If you’ve been following healthcare legislation in Massachusetts, you may have heard about the Patient First Act—a law designed to bring transparency to medical billing and help patients understand what they’ll pay before receiving treatment. Originally signed into law in 2021, this legislation has faced multiple delays, and there’s important news for injured workers and personal injury claimants about its current status.
Patient First Act: Another Two-Year Delay
In December 2024, the Massachusetts Senate proposed yet another extension to the Patient First Act’s implementation date. The law, which was originally scheduled to take effect on January 1, 2025, has now been pushed back to January 1, 2027. This marks the latest in a series of delays since the law’s original passage in 2021.
What the Patient First Act Was Supposed to Do
The Patient First Act addresses “surprise billing”—those unexpectedly high medical bills that patients sometimes receive from out-of-network providers. The law requires healthcare providers to give patients advance notice about several key items:
- Whether the provider participates in the patient’s health insurance network
- Estimated out-of-pocket costs for planned hospital stays, procedures, and services
- Cost information for referrals to other providers
Healthcare providers covered by the law include doctors, dentists, registered nurses, social workers, pharmacists, chiropractors, psychologists, hospitals, clinics, community health centers, and nursing homes.
Why the Repeated Delays?
The Patient First Act has been delayed multiple times due to implementation challenges. Healthcare providers have struggled with how to operationalize the new requirements while simultaneously complying with the federal No Surprises Act, which has overlapping obligations. The Commonwealth has repeatedly extended the deadline, recognizing these complexities and giving providers additional time to prepare their systems and processes.
The timeline of delays includes:
- Original effective date: January 1, 2022
- First delay: July 31, 2022
- Second delay: January 1, 2025
- Current delay: January 1, 2027
What This Means for Personal Injury and Workers’ Compensation Cases
The continued delays in implementing the Patient First Act have significant implications for injury victims:
Medical Bill Documentation: Without the transparency requirements in place, injured workers and personal injury claimants may continue to face challenges in understanding the true cost of their medical treatment upfront. This can complicate settlement negotiations when you’re trying to project future medical expenses.
Out-of-Network Billing Issues: Surprise billing remains a concern. You might receive treatment at an in-network facility but get billed separately by an out-of-network provider (such as an anesthesiologist or radiologist) without advance warning.
Settlement Valuations: The lack of advance cost disclosure can make it harder to accurately value personal injury claims, particularly when estimating future medical expenses or negotiating liens.
Enforcement When the Law Finally Takes Effect
When the Patient First Act does take effect in 2027, the Massachusetts Department of Public Health will have enforcement authority. Providers who fail to comply could face penalties of up to $2,500 for each violation. However, there will be an initial grace period where the penalty starts at $0 to give providers time to come into compliance.
Patients who don’t receive required notices will be able to file written complaints with the provider’s professional licensing board or, for licensed facilities, with the DPH Bureau of Health Care Safety and Quality. Providers will have ten days to submit documentation demonstrating compliance.
2026 PFML Updates: Higher Benefits for Injured Workers
While the Patient First Act remains on hold, there’s good news about Massachusetts Paid Family and Medical Leave benefits. Starting January 1, 2026, injured workers and others taking qualifying leave will see an increase in maximum weekly benefits.
Key Changes for 2026
The maximum weekly PFML benefit will increase from $1,170.64 to $1,230.39—a modest but meaningful increase that reflects adjustments to the statewide average weekly wage.
The contribution rates, however, will remain stable at 0.88% of eligible wages. Here’s how it breaks down:
- For employers with 25 or more covered individuals: 0.70% for medical leave (with employers paying 0.42% and employees paying 0.28%) and 0.18% for family leave (paid by employees)
- For employers with fewer than 25 covered individuals: 0.46% total (0.28% for medical leave and 0.18% for family leave, both paid by employees)
Understanding PFML Benefits
The Massachusetts Paid Family and Medical Leave program provides eligible employees with:
- Up to 20 weeks of paid medical leave per year for their own serious health condition
- Up to 12 weeks of paid family leave per year to bond with a new child, care for a family member with a serious health condition, or address military family needs
- A maximum of 26 weeks total per benefit year for any combination of leave types
How PFML Interacts with Workers’ Compensation
It’s important to understand that PFML and workers’ compensation serve different purposes and operate under separate frameworks:
Workers’ Compensation covers work-related injuries and illnesses, providing medical benefits and wage replacement (typically 60% of average weekly wages) regardless of fault. It’s a no-fault system that applies when the injury occurs in the course of employment.
PFML covers serious health conditions and family caregiving needs that are not necessarily work-related. It’s funded through payroll contributions and offers broader leave protections.
If you’re injured at work, workers’ compensation is your primary source of benefits for medical treatment and wage replacement. However, PFML might come into play if you need additional leave for caregiving responsibilities related to your recovery or if you’re caring for a family member.
Important Tax Changes for 2026
Beginning January 1, 2026, PFML medical leave payments may be subject to FICA taxes (Social Security and Medicare) for employees whose employers have 25 or more employees. This follows IRS guidance on the taxability of these benefits. The withholding will be automatic unless the employer is tax-exempt.
What Injured Workers Should Do Now
While waiting for the Patient First Act to take effect in 2027, here are some practical steps for protecting your rights:
Ask About Network Status: Even though providers aren’t required to disclose this information yet, you can always ask whether a provider is in your insurance network before receiving non-emergency treatment.
Request Cost Estimates: While not legally required until 2027, many providers will provide cost estimates if you ask. This is especially important for planned procedures.
Document Everything: Keep detailed records of all medical bills, insurance explanations of benefits, and communications with providers. This documentation is crucial for personal injury claims and workers’ compensation cases.
Understand Your PFML Rights: If you need to take leave in 2026, familiarize yourself with the increased benefit amounts and notify your employer at least 30 days in advance when possible.
Watch for Medical Liens: In personal injury cases involving workers’ compensation, remember that workers’ comp insurers have lien rights on third-party recoveries. Understanding how medical bills are paid and by whom is crucial for settlement negotiations.
Looking Ahead to 2027
When the Patient First Act finally takes effect in 2027, injured workers should see meaningful improvements in healthcare cost transparency. The law is designed to eliminate surprise billing and help patients make informed decisions about their medical care. For those pursuing personal injury or workers’ compensation claims, this transparency should make it easier to document medical expenses and project future treatment costs.
Until then, the status quo continues. The federal No Surprises Act provides some protections against surprise billing, particularly for emergency services and certain out-of-network charges, but Massachusetts’ state law was intended to go further in protecting consumers.
Need Help Navigating Your Injury Claim?
Understanding how healthcare laws, workers’ compensation, and personal injury claims intersect can be complex. Whether you’re dealing with medical bills after a work injury, negotiating with insurance companies, or trying to understand your PFML rights, experienced legal guidance can make a significant difference in the outcome of your case.
If you have questions about how these changes affect your personal injury or workers’ compensation claim, don’t hesitate to reach out to an experienced Massachusetts injury attorney who can help you understand your rights and pursue the compensation you deserve.
Attorney Blair E. Weigand — Helping those with legal questions for 35 years and counting.