Massachusetts 2023-2024 Regular Session

Massachusetts Senate Bill S742 Compare Versions

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

Old	New	Differences
1	1	1 of 1
2	2	SENATE DOCKET, NO. 1641 FILED ON: 1/19/2023
3	3	SENATE . . . . . . . . . . . . . . No. 742
4	4	The Commonwealth of Massachusetts
5	5	_________________
6	6	PRESENTED BY:
7	7	Sal N. DiDomenico
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 dually
13	13	eligible individuals.
14	14	_______________
15	15	PETITION OF:
16	16	NAME:DISTRICT/ADDRESS :Sal N. DiDomenicoMiddlesex and Suffolk 1 of 2
17	17	SENATE DOCKET, NO. 1641 FILED ON: 1/19/2023
18	18	SENATE . . . . . . . . . . . . . . No. 742
19	19	By Mr. DiDomenico, a petition (accompanied by bill, Senate, No. 742) of Sal N. DiDomenico
20	20	for legislation to ensure access and continuity of care to specialist and hospital services for
21	21	dually eligible individuals. Health Care Financing.
22	22	The Commonwealth of Massachusetts
23	23	_______________
24	24	In the One Hundred and Ninety-Third General Court
25	25	(2023-2024)
26	26	_______________
27	27	An Act to ensure access and continuity of care to specialist and hospital services for dually
28	28	eligible individuals.
29	29	Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
30	30	of the same, as follows:
31	31	1 SECTION 1. Section 9d of Chapter 118E of the General Laws, as appearing in the 2020
32	32	2Official Edition, is hereby amended by adding the following new paragraph:-
33	33	3 "(r) To ensure access to specialist and hospital care for dually eligible individuals
34	34	4residing in the Commonwealth, any dually eligible individual shall be permitted to receive health
35	35	5care services from any specialist or hospital provider in the commonwealth that participates in
36	36	6and is enrolled in Medicare or MassHealth, irrespective of any health plan or provider network
37	37	7limitation and subject to all others terms and conditions of the member’s benefit plan. In such
38	38	8situations where an existing contractual relationship between the health plan and the hospital or
39	39	9specialist provider does not exist, the provider shall be reimbursed by the One Care or SCO plan
40	40	10at the Medicare or MassHealth fee-for-service amount for the service rendered, as applicable,
41	41	11unless the plan and provider already have a contract agreement in place for the covered service,
42	42	12or mutually agree to a different reimbursement amount for the service. 2 of 2
43	43	13 (1) To ensure continued access to primary, specialist, and hospital care for our most
44	44	14vulnerable members MassHealth shall require any One Care or SCO plan and provider that has
45	45	15terminated a contract that includes the provision of health care services to One Care or SCO
46	46	16members, to allow impacted members to continue to receive services from their primary care,
47	47	17specialist provider, or any inpatient or outpatient hospital subject to the termination, under the
48	48	18terms of the pre-existing contract, for twelve months following the expiration of any continuity
49	49	19of care requirements that may follow the contractual termination. During this period, plans shall
50	50	20be required to maintain all contractual terms and conditions that were in effect with the provider
51	51	21prior to the notice of termination being sent by either party, including but not limited to
52	52	22reimbursement, unless mutually agreed upon by the plan and the provider. Plans and providers
53	53	23shall be prohibited from using this provision to avoid using good faith efforts to negotiate
54	54	24contractual arrangements."