Massachusetts 2023-2024 Regular Session

Massachusetts House Bill H1223 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	1 of 1
2	2	HOUSE DOCKET, NO. 1394 FILED ON: 1/18/2023
3	3	HOUSE . . . . . . . . . . . . . . . No. 1223
4	4	The Commonwealth of Massachusetts
5	5	_________________
6	6	PRESENTED BY:
7	7	Joseph W. McGonagle, Jr.
8	8	_________________
9	9	To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
10	10	Court assembled:
11	11	The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:
12	12	An Act to ensure access and continuity of care to specialist and hospital services for dual
13	13	eligibles.
14	14	_______________
15	15	PETITION OF:
16	16	NAME:DISTRICT/ADDRESS :DATE ADDED:Joseph W. McGonagle, Jr.28th Middlesex1/12/2023Sal N. DiDomenicoMiddlesex and Suffolk1/31/2023 1 of 2
17	17	HOUSE DOCKET, NO. 1394 FILED ON: 1/18/2023
18	18	HOUSE . . . . . . . . . . . . . . . No. 1223
19	19	By Representative McGonagle of Everett, a petition (accompanied by bill, House, No. 1223) of
20	20	Joseph W. McGonagle, Jr. and Sal N. DiDomenico for legislation to ensure medical assistance
21	21	access and continuity of care to specialist and hospital services for dually eligible individuals.
22	22	Health Care Financing.
23	23	The Commonwealth of Massachusetts
24	24	_______________
25	25	In the One Hundred and Ninety-Third General Court
26	26	(2023-2024)
27	27	_______________
28	28	An Act to ensure access and continuity of care to specialist and hospital services for dual
29	29	eligibles.
30	30	Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
31	31	of the same, as follows:
32	32	1 SECTION 1. Section 9d of Chapter 118E of the general laws is hereby amended by
33	33	2adding the following new paragraph (r):
34	34	3 (r) To ensure access to specialist and hospital care for dually eligible individuals residing
35	35	4in the Commonwealth, any dually eligible individual shall be permitted to receive health care
36	36	5services from any specialist or hospital provider in the Commonwealth that participates in and is
37	37	6enrolled in Medicare or MassHealth, irrespective of any health plan or provider network
38	38	7limitation and subject to all other terms and conditions of the member’s benefit plan. In such
39	39	8situations where an existing contractual relationship between the health plan and the hospital or
40	40	9specialist provider does not exist, the provider shall be reimbursed by the One Care or SCO plan
41	41	10at the Medicare or MassHealth fee-for-service amount for the service rendered, as applicable, 2 of 2
42	42	11unless the plan and provider already have a contract agreement in place for the covered service,
43	43	12or mutually agree to a different reimbursement amount for the service.
44	44	13 (r-1) To ensure continued access to primary, specialist, and hospital care for our most
45	45	14vulnerable members MassHealth shall require any One Care or SCO plan and provider that has
46	46	15terminated a contract that includes the provision of health care services to One Care or SCO
47	47	16members, to allow impacted members to continue to receive services from their primary care,
48	48	17specialist provider, or any inpatient or outpatient hospital subject to the termination, under the
49	49	18terms of the pre-existing contract, for twelve months following the expiration of any continuity
50	50	19of care requirements that may follow the contractual termination. During this period, plans shall
51	51	20be required to maintain all contractual terms and conditions that were in effect with the provider
52	52	21prior to the notice of termination being sent by either party, including but not limited to
53	53	22reimbursement, unless mutually agreed upon by the plan and the provider. Plans and providers
54	54	23shall be prohibited from using this provision to avoid using good faith efforts to negotiate
55	55	24contractual arrangements.