Massachusetts insurance laws

What it would do: Prohibits dental insurers from restricting payment methods to only credit cards and requires insurer consent from dental care providers before initiating credit card payments. Requires insurers to notify providers of associated fees, disclose payment options, and include explanation of benefits with each payment.

What it would do: Requires health insurers, HMOs, medical service corporations, and the state employee health plan to reimburse certified registered nurse anesthetists at rates not less than physicians for the same services, without reducing physician reimbursement.

What it would do: Requires health insurers and MassHealth to cover prosthetic and orthotic devices for daily use and physical activities, including repair and replacement, without discriminatory denials based on disability, and ensures access to at least two in-network providers.

What it would do: Requires health insurance plans, including student plans, group insurance commission plans, and individual policies, to provide coverage for coordinated specialty care services for first-episode psychosis and assertive community treatment services, with bundled payment models and presumed medical necessity following provider recommendation.

What it would do: Requires health insurance carriers to publicly list items requiring prior authorization, report approval and denial data to regulators, implement automated prior authorization systems, and prohibit retrospective denials of previously approved services. Establishes restrictions on artificial intelligence use in utilization review and creates a task force to study prior authorization's impact on healthcare costs and access.

What it would do: Requires the Group Insurance Commission, individual accident and sickness insurers, hospital service plans, medical service plans, and health maintenance organizations to cover the cost of enteral formulas for home use when prescribed by a physician for specified medical conditions including inherited metabolic disorders, eosinophilic gastrointestinal disorders, Crohn's Disease, and severe food allergies.

What it would do: Requires group insurance commission coverage, blanket and general insurance policies, hospital service plans, medical service agreements, and health maintenance contracts to provide coverage for biennial echocardiograms and concussion analysis for persons between ages five and eighteen.

What it would do: Restricts health care providers from charging facility fees except on hospital campuses or at emergency departments, requires written notice to patients about facility fees, and limits out-of-network billing by requiring carriers to reimburse unforeseen out-of-network services at in-network rates.

What it would do: Requires health insurance plans in Massachusetts, including group insurance commission plans, Medicaid, commercial insurers, and health maintenance organizations, to cover pain control methods during intrauterine device insertion without cost-sharing, with exemptions for church-controlled organizations.

What it would do: Requires health insurers, Medicaid, the Group Insurance Commission, and health maintenance organizations to cover opioid antagonists and agonists for opioid use disorder treatment without prior authorization, deductibles, copayments, or coinsurance, and prohibits balance billing.

What it would do: Requires health insurers, the group insurance commission, and health maintenance organizations in Massachusetts to cover one hearing aid per hearing-impaired ear every 36 months with a maximum $200 copayment, including related services and repairs, as durable medical equipment.

What it would do: Establishes the Massachusetts Merged Market Advisory Council to advise the governor on the merged health insurance market regulated under chapter 176J, oversee an independent actuarial analysis, and submit recommendations by December 31, 2026 to ensure affordability and stability for individuals and small employers.

What it would do: Requires the division of insurance to issue a comprehensive report at least every 5 years on the merged non-group and small-group health insurance market, examining premiums, cost-sharing, market competition, utilization trends, and other relevant subjects in consultation with the commonwealth health connector authority and center for health information and analysis.

What it would do: Requires health insurers and MassHealth to provide nondiscriminatory coverage for mental health and behavioral health services, including autism spectrum disorder, based on DSM or ICD diagnostic criteria. Prohibits discrimination in disability insurance based on mental health conditions and requires equal benefit limitations for mental versus physical disabilities.

What it would do: Adds transitional support services to addiction treatment coverage requirements across multiple insurance programs and MassHealth, requiring coverage for up to 30 days without preauthorization, and mandates reporting on treatment access and costs by October 2026 and 2028.

What it would do: Requires health insurers to pay an assessment based on excess net worth reserves exceeding 550% of risk-based capital, generating $400,000,000 total, with $200,000,000 each directed to the Health Safety Net Trust Fund and Medicaid Stabilization Trust Fund through December 31, 2026.

What it would do: Replaces the health care access bureau section to require the deputy commissioner to develop affordability standards for rate review considering consumer costs, purchaser costs, and health care cost growth benchmarks, and authorizes appointment of specified staff with an annual assessment of $2,000,000 against licensed carriers.

What it would do: Establishes a division of health insurance within the department of banking, insurance and health insurance, with a commissioner of health insurance overseeing health insurance markets including accident and sickness insurance, HMOs, health benefit plans, and related entities. Creates a health insurance access bureau with rate review authority and affordability standards.

What it would do: Expands the definition of providers authorized to diagnose disabilities, provide pharmacy care, and treat autism spectrum disorders under Massachusetts health insurance laws to include licensed nurse practitioners and licensed psychiatric nurse mental health clinical specialists in addition to licensed physicians, effective January 1, 2027.

What it would do: Allows the commissioner to exempt carriers from network adequacy requirements based on membership concentration in single rate regions, subsidized coverage enrollment, or government program funding. Modifies restrictions on select and tiered network plans to allow carriers to introduce or modify such plans without guaranteeing provider participation or requiring all-or-nothing provider group inclusion.

What it would do: Requires health insurance plans covering commonwealth employees, Medicaid, accident and sickness insurance, hospital service plans, medical service agreements, and health maintenance organizations to provide coverage for stuttering speech therapy treatment without annual visit limits, disease-based restrictions, or prior authorization requirements, including telehealth services, effective January 1, 2026.

What it would do: Prohibits health insurance carriers from including termination-without-cause provisions or unilateral contract change provisions in provider contracts, except changes required by law with 90+ days' written notice before the contract term ends. Applies to state commission health insurance purchases and service contracts.

What it would do: Establishes a 19-member special commission in the Department of Insurance to investigate and study foster care and child care liability insurance providers in Massachusetts, compile data on costs and claims, examine availability and barriers, and submit recommendations by December 1, 2026.

What it would do: Removes remarriage as a termination event for surviving spouse health insurance coverage under state employee and retiree plans, and changes the surviving spouse's premium contribution from full cost to one-half cost paid by the governmental unit.

What it would do: Requires insurers to include all cost sharing amounts paid by or on behalf of an enrollee when calculating deductibles and out-of-pocket costs, with specified exceptions for health savings account-qualified high-deductible health plans, effective January 1, 2026.