MA H1298

Amends Chapter 176J to allow the insurance commissioner to exempt certain health carriers from regulatory requirements based on three criteria: having majority membership in a single rate region, having majority membership in subsidized coverage under Chapter 176Q, or receiving 80% or more of income from government programs including subsidized coverage.

Prohibits contract provisions that grant health care providers a guaranteed right of participation in select or tiered network plans, limiting providers' ability to demand automatic inclusion.

Bars contract terms requiring carriers to place all members of a provider group (local practice groups or facilities) in the same tier of a tiered network plan.

Prohibits "all-or-nothing" contract provisions that would require carriers to include all members of a provider group in a select network plan together.

Filed by Representative David Allen Robertson (19th Middlesex) on January 16, 2025; similar legislation (H.1125) was filed in the 2023-2024 session.