CONSUMER CHOICE OF NURSE PRACTITIONER SERVICES

M.G.L. pt. Part I, tit. Title XXII, ch. c. 176R

in effect

M.G.L. c. 176R, § 1 Definitions

c. 176R, § 1. Definitions Section 1. As used in this chapter, the following words shall have the following meanings unless the context clearly requires otherwise: ''Carrier'', an insurer licensed or otherwise authorized to transact accident or health insurance under chapter 175; a nonprofit hospital service corporation organized under chapter 176A; a nonprofit medical service corporation organized under chapter 176B; a health maintenance organization organized under chapter 176G; an organization entering into a preferred provider arrangement under chapter 176I; a contributory group general or blanket insurance for persons in the service of the commonwealth under chapter 32A; a contributory group general or blanket insurance for persons in the service of counties, cities, towns and districts, and their dependents under chapter 32B; the medical assistance program administered by the division of medical assistance pursuant to chapter 118E and in accordance with Title XIX of the Social Security Act or any successor statute; and any other medical assistance program operated by a governmental unit for persons categorically eligible for such program. ''Commissioner'', the commissioner of insurance. ''Insured'', an enrollee, covered person, insured, member, policyholder or subscriber of a carrier. ''Nondiscriminatory basis'', a carrier shall be deemed to be providing coverage on a non-discriminatory basis if its plan does not contain any annual or lifetime dollar or unit of service limitation imposed on coverage for the care provided by a nurse practitioner which is less than any annual or lifetime dollar or unit of service limitation imposed on coverage for the same services by other participating providers. ''Nurse practitioner'', a registered nurse who holds authorization in advanced nursing practice as a nurse practitioner under section 80B of chapter 112 and regulations promulgated thereunder. ''Participating provider'', a provider who, under the terms and conditions of a contract with the carrier or with its contractor or subcontractor, has agreed to provide health care services to an insured with an expectation of receiving payment, other than coinsurance, co-payments or deductibles, directly or indirectly from the carrier. ''Primary care provider'', a health care professional qualified to provide general medical care for common health care problems, supervises, coordinates, prescribes, or otherwise provides or proposes health care services, initiates referrals for specialist care, and maintains continuity of care within the scope of practice.

M.G.L. c. 176R, § 2 Recognition of nurse practitioners as participating providers; coverage for care provided

c. 176R, § 2. Recognition of nurse practitioners as participating providers; coverage for care provided Section 2. The commissioner and the group insurance commission shall require that all carriers recognize nurse practitioners as participating providers subject to section 3 and shall include coverage on a nondiscriminatory basis to their insureds for care provided by nurse practitioners for the purposes of health maintenance, diagnosis and treatment. Such coverage shall include benefits for primary care, intermediate care and inpatient care, including care provided in a hospital, clinic, professional office, home care setting, long-term care setting, mental health or substance abuse program, or any other setting when rendered by a nurse practitioner who is a participating provider and is practicing within the scope of his professional license to the extent that such policy or contract currently provides benefits for identical services rendered by a provider of health care licensed by the commonwealth.

M.G.L. c. 176R, § 3 Qualification of nurse practitioner as primary care provider

c. 176R, § 3. Qualification of nurse practitioner as primary care provider Section 3. A participating provider nurse practitioner practicing within the scope of his license including all regulations requiring collaboration with a physician under section 80B of chapter 112, shall be considered qualified within the carrier's definition of primary care provider to an insured.

M.G.L. c. 176R, § 4 Designation by insured of nurse practitioner as primary care provider

c. 176R, § 4. Designation by insured of nurse practitioner as primary care provider Section 4. Notwithstanding any general or special law to the contrary, a carrier that requires the designation of a primary care provider shall provide its insured with an opportunity to select a participating provider nurse practitioner as a primary care provider or to change its primary care provider to a participating provider nurse practitioner at any time during their coverage period.

M.G.L. c. 176R, § 5 Inclusion of nurse practitioners on publicly accessible list of participating providers

c. 176R, § 5. Inclusion of nurse practitioners on publicly accessible list of participating providers Section 5. Notwithstanding any general or special law to the contrary, a carrier shall ensure that all participating provider nurse practitioners are included on any publicly accessible list of participating providers for the carrier.

M.G.L. c. 176R, § 6 Complaint against carrier for noncompliance

c. 176R, § 6. Complaint against carrier for noncompliance Section 6. A complaint for noncompliance against a carrier shall be filed with and investigated by the commissioner or the group insurance commission, whichever shall have regulatory authority over the carrier. The commissioner and the group insurance commission shall promulgate regulations to enforce this chapter.

Source: Massachusetts General Court (malegislature.gov)URL: https://malegislature.gov/Laws/GeneralLaws/PartI/TitleXXII/Chapter176RFetched: 10/20/2026