Chapter 118E

Section 1. The executive office for health and human services shall be the single state agency responsible for the administration of programs of medical assistance and medical benefits established pursuant to this chapter. All actions of the executive office of health and human s…

Section 10. The division shall establish a program of medical care and assistance for pregnant women and infants who are not otherwise eligible for medical assistance under this chapter and who lack private health insurance coverage or have a health insurance policy which does no…

Section 10A. The division shall provide coverage for abortion, as defined in section 12K of chapter 112, abortion-related care, prenatal care, childbirth and postpartum care, with a minimum of forty-eight hours of in-patient care following a vaginal delivery and a minimum of nine…

Section 10B. The division shall provide coverage for the cost of a newborn hearing screening test to be performed before the newborn infant is discharged from the hospital or birthing center to the care of the parent or guardian or as provided by regulations of the department of …

Section 10C. The division shall provide coverage for the following items if such items are within a category of benefits or services for which coverage is otherwise afforded, have been prescribed by a health care professional legally authorized to prescribe such items and if the …

Section 10D. The division shall, within the limits of the funds appropriated for such purpose, provide coverage to eligible women who require medical treatment for either breast or cervical cancer in accordance with 1902(a)(10)(A)(ii)(XVIII) of the breast and cervical cancer prev…

Section 10E. The division shall establish a program of medical care and assistance for pregnant women and infants who are not otherwise eligible for medical assistance under chapter 118E and who lack private health insurance coverage or have health insurance coverage which does n…

Section 10F. (a) There is hereby established a program of managed care to provide primary and preventive health care services for uninsured dependent and adopted youths from birth through age eighteen; provided, however, that only said youths who are ineligible for medical benefi…

Section 10G. For children under the age of 18, the division shall cover the cost of treating cleft lip and cleft palate. The coverage shall include benefits for medical, dental, oral and facial surgery, surgical management and follow-up care by oral and plastic surgeons, orthodon…

Section 10H. Subject to the availability of federal financial participation, the division shall cover medically necessary treatments for persons younger than 21 years old who are receiving medical coverage under this chapter and who are diagnosed with an autism spectrum disorder …

Section 10I. The division and its contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third-party administrators under contract to a Medicaid managed care organization or primary care clinician plan shall provide cove…

Section 10J. The division shall provide coverage for medical or drug treatments to correct or repair disturbances of body composition caused by HIV associated lipodystrophy syndrome including, but not limited to, reconstructive surgery, such as suction assisted lipectomy, other r…

Section 10K. (a) The division and its contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third-party administrators under contract to a Medicaid managed care organization or primary care clinician plan shall provide …

Section 10L. The division and its contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third party administrators under contract to a Medicaid managed care organization or primary care clinician plan shall provide, for…

Section 10M. (a) The division and its contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third-party administrators under contract to a Medicaid managed care organization or primary care clinician plan shall provide …

Section 10N. (a) For the purposes of this section, the following words shall, unless the context clearly requires otherwise, have the following meanings:- ''Division'', the division of medical assistance within the executive office of health and human services. ''Urgent care faci…

Section 10O. For the purposes of this section, the following terms shall have the following meanings unless the context clearly requires otherwise:- ''Community-based acute treatment'', 24–hour clinically managed mental health diversionary or step-down services for children and a…

Section 10P. (a) For the purposes of this section, ''psychiatric collaborative care model'' shall mean the evidence-based, integrated behavioral health service delivery method in which a primary care team consisting of a primary care provider and a care manager provides structure…

Section 10Q. (a) For the purpose of this section, the following words shall have the following meanings: ''Licensed mental health professional'', a licensed physician who specializes in the practice of psychiatry, a licensed psychologist, a licensed independent clinical social wo…

Section 10R. (a) For the purposes of this section, ''noninvasive prenatal screening'' shall mean a cell-free DNA prenatal screening to ascertain if a pregnancy has a risk of fetal chromosomal aneuploidy; provided, however, that such screening shall include, but not be limited to,…

Section 10S. The division and its contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third-party administrators under contract to a Medicaid managed care organization or primary care clinician plan shall provide cove…

Section 10T. (a) The division and its contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third-party administrators under contract to a Medicaid managed care organization or primary care clinician plan shall provide …

Section 10U. (a) For purposes of this section, the following terms shall have the following meanings unless the context clearly requires otherwise: ''Maternal and infant health outcomes'', outcomes arising for the gestational parent and the gestational parent's offspring during t…

Section 10V. The division and its and its contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third-party administrators under contract to a Medicaid managed care organization, accountable care organization or primary…

Section 10W. (a) As used in this section, the following words shall, unless the context clearly requires otherwise, have the following meanings:— ''Cost sharing'', a deductible, coinsurance, copayment and any maximum limitation on the application of such a deductible, coinsurance…

Section 10X. (a) The division and its contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third-party administrators under contract to a Medicaid managed care organization, accountable care organization or primary car…

Section 10Y. The division and its contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third-party administrators under contract to a Medicaid managed care organization, accountable care organization or primary care cl…

Section 10Z. (a) As used in this section, the following words shall have the following meanings unless the context clearly requires otherwise: ''Brand name drug'', a drug that is: (i) produced or distributed pursuant to an original new drug application approved under 21 U.S.C. 35…

Section 11. The division shall, within the limits of the funds which have been appropriated for the purposes of this chapter, cooperate with the appropriate federal authorities in the administration of Title XIX, under which federal funds are available to the commonwealth for Med…

Section 12. In administering the medical assistance programs established under this chapter, the division shall formulate such methods, policies, procedures, standards and criteria, except medical standards and criteria, as may be necessary for the proper and efficient operation …

Section 12A. (a) As used in this section, the following word shall, unless the context clearly requires otherwise, have the following meaning: ''Manufacturer'', an entity that manufactures a pharmaceutical drug covered by MassHealth. (b) Notwithstanding any general or special law…

Section 13. The commissioner shall review, and approve or disapprove, any change in Title XIX rates or Title XIX rate methodology proposed by the executive office of health and human services, which shall be called the ''executive office'' only for the purposes of this section or…

Section 13A. For hospital fiscal years beginning on or after October first, nineteen hundred and ninety-seven, rates and terms of payment established by the division with non-acute hospitals for services rendered to patients entitled to medical assistance under this chapter shall…

Section 13B. Hospital rate increases shall be made contingent upon hospital adherence to quality standards and achievement of performance benchmarks, including the reduction of racial and ethnic disparities in the provision of health care. Such benchmarks shall be developed or ad…

Section 13C. The secretary of the executive office shall establish rates of payment for health care services; provided, that the secretary may designate another governmental unit to perform such ratemaking functions. The secretary of the executive office shall have the responsibi…

Section 13D. The executive office, or a governmental unit designated to perform ratemaking functions by the executive office shall: (i) determine, after public hearing, at least annually for institutional providers, and at least biennially for non-institutional providers, the rat…

Section 13E. Except for rates established under section 13F, any person, corporation or other party aggrieved by an interim rate or a final rate established by the executive office or a governmental unit designated to perform ratemaking functions by the executive office, or by fa…

Section 13F. All rates of payment to acute hospitals and non-acute hospitals under Title XIX shall be established by contract between the provider of such hospital services and the office of Medicaid, except as provided in subsections (a) and (b), or otherwise permitted by law. A…

Section 13G. The executive office, or a governmental unit designated to perform ratemaking functions by the executive office, shall not consider the following as resources of such hospitals in the establishment, review or approval of acute and non-acute hospital rates and charges…

Section 13H. No acute hospital shall deny access to care and services which the hospital would provide under this chapter to recipients of benefits under chapter 117A.

Section 13I. Notwithstanding any provisions of this chapter to the contrary, all costs and charges for patients who are residents of other countries shall, as provided herein, be exempted from the limitations imposed by this chapter. Any hospital shall be allowed to impose a surc…

Section 13J. A health maintenance organization organized under chapter 176G may; (i) negotiate directly with any hospital with respect to such health maintenance organization's rate of payment for hospital services; and (ii) enter into an agreement with such hospital reflecting s…

Section 13K. Upon petition of a receiver appointed under section 72N of chapter 111, the executive office shall, under regulations to be promulgated hereunder, adjust the facility's rate, if necessary, to insure compensation of the receiver and payment for a bond. Such adjustment…

Section 13L. The secretary of health and human services, hereinafter ''the secretary'', shall not restrict or limit an eligible hospital's access to the discounted purchase of prescription drugs to the full extent permitted under section 340B of the Public Health Service Act, as …

Section 14. Pursuant to the second paragraph of section twelve, the division shall enter into negotiated rate contracts with nursing homes that recognize the acquisition cost, or portion thereof which exceeds the allowable basis under relevant regulations of the executive office …

Section 14A. The division shall treat admissions to acute care hospitals and chronic disease or rehabilitation hospitals as equivalent for purposes of reimbursing nursing homes to reserve beds for medical assistance recipients during brief absences from nursing homes by such reci…

Section 15. The division shall provide Medicaid benefits for such medical care or services as Title XIX and regulations adopted thereunder by the secretary require. The division may provide Medicaid benefits for such additional medical care or services as Title XIX and said regul…

Section 16. The division shall establish a program of primary and supplemental medical care and assistance for certain disabled residents of the commonwealth including persons who are blind who are not eligible for medical assistance pursuant to Title XIX of the federal Social Se…

Section 16A. The division shall establish a program of medical care and assistance for certain disabled children of the commonwealth, including children who are blind. The benefits of such program shall be available to children who are not eligible for medical assistance programs…

Section 16C. (1) There is hereby established the child health insurance program, which shall provide medical assistance or medical benefits to infants, children and adolescents to age 18, inclusive, whose financial eligibility as determined by the division does not exceed 300 per…