Mass. Gen. Laws ch. 118E – Division of Medical Assistance | Midpage

Collections
Massachusetts General Laws

Chapter 118E

Mass. Gen. Laws ch. 118E

Division of Medical Assistance

1Duties of office 2Established authority 2ADirector of dental services 6Medical care advisory committee; member; staff; report from office of Medicaid 7Powers 8Definitions 8ADefinitions for Secs. 13C to 13K and Secs. 64 to 70 9Eligibility 9AMassHealth; beneficiaries; eligibility; payment; information applications 9CMedical insurance reimbursement programs; definitions; eligibility; expenditures; submission of plans 9DSenior care options initiative; senior care organizations; enrollment choices; advisory committee; report 9EApplication for authority; implementation of measures; waiver of measures due to hardship 9FDuals demonstration; review of request for financial solvency 10Medical care assistance program for pregnant women and infants 10ARequired coverage for abortion, abortion-related care, prenatal care, childbirth and postpartum care 10A 1/2MassHealth standard coverage for pregnant or postpartum residents 10BRequired coverage for newborn hearing screening tests 10CRequired coverage for items medically necessary for the diagnosis or treatment of diabetes 10DRequired coverage for treatment of breast and cervical cancer 10EHealthy start program; medical assistance for pregnant women and infants; eligibility; types of assistance; protection from billing and collection practices 10FHealth care services for dependent and adopted youths; funding; types of services; eligibility; program reports; no entitlement 10GCoverage for children under age 18 for cleft lip and cleft palate 10HCoverage for medically necessary treatments for persons younger than 21 years old diagnosed with an autism spectrum disorder by a licensed physician or a licensed psychologist 10H 1/2Coverage for treatment of Down syndrome through speech therapy, occupational therapy, physical therapy and applied behavior analysis services 10H.5Coverage for treatment of Down syndrome through speech therapy, occupational therapy, physical therapy and applied behavior analysis services 10ICoverage for administration of all federal Food and Drug Administration approved drugs for opioid or alcohol dependence treatment 10JCoverage for medical or drug treatments to correct or repair disturbances of body composition caused by HIV associated lipodystrophy syndrome 10KCoverage for certain services and contraceptive methods 10LFilling of remaining portion of prescription for covered drug that is a narcotic substance earlier filled in lesser quantity 10MCoverage for tobacco use cessation counseling and products 10NUrgent care facilities; referrals; primary care providers 10OCoverage for mental health acute treatment, community-based acute treatment and intensive community-based acute treatment 10PCoverage for mental health or substance use disorder services delivered through psychiatric collaborative care model 10QCoverage for annual mental health wellness examination 10RCoverage for noninvasive prenatal screening 10SCoverage for postpartum depression and major depressive disorder screenings conducted pursuant to section 247 of chapter 111 10TCoverage for the provision of medically necessary pasteurized donor human milk and donor human milk-derived products 10UCoverage of doula services 10VCoverage for universal postpartum home visiting services 10WCoverage for diagnostic examinations for breast cancer screening; digital breast tomosynthesis screening, MRIs and ultrasounds 10XCoverage for prescribed, ordered or dispensed opioid antagonists 10YCoverage for the provision of services by a recovery coach 10ZCoverage for identified generic and brand name drug used to treat diabetes, asthma, and certain heart conditions 11Cooperation with federal authorities 12Policies; procedures; rules and regulations; contracts 12APharmaceutical drugs; negotiation of supplemental rebate agreements 13Rate changes; review 13ANon-acute hospitals; rates and terms of payment 13BHospital rate increases; quality standards and benchmarks 13CEstablishment of rates of payment for health care services 13DDuties of ratemaking authority; criteria for establishing rates 13D 1/2Minimum payment rates to be paid to providers of behavioral health services delivered in community behavioral health centers by managed care entities; annual review and reporting 13EAppeals of interim or final rates 13E 1/2Contractual arrangements with acute and non-acute hospitals 13FContracts between acute and non-acute hospital service providers and office of Medicaid 13GHospital assets not to be considered as resources for purpose of establishing rates 13HRecipients of benefits under chapter 117A 13IPatients with foreign residency 13JHealth maintenance organizations; contracting rights 13KAdjustment of facility's rate 13LRestriction of hospital access to discounted purchase of prescription drugs 14Nursing home negotiated rate contracts 14AReimbursement to nursing homes for admissions to acute care and chronic disease or rehabilitation hospitals 15Medicaid benefits; rules and regulations; managed care; personal expenses 16Primary and supplemental medical care and assistance program for residents with disabilities; assistance program for chronically ill persons or persons with disabilities forced to leave employment or substantially reduce work hours 16AMedical care and assistance program for children with disabilities 16A 1/2Costs incurred for medical programs projected to exceed available appropriations; notice 16CChild health insurance program; medical benefits; eligibility 16DAliens or persons residing in United States under color of law; benefits 17Reimbursements for non-generic drugs 17AEmergency services provided to beneficiaries for emergency medical conditions 18Medical insurance purchases for persons eligible for assistance 19Prior approval of medical services; methods; rules and regulations; posttreatment examinations 20Application; forms; application by institution 21Inquiry by department; notification of applicant; agreement 21AMedical assistance eligibility of an institutionalized spouse 22Third party payments; repayment; assignment; subrogation 23Subrogation rights; health insurance benefits; garnishment of wages 23AFinancial institutions; request for deposit and withdrawal records; penalty 25Exempt income and resources 25ADetermination of eligibility for Qualified Medicare Beneficiary, Specified Low-Income Medicare Beneficiary and Qualified Individual programs; consideration of certain income or assets 26Identification card 27Redetermination of eligibility 28Disposal of resources at less than fair market value; period of ineligibility; transfers for sole benefit of individual age 65 or older 29Transfer of interest in real property; notice 30Time of payment 31Adjustment or recovery of payments 32Provision of death certificate and probate petition to division; liability of estate beneficiaries; claims against estate; sale or transfer of property subject to lien or claim 33Long term care insurance purchasers; liability for medical assistance paid 34Liens and encumbrances 35Reimbursement for covered claims; submission of information 36Eligible providers; responsibility for overpayments 37Distribution of rules, regulations to providers; administrative sanctions 38Submission of bills by providers; appeals for erroneous denials; overpayments; civil collection actions 38ARetroactive claims denials for behavioral health services 39False representations, failure to disclose; penalty 40False statements or representations by providers; penalty 41Bribery or rebates; penalty 42Excess charges; penalty 43Health care facilities; additional charges as precondition for admission or continuance; penalty 44Civil remedies; limitations 45Venue; actions relating to false claims 46Availability of other remedies 46AProviders; submission of claims for payment not in compliance with policies and procedures of medical assistance program; proof of clerical or administrative error 47Persons aggrieved; written notification of denial of requested benefits or services; right to hearing; investigation; decision; rehearing; notice 47ABenefits available only to otherwise eligible individuals showing lawful presence in the United States or meeting applicable federal requirements necessary to qualify for benefits for which the commonwealth receives federal reimbursement 48Board of hearings 49Use and disclosure of information 50Contract for administrative functions; underwriting of program 51Utilization review of care and services; data processing and collection procedures; liability in civil actions 51AStep therapy protocol clinical review criteria; prescription coverage 52Maintenance of standards for providers; development of new programs 53Covered services 54Wellness program for MassHealth enrollees 56Controlled substance management program for MassHealth enrollees 61Availability of benefits to persons recognized as a spouse under laws of the commonwealth 62Acceptance and recognition of information submitted pursuant to coding standards and guidelines required; use of standardized claim formats 63Assessment per non–Medicare reimbursed patient day 64Definitions for Secs. 64 through 69 65Health safety net office 66Health Safety Net Trust Fund 67Liability of acute hospital to fund 67ANonpublic ambulance services; liability; uniform assessment; enforcement 68Managed care organization services assessment; calculation of liability; payment to health safety net trust fund 69Reimbursements to hospitals and community health centers for health services provided to uninsured and underinsured individuals 70Definitions for Secs. 70 through 75 71PCA quality home care workforce council 72Duties of workforce council; PCA recruitment, training and referral resources; lists of PCAs 73Rights of consumers regarding PCAs; public employee status for limited purposes; collective bargaining 74PCA quality home care workforce council; scope of power and authority 75Performance reviews 76Designation of another governmental unit to perform functions set forth in Secs. 13C through 13K and 64 through 75 77Office of Medicaid to attribute members to primary care providers 78Employer healthcare coverage form 79Coverage for health care services delivered via telehealth by a contracted health care provider; right in in-person services; copayment or coinsurance; rate of payment; standards of care 80Sickle cell disease; executive office review; content of report 81Mental health and substance use disorder benefits; benefits for children and adolescents under the age of 19 for the diagnosis and treatment of mental, behavioral, emotional or substance use disorders substantially interfering with or limiting the functioning and social interactions of such child or adolescent; consent to disclosure of information 82Requirement that division meets parity requirements described under federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 and related guidance or regulations 83Dispensing of OTC oral contraceptive to MassHealth member or HSN patient by licensed pharmacist 84Dispensing of a prenatal vitamin to MassHealth member or HSN patient by licensed pharmacist 85Establishment of Medicaid rates for licensed skilled nursing facilities 86Skilled nursing facility rate add–on programs; bariatric care; 1–on–1 staffing of at-risk residents 87Payment to state agencies for claims related to Medicaid