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