Postponement in the Massachusetts Patients First Act Penalties

04 August 2022 Health Care Law Today Blog
Author(s): Lawrence W. Vernaglia Alexandra B. Shalom

Thank you to co-author Ilana Meyer, a summer associate in Foley's Boston office, for her contributions to this post.

On July 5, 2022, the Commonwealth of Massachusetts re-extended the implementation and enforcement date for the “Patients First Act”, sometimes referred to as the Massachusetts No Surprises Act, to January 1, 2025. As discussed in our prior blog, this law requires Massachusetts health care providers to disclose additional information to their patients about the cost of scheduled hospital stays, medical procedures, health care services, or referrals, based on the patient’s specific health insurance.

The penalties in Massachusetts were originally set to start on January 1, 2022. The Massachusetts Department of Public Health first delayed these penalties until July 31, 2022, and recently re-extended the enforcement date to January 1, 2025. Many in the industry struggled with how to operationalize the new Massachusetts law while simultaneously addressing the Federal No Surprises Act and regulations that have overlapping obligations. This new delay in implementation reflects the Commonwealth’s appreciation of those challenges. We should also note that our reading of the statute is that not only are the penalties delayed, but the statute is not self-implementing and implementation is delayed as well, meaning that the requirements under this law are not effective until January 1, 2025.

Delayed implementation and enforcement for non-compliance with the Patients First Act and the Federal No Surprises Act illustrates the complexities in solving the industry-wide problem of out-of-network billing.

It’s important to note that this new section of the law, now not effective until January 1, 2025, replaced any prior statutory language in MGL 111 sec. 228 requiring providers to give patients or prospective patients allowed amounts upon request.

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