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HOUSE DOCKET, NO. 817 FILED ON: 1/17/2023
HOUSE . . . . . . . . . . . . . . . No. 1221
The Commonwealth of Massachusetts
_________________
PRESENTED BY:
David Paul Linsky
_________________
To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
Court assembled:
The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:
An Act ensuring protections for physicians and hospitals that contract with Medicaid managed
care organizations.
_______________
PETITION OF:
NAME:DISTRICT/ADDRESS :DATE ADDED:David Paul Linsky5th Middlesex1/17/2023 1 of 2
HOUSE DOCKET, NO. 817 FILED ON: 1/17/2023
HOUSE . . . . . . . . . . . . . . . No. 1221
By Representative Linsky of Natick, a petition (accompanied by bill, House, No. 1221) of David
Paul Linsky relative to physicians and hospitals that contract with Medicaid managed care
organizations. Health Care Financing.
[SIMILAR MATTER FILED IN PREVIOUS SESSION
SEE HOUSE, NO. 1289 OF 2021-2022.]
The Commonwealth of Massachusetts
_______________
In the One Hundred and Ninety-Third General Court
(2023-2024)
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An Act ensuring protections for physicians and hospitals that contract with Medicaid managed
care organizations.
Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
of the same, as follows:
1 SECTION 1. Section 12 of Chapter 118E of the General Laws, is hereby amended by
2inserting after the last paragraph the following paragraph:-
3 Reimbursement from managed care organizations that contract with the executive office
4for hospital and physician services provided to beneficiaries under this chapter shall be subject to
5negotiation between providers of medical services and managed care organizations and shall not
6be limited or determined through contracts between the executive office and managed care
7organizations, including accountable care organizations and dual-eligible health plans. 2 of 2
8 SECTION 2. The last sentence of the first paragraph of Section 13E1/2 of Chapter 118E
9of the General Laws, is hereby amended by inserting after the word “services” the following
10words:-
11 provided further, that acute hospital and non-acute hospital reimbursement from managed
12care organizations that contract with the executive office shall for health services provided to
13beneficiaries under this chapter be subject to negotiation between those hospitals and managed
14care organizations and shall not be limited or determined through contracts between the
15executive office and managed care organizations, including accountable care organizations and
16dual-eligible health plans.
17 SECTION 3. Section 13F of Chapter 118E of the General Laws, is hereby amended by
18inserting after subsection c the following subsection:-
19 (d) the executive office shall not, in its contracts with acute hospitals and non-acute
20hospitals or through any other rule or regulation, require hospitals to accept fee-for-service rates
21established by the office of Medicaid for non-emergency services provided to beneficiaries
22enrolled in managed care organizations including for accountable care organizations and dual-
23eligible health plans. The office may require hospitals that are not in a managed care
24organization’s provider network to accept fee-for-service rates established by the office for
25emergency services only.