Massachusetts requires carriers to follow payment standards that mirror and supplement the federal NSA, including:

1. An initial payment requirement to providers for emergency services and certain OON services at INN facilities.
2. Use of the plan’s recognized amount, which is typically based on the Qualified Payment Amount (QPA)methodology unless otherwise specified by Massachusetts law for particular regulated plans.

While Massachusetts does not impose an APCD-based benchmark like Maine, the state regulates carrier practices for commercially insured plans and enforces minimum consumer protections.

Massachusetts uses the federal IDR system for most OON payment disputes.
The state does not have a separate, specified state law that replaces federal NSA arbitration.

This means federal NSA IDR governs:

• Emergency OON claims
• Non-emergency OON services at INN facilities
• Air ambulance services
• Disputes over QPA-based payments

Massachusetts does not operate its own state arbitration program.

Before initiating federal IDR, parties have a 30-day negotiation window, identical to the federal rule:

• Begins the day the provider receives the initial payment or denial.
• If unresolved, either party may submit to Federal IDR (IDRE selection + arbitration).

Since Massachusetts follows the federal process, the IDR entities consider the federal statutory criteria, including:

• QPA (central guiding factor)
• Provider training, experience, and patient acuity
• Market share of provider or plan
• Prior contracted rates (last 4 years)
• Efforts or failure to enter into network agreements
• Case complexity and facility characteristics

State-specific factors may be included only if allowed under the NSA.

Massachusetts regulates surprise billing protections through:

• M.G.L. c. 176O (Health insurance consumer protections)
• Division of Insurance (DOI) guidance
• MassHealth requirements, aligned to NSA
• Adoption of federal NSA standards under 45 CFR 149.510 / 149.520

Massachusetts does not maintain a separate specified state law for determining OON payment rates.

Because Massachusetts does not have a designated Specified State Law (SSL) for determining OON rates, CMS has determined:

• Insured group health plans
• Individual health insurance
• Group insurance coverage
• Self-funded ERISA plans (unless opting into another state's SSL, which is rare)

Massachusetts is not bifurcated — the state relies on the federal NSA IDR system for OON payment disputes.

This means:

• The federal QPA is the primary benchmark
• The federal arbitration process applies
• Massachusetts commercial plans must follow federal payment + IDR requirements
• There is no separate state arbitration system for commercial plans