Massachusetts 2025-2026 Regular Session

Massachusetts House Bill H1096 Compare Versions

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

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1	1	1 of 1
2	2	HOUSE DOCKET, NO. 2728 FILED ON: 1/16/2025
3	3	HOUSE . . . . . . . . . . . . . . . No. 1096
4	4	The Commonwealth of Massachusetts
5	5	_________________
6	6	PRESENTED BY:
7	7	Natalie M. Blais
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 relative to rate equity for community health centers.
13	13	_______________
14	14	PETITION OF:
15	15	NAME:DISTRICT/ADDRESS :DATE ADDED:Natalie M. Blais1st Franklin1/16/2025Joanne M. ComerfordHampshire, Franklin and Worcester1/25/2025Hadley Luddy4th Barnstable1/25/2025Russell E. Holmes6th Suffolk2/6/2025David T. Vieira3rd Barnstable2/24/2025 1 of 8
16	16	HOUSE DOCKET, NO. 2728 FILED ON: 1/16/2025
17	17	HOUSE . . . . . . . . . . . . . . . No. 1096
18	18	By Representative Blais of Deerfield, a petition (accompanied by bill, House, No. 1096) of
19	19	Natalie M. Blais and others relative to rates for community health centers. Financial Services.
20	20	The Commonwealth of Massachusetts
21	21	_______________
22	22	In the One Hundred and Ninety-Fourth General Court
23	23	(2025-2026)
24	24	_______________
25	25	An Act relative to rate equity for community health centers.
26	26	Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
27	27	of the same, as follows:
28	28	1 SECTION 1. Chapter 32A of the General Laws, as appearing in the 2022 Official
29	29	2Edition, is hereby amended by inserting after section 33 the following new section:-
30	30	3 Section 34. (a) For the purposes of this section, the following terms shall have the
31	31	4following meanings unless the context clearly requires otherwise:
32	32	5 “Federally Qualified Health Center”, any entity receiving a grant under 42 U.S.C. 254B.
33	33	6 “Federally Qualified Health Center Services”, as such term is defined in 42 U.S.C.
34	34	71396d(a)(2)(C), and as further defined in 101 CMR 304.00.
35	35	8 (b) Notwithstanding any general or special law to the contrary, the Commission shall
36	36	9ensure that the rate of payment for any Federally Qualified Health Center services provided to a
37	37	10patient by a community health center, shall be reimbursed in an amount at least equivalent to the
38	38	11annual aggregate revenue that the health center would have received if reimbursed by 2 of 8
39	39	12MassHealth pursuant to methodology that conforms with 42 U.S.C. § 1396a(bb) and
40	40	131396b(m)(2)(A)(ix) as they appear in Title 42 of the United States Code as of January 1, 2025.
41	41	14 SECTION 2. Chapter 118E of the General Laws, as appearing in the 2022 Official
42	42	15Edition, is hereby amended by inserting after section 13d ½ the following new section:-
43	43	16 Section 13d ¾. (a) For purposes of this section, the term “community health center” shall
44	44	17mean any entity reimbursed as a community health center under this chapter.
45	45	18 (b) Notwithstanding any general or special law to the contrary, reimbursement for
46	46	19community health centers under this chapter, shall be through a methodology that conforms with
47	47	2042 USC § 1396a(bb) and 1396b(m)(2)(A)(ix) as appearing in Title 42 of the United States Code
48	48	21as of January 1, 2025.
49	49	22 SECTION 3. Chapter 175 of the General Laws, as appearing in the 2022 Official Edition,
50	50	23is hereby amended by inserting after section 47UU the following new section:-
51	51	24 Section 47VV. (a) For the purposes of this section, the following terms shall have the
52	52	25following meanings unless the context clearly requires otherwise:
53	53	26 “Federally Qualified Health Center”, any entity receiving a grant under 42 U.S.C. 254B.
54	54	27 “Federally Qualified Health Center Services”, as such term is defined in 42 U.S.C.
55	55	281396d(a)(2)(C), and as further defined in 101 CMR 304.00.
56	56	29 (b) Notwithstanding any general or special law to the contrary, insurers organized under
57	57	30this chapter shall ensure that the rate of payment for any Federally Qualified Health Center
58	58	31services provided to a patient by a community health center, shall be reimbursed in an amount at
59	59	32least equivalent to the annual aggregate revenue that the health center would have received if 3 of 8
60	60	33reimbursed by MassHealth pursuant to methodology that conforms with 42 U.S.C. § 1396a(bb)
61	61	34and 1396b(m)(2)(A)(ix) as they appear in Title 42 of the United States Code as of January 1,
62	62	352025.
63	63	36 (c) The Division of Insurance shall issue regulations governing issuance of payments to
64	64	37community health centers to conform with this section. The Division of Insurance shall consult
65	65	38with MassHealth to receive technical assistance regarding the per visit payment rate for each
66	66	39individual Federally Qualified Health Center for a given year. MassHealth shall provide the
67	67	40Division of Insurance with a proxy rate for any Federally Qualified Health Center who has not
68	68	41received an individual prospective payment system rate and the Division of Insurance shall make
69	69	42available to health plans upon request the necessary prospective payment system rate information
70	70	43regarding their contracted Federally Qualified Health Centers such that the health plan can
71	71	44ensure compliance with this requirement. The Division of Insurance shall promulgate regulations
72	72	45no later than January 1, 2027 in order to implement the provisions of this Chapter.
73	73	46 (d) Any entity licensed by the Division of Insurance and providing reimbursement to
74	74	47federally qualified health centers for services provided to patients, including, but not limited to,
75	75	48non-profit hospital service corporations, medical service corporations, dental service
76	76	49corporations, health maintenance organizations, and preferred provider organizations, or any
77	77	50other entity not specifically enumerated hereunder licensed by the Division of Insurance and
78	78	51providing reimbursement to federally qualified health centers for services provided to patients,
79	79	52shall submit an annual report to the Division of Insurance as a condition of their licensure
80	80	53evidencing that the total reimbursement to Federally Qualified Health Centers for services
81	81	54provided to patients in the prior year was equivalent to the annual aggregate revenue the health
82	82	55center would have received if reimbursed by MassHealth. 4 of 8
83	83	56 SECTION 4. Chapter 176A of the General Laws, as appearing in the 2022 Official
84	84	57Edition, is hereby amended by inserting after Section 38 the following new section:-
85	85	58 Section 39. (a) For the purposes of this section, the following terms shall have the
86	86	59following meanings unless the context clearly requires otherwise:
87	87	60 “Federally Qualified Health Center”, any entity receiving a grant under 42 U.S.C. 254B.
88	88	61 “Federally Qualified Health Center Services”, as such term is defined in 42 U.S.C.
89	89	621396d(a)(2)(C), and as further defined in 101 CMR 304.00.
90	90	63 (b) Notwithstanding any general or special law to the contrary, any corporation organized
91	91	64under this chapter shall ensure that the rate of payment for any Federally Qualified Health Center
92	92	65services provided to a patient by a community health center, shall be reimbursed in an amount at
93	93	66least equivalent to the annual aggregate revenue that the health center would have received if
94	94	67reimbursed by MassHealth pursuant to methodology that conforms with 42 U.S.C. § 1396a(bb)
95	95	68and 1396b(m)(2)(A)(ix) as they appear in Title 42 of the United States Code as of January 1,
96	96	692025.
97	97	70 SECTION 5. Section 1 of Chapter 176B of the General Laws, as appearing in the 2022
98	98	71Official Edition, is hereby amended by inserting after the definition of “Dependent” the
99	99	72following new definitions:-
100	100	73 “Federally Qualified Health Center”, any entity receiving a grant under 42 U.S.C. 254B.
101	101	74 “Federally Qualified Health Center Services”, as such term is defined in 42 U.S.C.
102	102	751396d(a)(2)(C), and as further defined in 101 CMR 304.00. 5 of 8
103	103	76 SECTION 6. Chapter 176B of the General Laws, as so appearing is hereby further
104	104	77amended by inserting after Section 25 the following new section:-
105	105	78 Section 26: (a) Notwithstanding any general or special law to the contrary, any medical
106	106	79service plan organized under this chapter shall ensure that the rate of payment for any Federally
107	107	80Qualified Health Center services provided to a patient by a community health center, shall be
108	108	81reimbursed in an amount at least equivalent to the annual aggregate revenue that the health
109	109	82center would have received if reimbursed by MassHealth pursuant to methodology that conforms
110	110	83with 42 U.S.C. § 1396a(bb) and 1396b(m)(2)(A)(ix) as they appear in Title 42 of the United
111	111	84States Code as of January 1, 2025.
112	112	85 SECTION 7. Section 1 of Chapter 176E of the General Laws, as appearing in the 2022
113	113	86Official Edition, is hereby amended by inserting after the definition of “Dental Service
114	114	87Corporation” the following new definitions:-
115	115	88 “Federally Qualified Health Center”, any entity receiving a grant under 42 U.S.C. 254B.
116	116	89 “Federally Qualified Health Center Services”, as such term is defined in 42 U.S.C.
117	117	901396d(a)(2)(C), and as further defined in 101 CMR 304.00.
118	118	91 SECTION 8. Said Chapter 176E is further amended by inserting after section 15A the
119	119	92following new section:-
120	120	93 Section 15B. (a) Notwithstanding any general or special law to the contrary, any Dental
121	121	94Service Corporation organized under this chapter shall ensure that the rate of payment for any
122	122	95Federally Qualified Health Center services provided to a patient by a community health center,
123	123	96shall be reimbursed in an amount at least equivalent to the annual aggregate revenue that the 6 of 8
124	124	97health center would have received if reimbursed by MassHealth pursuant to methodology that
125	125	98conforms with 42 U.S.C. § 1396a(bb) and 1396b(m)(2)(A)(ix) as they appear in Title 42 of the
126	126	99United States Code as of January 1, 2025.
127	127	100 SECTION 9. Section 1 of Chapter 176G of the General Laws, as appearing in the 2022
128	128	101Official Edition, is hereby amended by inserting after the definition of “Evidence of Coverage”
129	129	102the following new definitions:-
130	130	103 “Federally Qualified Health Center”, any entity receiving a grant under 42 U.S.C. 254B.
131	131	104 “Federally Qualified Health Center Services”, as such term is defined in 42 U.S.C.
132	132	1051396d(a)(2)(C), and as further defined in 101 CMR 304.00.
133	133	106 SECTION 10. Said Chapter 176G is further amended by inserting after section 33 the
134	134	107following new section:-
135	135	108 Section 34. (a) Notwithstanding any general or special law to the contrary, any Health
136	136	109Maintenance Organization organized under the laws of the Commonwealth shall ensure that the
137	137	110rate of payment for any Federally Qualified Health Center services provided to a patient by a
138	138	111community health center, shall be reimbursed in an amount at least equivalent to the annual
139	139	112aggregate revenue that the health center would have received if reimbursed by MassHealth
140	140	113pursuant to methodology that conforms with 42 U.S.C. § 1396a(bb) and 1396b(m)(2)(A)(ix) as
141	141	114they appear in Title 42 of the United States Code as of January 1, 2025.
142	142	115 SECTION 11. Section 1 of Chapter 176I of the General Laws, as appearing in the 2022
143	143	116Official Edition, is hereby amended by inserting after the definition of “Emergency Care” the
144	144	117following new definitions:- 7 of 8
145	145	118 “Federally Qualified Health Center”, any entity receiving a grant under 42 U.S.C. 254B.
146	146	119 “Federally Qualified Health Center Services”, as such term is defined in 42 U.S.C.
147	147	1201396d(a)(2)(C), and as further defined in 101 CMR 304.00.
148	148	121 SECTION 12. Said Chapter 176I, as so appearing, is further amended by inserting after
149	149	122section 13 the following new section:-
150	150	123 Section 14. (a) Notwithstanding any general or special law to the contrary, any preferred
151	151	124provider contract shall ensure that the rate of payment for any Federally Qualified Health Center
152	152	125services provided to a patient by a community health center, shall be reimbursed in an amount at
153	153	126least equivalent to the annual aggregate revenue that the health center would have received if
154	154	127reimbursed by MassHealth pursuant to methodology that conforms with 42 U.S.C. § 1396a(bb)
155	155	128and 1396b(m)(2)(A)(ix) as they appear in Title 42 of the United States Code as of January 1,
156	156	1292025.
157	157	130 SECTION 13. Chapter 15A of the General Laws, as appearing in the 2022 Official
158	158	131Edition, is hereby amended by inserting after section 18 the following new section:-
159	159	132 Section 18A. (a) For the purposes of this section, the following terms shall have the
160	160	133following meanings unless the context clearly requires otherwise:
161	161	134 “Federally Qualified Health Center”, any entity receiving a grant under 42 U.S.C. 254B.
162	162	135 “Federally Qualified Health Center Services”, as such term is defined in 42 U.S.C.
163	163	1361396(a)(2)(C), and as further defined in 101 CMR 304.00.
164	164	137 (b) Notwithstanding any general or special law to the contrary, any student health
165	165	138insurance program or plan authorized under Section 18 of Chapter 15A shall ensure that the rate 8 of 8
166	166	139of payment for any Federally Qualified Health Center services provided to a patient by a
167	167	140community health center, shall be reimbursed in an amount at least equivalent to the annual
168	168	141aggregate revenue that the health center would have received if reimbursed by MassHealth
169	169	142pursuant to methodology that conforms with 42 U.S.C. § 1396a(bb) and 1396b(m)(2)(A)(ix) as
170	170	143they appear in Title 42 of the United States Code as of January 1, 2025.