H 4955

SECTION 1. Subsection (a) of section 11 of chapter 176J of the General Laws, as appearing in the 2022 Official Edition, is hereby amended by inserting at the end thereof the following:- The commissioner may also exempt carriers from complying with this section based on (i) whether the majority of a carrier’s chapter 176J membership is enrolled in a single rate region; or (ii) whether the majority of the carrier’s chapter 176J membership is enrolled in subsidized coverage offered under chapter 176Q through which such members receive state or federal subsidies; or (iii) whether the carrier receives 80 per cent or more of its income from government programs, including subsidized coverage offered under chapter 176Q through which such members receive state or federal subsidies. SECTION 2. Section 9A of chapter 176O, as so appearing, is hereby amended by striking out subsection (a) and inserting in place thereof the following subsection:- "(a)(i) limits the ability of the carrier to introduce or modify a select network plan or tiered network plan by granting the health care provider a guaranteed right of participation; (ii) requires the carrier to place all members of a provider group, whether local practice groups or facilities, in the same tier of a tiered network plan; or (iii) requires the carrier to include all members of a provider group, whether local practice groups or facilities, in a select network plan on an all-or-nothing basis; or"