HB 925 Clawback Bill Fact Sheet

CU’s third priority bill is House Bill 925, An Act to limit retroactive denials of health insurance claims for mental health and substance abuse services. Health insurance companies have the ability to audit and take back reimbursements ( often called “clawbacks”) given to health care providers for services rendered, sometimes years in the past. The process for doing this is not transparent and has a chilling effect on how health care providers practice and the access to services. Currently, many other states have statutes on the books that protect health care providers from this practice.

This bill will:

• Limit both MassHealth and commercial health insurers to a six month period for recovering payments to a provider for services completed. When providers deliver a service in good faith and in compliance with eligibility rules, they should be compensated without fear of insurance companies taking back these reimbursements years or months after the services were provided.

• Require that MassHealth institute a back-end process to reconcile payment between payers withoutinvolving the provider. This process could mirror the current process in the auto insurance industry.

Click here to view the clawback bill (HB925) fact sheet.

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