Chapter 118E

Section 19. The division shall establish methods of approving services to be performed as a prerequisite to extending medical assistance. Said methods of prior approval may include, but need not be limited to: (1) in the case of restorative dentistry, or dentures, examination of …

Section 2. All powers and duties established pursuant to this chapter shall be exercised by the secretary of health and human services, through the division of medical assistance and the secretary of aging and independence, as appropriate.

Section 20. An application or reapplication by an individual for medical assistance shall be made to the division on forms prepared by the division. Such forms shall include but not be limited to the following:—the name, address and social security number of the applicant and the…

Section 21. Upon receipt of such application, the division shall make full inquiry concerning the eligibility of the applicant, his or her need for medical assistance and his or her resources and income, if any, and, shall make its decision: (1) within ninety days after receipt o…

Section 21A. (a) In determining the eligibility for medical assistance of an institutionalized spouse, the division shall comply with all the requirements set forth in 42 U.S.C. 1396r–5, including, but not limited to, the following: (1) Upon a determination of eligibility for med…

Section 22. (a) As used in this section, the following words shall have the following meanings unless the context clearly requires otherwise: ''Claimant'', a person who suffers a loss from accident, illness, injury or otherwise for which monies may be provided by liability insura…

Section 23. As used in this section, health care insurer, health insurer and health insurance shall include, but not be limited to, any health insurance company, health maintenance organization, group or nongroup health plan, self-insured plan, service benefit plan, managed care …

Section 23A. Upon written request signed by an authorized employee or agent of the division, the treasurer of a financial institution shall provide, without charge, the deposit and withdrawal records of the preceding 5 years for an applicant for or recipient of medical assistance…

Section 25. For purposes of determining an individual's eligibility for Medicaid, the following income and resources shall be exempt and shall neither be taken into consideration nor, except as permitted under Title XIX, required to be applied toward the payment or part payment o…

Section 25A. (a)(1) For individuals 65 years of age or older, the division shall not consider income in an amount equivalent to 90 per cent of the federal poverty level as adjusted annually, in determining eligibility for the Qualified Medicare Beneficiary, Specified Low-Income M…

Section 26. The division shall issue a numbered identification card to persons receiving medical assistance under this chapter. Such card shall bear the date of issue and shall be presented to providers as verification of eligibility for medical assistance. The division shall est…

Section 27. If an individual has become eligible under this chapter, eligibility shall be reconsidered or redetermined: (a) When required on the basis of information the division has obtained previously about anticipated changes in the individual's situation. (b) Promptly within …

Section 28. In determining the eligibility of an institutionalized individual, as defined by Title XIX, the division shall impose a period of ineligibility, consistent with said Title XIX, against any such individual if said individual or his spouse disposes of resources for less…

Section 29. Whenever an individual who is receiving medical assistance under this chapter transfers an interest in real or personal property, such individual shall notify the division. Such notice shall include, at a minimum, the individual's name, social security number or, if d…

Section 2A. (a) In order to improve, promote and protect oral health, there shall be, in the office of Medicaid, a full-time director of dental services who shall work collaboratively with the department of public health to facilitate the integration of programs to improve oral h…

Section 30. When the division determines that an applicant is eligible for Medicaid, it shall pay for eligible care and services furnished on or after the date of application. Payment shall be made to the provider, institution or insurance entity supplying medical services. The d…

Section 31. (a) This subsection shall apply to estates of individuals dying prior to April first, nineteen hundred and ninety-five. There shall be no adjustment or recovery of medical assistance correctly paid except as follows: (1) Recovery from the Permanently Institutionalized…

Section 32. (a) Notwithstanding any provision of law to the contrary, a petition for admission to probate of a decedent's will or for administration of a decedent's estate shall include a sworn statement that copies of said petition and death certificate have been sent to the div…

Section 33. No claim for costs of a nursing facility or other long-term care services shall be made by the division under section 31 or 32 if the individual receiving medical assistance was permanently institutionalized, had notified the division that the individual had no intent…

Section 34. No lien or encumbrance of any kind except as may be permitted by the Secretary, shall be required from or imposed against the property of any individual prior to his death because of Medicaid benefits paid or to be paid on his behalf except pursuant to the judgment of…

Section 35. No claim for medical care or services provided for under this chapter shall be reimbursed if any health insurance company, non-profit hospital service corporation, medical service corporation, or other health insurer is liable for such claim under the terms of a group…

Section 36. Participation in the medical assistance programs established under this chapter shall be limited to providers of services who have not been convicted of larceny or fraud or any other crime in connection with such services, or the billing therefor and who: (1) indicate…

Section 37. The division shall distribute to all providers a copy of the rules, regulations, standards, and laws governing the medical assistance programs established by this chapter and shall establish administrative sanctions against providers, including, but not limited to, ad…

Section 38. Providers shall submit to the division a bill for goods sold and services rendered not later than ninety days after the goods are sold or the services rendered, and the division shall verify no less than ten percent of said bills with the recipient of said goods or se…

Section 38A. (a) For the purposes of this section, the following words shall have the following meanings unless the context clearly requires otherwise: ''Behavioral health services'', as defined in section 1 of chapter 175, or ''services''. ''Provider'', (i) a mental health clini…

Section 39. Any person or institution which knowingly makes a false representation or, contrary to a legal duty to do so, knowingly fails to disclose any material fact to the division or its agents affecting eligibility or level of benefits for the purpose of causing any person, …

Section 40. Any person who furnishes items or services for which payment may be made under this chapter, who: (1) knowingly and willfully makes or causes to be made any false statement or representation of a material fact in any application for any benefit or payment under this c…

Section 41. Whoever solicits or receives any remuneration, including any bribe or rebate, directly or indirectly, overtly or covertly, in cash or in kind in return for purchasing, leasing, ordering or arranging for or recommending purchasing, leasing, or ordering any good, facili…

Section 42. Whoever knowingly and willfully charges for any service provided to a patient under this chapter, money or other consideration at a rate in excess of the rates established in accordance with this chapter, shall be punished by a fine of not more than ten thousand dolla…

Section 43. Whoever knowingly and willfully charges, solicits, accepts or receives, in addition to any amount otherwise required to be paid under this chapter, any gift, money, donation, or other consideration as a precondition or guarantee of admitting a recipient of services un…

Section 44. If any person violates the provisions of this chapter, the attorney general or a district attorney may bring a civil action, either in lieu of or in addition to a criminal prosecution, and recover three times the amount of damages sustained including the costs of inve…

Section 45. Any action brought under this chapter may be filed in the district or superior courts of Suffolk county.

Section 46. The remedies in sections thirty-nine to forty-five, inclusive, are in addition to and do not supersede any other available remedies.

Section 46A. Any provider making a claim for payment under any medical assistance program administered by the division, which is not submitted in compliance with the billing policies and procedures of said program, shall not be considered in violation of sections 39 to 46, inclus…

Section 47. Any applicant for or recipient of medical assistance, or the legal representative of such applicant or recipient, aggrieved by the failure of the division to grant medical assistance or by the failure of the division to approve or reject an application within the time…

Section 47A. Benefits for individuals age 19 or older for any program established pursuant to this chapter or chapter 118H shall be available only to otherwise eligible individuals who provide satisfactory documentation that they are lawfully present in the United States, includi…

Section 48. There shall be within the division a board of hearings for the purpose of holding the hearings referred to herein and rendering decisions. Said board shall be under the supervision of a director appointed by the commissioner and shall be independent of all other subdi…

Section 49. The use or disclosure of information concerning applicants and recipients shall be limited to purposes directly connected with the administration of the medical assistance programs established under this chapter and the names of applicants and recipients shall not be …

Section 50. To the extent feasible the division may contract with one or more federal agencies or corporations authorized to do business in the commonwealth, including nonprofit hospital and medical service corporations, to carry out the necessary administrative functions of the …

Section 51. The division, in cooperation with the department of public health and in accordance with the regulations of the secretary, shall establish processes of utilization review for care or services for which medical assistance is available under this chapter. The division s…

Section 51A. (a) For the purposes of this section, the following words shall, unless the context clearly requires otherwise, have the following meanings: ''Clinical review criteria'', as defined in section 1 of chapter 176O. ''Step therapy protocol'', a utilization management pol…

Section 52. The division, in cooperation with the department of public health, shall establish and maintain standards and conditions of participation for providers of all medical care and services for which medical assistance is available under this chapter. The department of pub…

Section 53. The division shall include within its covered services for adults all federally optional services that were included in its state plan or demonstration program in effect on January 1, 2002. Covered services for adults in the MassHealth Essential program shall include …

Section 54. The executive office of health and human services shall implement, in cooperation with the department of public health, a wellness program for MassHealth enrollees to encourage activities that lead to desired health outcomes, including smoking cessation, diabetes scre…

Section 56. The division shall establish a controlled substance management program for MassHealth enrollees who use excessive quantities of prescribed drugs. Those enrollees shall be restricted to obtaining prescription drugs only from the provider that the division designates as…

Section 6. There shall be a medical care advisory committee which shall advise the executive office about health and medical care services. The committee shall have the opportunity to participate in policy development and program administration. The secretary of health and human …