Chapter 118E

Section 61. Notwithstanding the unavailability of federal financial participation, no person who is recognized as a spouse under the laws of the commonwealth shall be denied benefits that are otherwise available under this chapter due to the provisions of 1 U.S.C. § 7 or any othe…

Section 62. (a) Subject to subsection (c), for the purposes of processing claims for health care services submitted by a health care provider and to provide uniformity and consistency in the reporting of patient diagnostic information, patient care service and procedure informati…

Section 63. (a) For the purposes of this section, the following words shall, unless the context clearly requires otherwise, have the following meanings: "Assessment'', the user fee imposed under this section; provided, that for all nursing homes, the user fee shall be imposed per…

Section 64. As used in sections 64 to 69, inclusive, the following words shall, unless the context clearly requires otherwise, have the following meanings: "Acute hospital'', the teaching hospital of the University of Massachusetts medical school and any hospital licensed under s…

Section 65. (a) There shall be established within the office of Medicaid a health safety net office which shall be under the supervision and control of a director. The director shall be appointed by the secretary of the executive office and shall be a person of skill and experien…

Section 66. (a) There shall be established and set up on the books of the commonwealth a fund to be known as the Health Safety Net Trust Fund, in this section and in sections 67 to 69, inclusive, called the fund, which shall be administered by the health safety net office, herein…

Section 67. (a) Subject to all required federal approvals, including any required waivers under 42 CFR 433.68, a hospital's annual liability to the fund shall be calculated in accordance with this section. The annual aggregate liability of all hospitals to the fund shall equal th…

Section 67A. (a) The following words shall, unless the context clearly requires otherwise, have the following meanings: ″Ambulance service″, as defined in section 1 of chapter 111C. ″Emergency″, as defined in section 1 of chapter 111C. ″Executive office″, the executive office of …

Section 68. (a) Subject to all required federal approvals, including any required waivers under 42 CFR 433.68, a managed care organization's annual liability to the fund shall be calculated in accordance with this section. The annual aggregate liability of all managed care organi…

Section 69. (a) Reimbursements from the fund to hospitals and community health centers for health services provided to uninsured and underinsured individuals shall be subject to further rules and regulations promulgated by the office and shall be made in the following manner:— (1…

Section 7. In addition to all powers conferred on state agencies, the division or the department of aging and independence, as appropriate shall have the following powers: a. to make, amend, and repeal rules and regulations for the management of its affairs; b. to make contracts …

Section 70. As used in sections 70 to 75 inclusive, the following words shall, unless the context requires otherwise, have the following meanings:— ''Consumer,'' a person to whom a personal care attendant provides personal care services. ''PCA quality home care workforce council'…

Section 71. (a) There shall be a PCA quality home care workforce council which shall be within the executive office of health and human services but shall not be subject to the control of the executive office, to ensure the quality of long-term, in-home, personal care by recruiti…

Section 72. (a) The workforce council shall carry out the following duties: (1) Undertake recruiting efforts to identify and recruit prospective personal care attendants; (2) Provide training opportunities, either directly or through contract, for personal care attendants and con…

Section 73. (a) Consumers or the consumer's surrogate shall retain the right to select, hire, schedule, train, direct, supervise and terminate any personal care attendant providing services to the consumer or consumer's surrogate. Consumers or the consumer's surrogate may elect t…

Section 74. (a) The PCA quality home care workforce council may make and execute contracts and all other instruments necessary or convenient for the performance of its duties or exercise of its powers, including contracts with public and private agencies, organizations, corporati…

Section 75. (a) The council shall conduct a performance review every 2 years, submit a report of the review to the legislature and the governor and make the report available to the public upon submission to the governor and the legislature. (b) The performance review and report s…

Section 76. The secretary of the executive office may designate another governmental unit or units to perform any or all functions set forth in sections 13C to 13K, inclusive, and sections 64 to 75, inclusive. Such designee specifically may include the center for health informati…

Section 77. To the maximum extent possible, the office of Medicaid shall attribute every member to a primary care provider. Members may change their primary care provider, provided that the member gives notice to the office of Medicaid.

Section 78. (a) The division shall create an employer healthcare coverage form. Every employer with 6 or more employees, doing business in the commonwealth, shall annually complete and submit the form under oath. The form shall indicate whether the employer has offered to pay or …

Section 79. (a) For the purposes of this section, the following words shall, unless the context clearly requires otherwise, have the following meanings:- ''Behavioral health services'', care and services for the evaluation, diagnosis, treatment or management of patients with ment…

Section 8. As used in this chapter the following terms and phrases shall, unless the context clearly requires otherwise, have the following meanings: a. ''Commissioner'', the commissioner of medical assistance or the secretary of elder affairs, as appropriate. a1/2. ''Department'…

Section 80. (a) Every 2 years, not later than November 15, the executive office shall review data and report on findings from the review based on data collected for the prior 2 years. The review shall consist of: (i) the available covered medications; (ii) treatments; and (iii) w…

Section 81. (a) The division and its health insurers, health plans, health maintenance organizations, behavioral health management firms and third-party administrators under contract with the division, a Medicaid managed care organization or a primary care clinician plan shall pr…

Section 82. Notwithstanding any general or special law to the contrary, the office of Medicaid shall seek a waiver and promulgate regulations in order to require the division and its health insurers, health plans, health maintenance organizations, behavioral health management fir…

Section 83. (a) As used in this section and section 84, the following words shall have the following meaning unless the context clearly requires otherwise: ''HSN'', the payment program established and administered in accordance with section 8A and sections 64 to 69, inclusive. ''…

Section 84. (a) For the purposes of this section, ''Prenatal vitamin'', shall mean an oral multivitamin for supporting health during pregnancy. (b) Notwithstanding any general or special law to the contrary, a physician who is registered to prescribe or dispense a controlled subs…

Section 85. To establish Medicaid rates for skilled nursing facilities licensed pursuant to section 71 of chapter 111, the division of medical assistance shall use as base year costs for rate determination purposes the reported costs of the calendar year not more than 2 years pri…

Section 86. (a) The division of medical assistance shall establish a skilled nursing facility rate add–on program for bariatric patient care and a rate add–on program for 1–on–1 staffing of at-risk residents requiring 24–hour monitoring and supervision for their safety and the sa…

Section 87. Notwithstanding any general or special law to the contrary, the executive office may directly pay other state agencies, including county correctional facilities and department of correction facilities operated by such state agencies, for any claims related to Medicaid…

Section 8A. For the purposes of sections 13C to 13K, inclusive, and sections 64 to 70, inclusive, the following terms and phrases shall, unless the context clearly requires otherwise, have the following meanings: ''Actual costs'', all direct and indirect costs incurred by a hospi…

Section 9. There is hereby established, pursuant to and in conformity with the provisions of Title XIX, a program of medical assistance, hereafter referred to in this chapter as Medicaid, for certain residents of the commonwealth. Medicaid benefits shall be available to all perso…

Section 9A. (1) As used in this section and in section nine B, the following words shall have the following meanings: ''Beneficiary'', a person who, pursuant to eligibility criteria established by the terms and conditions of a demonstration project and regulations promulgated by …

Section 9C. (1) For purposes of this section, the following words shall have the following meanings:— ''Eligible employer'', (i) an individual or an unincorporated business that employs one or more residents of the commonwealth, (ii) a corporation, including a foreign corporation…

Section 9D. (a) As used in this section, the following words shall have the following meanings:— ''Aging services access point'' or ''ASAP'', any agency designated by the executive office of aging and independence pursuant to section 4B of chapter 19A. ''Capitation'', a set dolla…

Section 9E. The secretary of health and human services may apply for authority from the secretary of the United States Department of Health and Human Services, pursuant to section 1115 of the Social Security Act that authorizes the secretary to waive provisions of Title XIX of th…

Section 9F. (a) The secretary of health and human services may establish, subject to appropriation, all required federal approvals and agreements and the availability of federal financial participation a demonstration to integrate care for dual eligible individuals program, herei…