are not within their managed care network.
Coverage Requirement: The bill requires Medicare and Medicaid managed care providers to cover certain out-of-network healthcare services. This includes situations where:
Cost-Sharing Protections: The bill may include provisions to limit the amount of cost-sharing (such as copayments and deductibles) that beneficiaries would have to pay when accessing out-of-network services.
Provider Notification: Managed care providers will be required to inform beneficiaries about their rights to access out-of-network services and any associated costs.
Beneficiaries: The primary beneficiaries of this bill are individuals enrolled in Medicare and Medicaid managed care plans who may need to access out-of-network healthcare services.
Healthcare Providers: Out-of-network healthcare providers may see an increase in patient volume as beneficiaries seek necessary services that are not available within their managed care networks.
Managed Care Organizations: These organizations will need to adjust their policies and procedures to comply with the new coverage requirements, which may involve changes in billing practices and provider agreements.
Current Status: As of March 21, 2025, the bill has been referred to the Health Committee for further consideration.
Related Legislation: This bill is related to several prior-session bills (A 8606, A 2342, A 6465) that may address similar issues regarding out-of-network coverage. Additionally, there is a companion bill (S 2449) in the Senate that may parallel the provisions of A 7239.
Bill A 7239 represents a significant step towards improving healthcare access for Medicare and Medicaid beneficiaries by ensuring coverage for necessary out-of-network services. As the bill progresses through the legislative process, its implications for patients, providers, and managed care organizations will be closely monitored.
Compiled from official sources — confirm details with the bill’s official record.
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