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