CONSUMER CHOICE OF PHYSICIAN ASSISTANT SERVICES

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

in effect

M.G.L. c. 176S, § 1 Definitions

c. 176S, § 1. Definitions Section 1. As used in this chapter, the following words shall, unless the context clearly requires otherwise, have the following meanings:— ''Carrier'', (1) an insurer licensed or otherwise authorized to transact accident or health insurance under chapter 175; (2) a nonprofit hospital service corporation organized under chapter 176A; (3) a nonprofit medical service corporation organized under chapter 176B; (4) a health maintenance organization organized under chapter 176G; (5) an organization entering into a preferred provider arrangement under chapter 176I; (6) a contributory group general or blanket insurance for persons in the service of the commonwealth under chapter 32A; (7) a contributory group general or blanket insurance for persons in the service of counties, cities, towns and districts, and their dependents under chapter 32B; (8) the medical assistance program administered by the office of Medicaid pursuant to chapter 118E and in accordance with Title XIX of the Social Security Act or any successor statute; and (9) 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 physician assistant 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. ''Participating provider'', a provider who, under 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. ''Physician assistant'', a person who is a graduate of an approved program for the training of physician assistants who is supervised by a registered physician in accordance with sections 9C to 9H, inclusive, of chapter 112, and who has passed the Physician Assistant National Certifying Exam or its equivalent. ''Primary care provider'', a health care professional qualified to provide general medical care for common health care problems who (1) supervises, coordinates, prescribes, or otherwise provides or proposes health care services; (2) initiates referrals for specialist care; and (3) maintains continuity of care within the scope of practice.

M.G.L. c. 176S, § 2 Physician assistants to be recognized as participating providers subject to Sec. 3

c. 176S, § 2. Physician assistants to be recognized as participating providers subject to Sec. 3 Section 2. The commissioner and the group insurance commission shall require that all carriers recognize physician assistants as participating providers subject to section 3 and shall include coverage on a nondiscriminatory basis to their insureds for care provided by physician assistants 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 physician assistant who is a participating provider and is practicing within the scope of his or her professional authority as defined by statute, rule and physician delegation 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. 176S, § 3 Physician assistant to be considered qualified as primary care provider

c. 176S, § 3. Physician assistant to be considered qualified as primary care provider Section 3. A participating provider physician assistant practicing within the scope of such physician assistant's license, including all regulations requiring collaboration with or supervision by a physician under section 9E of chapter 112, shall be considered qualified within the carrier's definition of primary care provider to an insured.

M.G.L. c. 176S, § 4 Participating provider physician assistant eligible as primary care provider

c. 176S, § 4. Participating provider physician assistant eligible 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 physician assistant as a primary care provider.

M.G.L. c. 176S, § 5 Participating provider physician assistants to be included on publicly accessible list of participating providers

c. 176S, § 5. Participating provider physician assistants to be included 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 physician assistants are included on any publicly accessible list of participating providers for the carrier.

M.G.L. c. 176S, § 6 Complaint for noncompliance

c. 176S, § 6. Complaint 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/Chapter176SFetched: 10/20/2026