The bill establishes a new chapter, "Equitable Funding for Healthcare Provider Bad Debt," within Title 27 of the General Laws concerning insurance. It mandates that health insurers reimburse healthcare providers no less than sixty-five percent (65%) of each unpaid co-payment, co-insurance, or deductible amount due under an insured's health benefit plan after reasonable collection efforts have been made by the healthcare provider.

The bill provides specific definitions for terms such as co-insurance, co-payment, and deductible. It outlines the criteria for healthcare providers to submit reimbursement requests, which include documentation of collection efforts and a requirement that claims must be for amounts of at least $250. The healthcare provider must demonstrate that reasonable collection efforts were made, including documentation of attempts to contact the insured.

Additionally, the bill stipulates that health insurers cannot prohibit healthcare providers from collecting co-payments, co-insurance, or deductible amounts at the time of service. The health insurance commissioner is required to promulgate regulations by January 1, 2027, that align with federal guidelines for reasonable collection efforts. If the commissioner fails to do so, the provisions of the chapter will be self-implementing.

Furthermore, health insurers must conduct audits of reimbursement requests to verify eligibility and coverage at the time of service. They are required to pay healthcare providers sixty-five percent (65%) of undisputed amounts within one hundred twenty (120) days of receiving reimbursement requests. Insurers must also report annually on the total number and amount of uncollected co-payments, co-insurances, and deductibles, which will be made publicly available.

The act will take effect upon passage.