Massachusetts 2025-2026 Regular Session

Massachusetts Senate Bill S856 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. 1815 FILED ON: 1/16/2025
3	3	SENATE . . . . . . . . . . . . . . No. 856
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 ensuring 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. 1815 FILED ON: 1/16/2025
18	18	SENATE . . . . . . . . . . . . . . No. 856
19	19	By Mr. DiDomenico, a petition (accompanied by bill, Senate, No. 856) 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	[SIMILAR MATTER FILED IN PREVIOUS SESSION
23	23	SEE SENATE, NO. 742 OF 2023-2024.]
24	24	The Commonwealth of Massachusetts
25	25	_______________
26	26	In the One Hundred and Ninety-Fourth General Court
27	27	(2025-2026)
28	28	_______________
29	29	An Act ensuring access and continuity of care to specialist and hospital services for dually
30	30	eligible individuals.
31	31	Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
32	32	of the same, as follows:
33	33	1 Section 9d of Chapter 118E of the General Laws, as appearing in the 2022 Official
34	34	2Edition, is hereby amended by adding the following new paragraph:-
35	35	3 "(r) To ensure access to specialist and hospital care for dually eligible individuals
36	36	4residing in the Commonwealth, any dually eligible individual shall be permitted to receive health
37	37	5care services from any specialist or hospital provider in the commonwealth that participates in
38	38	6and is enrolled in Medicare or MassHealth, irrespective of any health plan or provider network
39	39	7limitation and subject to all others terms and conditions of the member’s benefit plan. In such
40	40	8situations where an existing contractual relationship between the health plan and the hospital or
41	41	9specialist provider does not exist, the provider shall be reimbursed by the One Care or SCO plan 2 of 2
42	42	10at the Medicare or MassHealth fee-for-service amount for the service rendered, as applicable,
43	43	11unless the plan and provider already have a contract agreement in place for the covered service,
44	44	12or mutually agree to a different reimbursement amount for the service.
45	45	13 (1) To ensure continued access to primary, specialist, and hospital care for our most
46	46	14vulnerable members MassHealth shall require any One Care or SCO plan and provider that has
47	47	15terminated a contract that includes the provision of health care services to One Care or SCO
48	48	16members, to allow impacted members to continue to receive services from their primary care,
49	49	17specialist provider, or any inpatient or outpatient hospital subject to the termination, under the
50	50	18terms of the pre-existing contract, for twelve months following the expiration of any continuity
51	51	19of care requirements that may follow the contractual termination. During this period, plans shall
52	52	20be required to maintain all contractual terms and conditions that were in effect with the provider
53	53	21prior to the notice of termination being sent by either party, including but not limited to
54	54	22reimbursement, unless mutually agreed upon by the plan and the provider. Plans and providers
55	55	23shall be prohibited from using this provision to avoid using good faith efforts to negotiate
56	56	24contractual arrangements."