H 4338
An Act to reduce inequities in access to medical procedures
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- Passed House
- Passed Senate
- To Governor
- Became Law
Bill overview
This bill aims to address inequities in healthcare access by preventing insurance companies from reducing payments to providers solely because they also provide other services, such as minor surgery, on the same day. It focuses on ensuring fair reimbursement for evaluation and management services and procedural services. The bill establishes guidelines for administrative services provided by carriers or utilization review organizations.
Key provisions
- Carriers cannot reduce payments to providers for evaluation and management or procedural services if those services are furnished by a participating provider and are otherwise covered.
- Provisions in provider agreements that allow for reduced reimbursement based on bundled services are void.
- Carriers or utilization review organizations must recommend coverage authorization to the third-party payor.
- The bill addresses payment inequities related to bundled services.
- It clarifies the responsibilities of carriers and utilization review organizations regarding payment recommendations.
- It focuses on evaluation and management and procedural services.
- It prohibits payment reductions based on bundled services.
- It establishes guidelines for administrative services.
Who is affected
- Healthcare providers
- Insurance companies
- Patients
- Health benefit plan enrollees
- Carriers and utilization review organizations
Notable changes
Sponsors
Official sponsors from legislative records.
Primary sponsor
Joint Committee on Financial Services
Cosponsor
William C. Galvin
Arguments in favor
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Bill H.4338 194th (Current)
An Act to reduce inequities in access to medical procedures
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Bill Information
Bill Information
Sponsor: Joint Committee on Financial Services Status: Referred to Joint Committee on Health Care Financing
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Bill History Cosponsors Committee Vote Committee Summary
Bill History
Displaying 5 actions for Bill H.4338
| Date | Branch | Action |
| 7/31/2025 | House | Reported from the committee on Financial Services |
| 7/31/2025 | House | New draft of H1162 |
| 7/31/2025 | House | Reported favorably by committee and referred to the committee on Health Care Financing |
| 12/8/2025 | House | Reporting date extended to Wednesday, March 18, 2026 |
| 3/19/2026 | House | Reporting date extended to Monday, June 15, 2026 |
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