Mass. Gen. Laws ch. 111K, sec. 5 — MA Code / Part I / Title XVI / Chapter 111K / Section 5
Powers and duties of commission
Status: in_force

Section 5. The commission shall have the following powers and duties:— (a) to establish a program to administer the fund and authorize the payment or medical reimbursement of the medical and related expenses of children with catastrophic illnesses; (b) to establish procedures for applying to the fund, determining the eligibility for the payment or reimbursement of medical expenses for each child and processing claim disputes; (c) to establish procedures for reimbursement of the fund where a family, after receiving assistance from the fund, recovers the costs for a child's medical expenses from a catastrophic illness pursuant to a settlement or judgment in a legal action; (d) to establish the amount of reimbursement for the medical expenses of each child using a sliding fee scale based on a family's ability to pay for medical expenses, which takes into account family size, family income and assets and family medical expenses; (e) to adjust the financial eligibility criteria established pursuant to section 1 based upon the monies available in the fund; (f) to disseminate information on the fund and the program to the public; (g) to maintain confidential records on each child who applies for assistance under the fund; and (h) to authorize and make payment of all administrative costs, not to exceed 10 per cent of the monies transferred into the fund in a given fiscal year or 10 per cent of the carry forward balance for any fiscal year with reduced or no transfers into the fund, related to the management of the program including, but not limited to, costs for staff to manage the program and coordinate the work assigned by the commission and materials development, printing, postage and telephone expenses; provided, however, that administrative costs shall not include staff costs related to case management services, including the evaluation and processing of applications; and (i) to review and approve annual operating expenses.

Section 5. The commission shall have the following powers and duties:—

(a) to establish a program to administer the fund and authorize the payment or medical reimbursement of the medical and related expenses of children with catastrophic illnesses;

(b) to establish procedures for applying to the fund, determining the eligibility for the payment or reimbursement of medical expenses for each child and processing claim disputes;

(c) to establish procedures for reimbursement of the fund where a family, after receiving assistance from the fund, recovers the costs for a child's medical expenses from a catastrophic illness pursuant to a settlement or judgment in a legal action;

(d) to establish the amount of reimbursement for the medical expenses of each child using a sliding fee scale based on a family's ability to pay for medical expenses, which takes into account family size, family income and assets and family medical expenses;

(e) to adjust the financial eligibility criteria established pursuant to section 1 based upon the monies available in the fund;

(f) to disseminate information on the fund and the program to the public;

(g) to maintain confidential records on each child who applies for assistance under the fund; and

(h) to authorize and make payment of all administrative costs, not to exceed 10 per cent of the monies transferred into the fund in a given fiscal year or 10 per cent of the carry forward balance for any fiscal year with reduced or no transfers into the fund, related to the management of the program including, but not limited to, costs for staff to manage the program and coordinate the work assigned by the commission and materials development, printing, postage and telephone expenses; provided, however, that administrative costs shall not include staff costs related to case management services, including the evaluation and processing of applications; and

(i) to review and approve annual operating expenses.