The bill aims to address inequities in access to medical procedures by amending Section 16 of chapter 176O of the General Laws. It specifically prohibits carriers from reducing the payment of negotiated rates for evaluation and management or procedural services provided by participating providers, even if those providers bill for additional health care services, such as minor surgery, on the same day. Any provisions in provider agreements that allow for such reductions in reimbursement will be rendered void.

Additionally, the bill introduces a new subsection that clarifies the obligations of carriers or utilization review organizations regarding insured individuals enrolled in health benefit plans where only administrative services are provided. In these cases, the responsibilities of the carrier or review organization will be limited to recommending coverage authorization to the third-party payor. This amendment seeks to ensure fair compensation for medical services and streamline the administrative process for health benefit plans.

Statutes affected:
Bill Text: 176O-16