Mass. Gen. Laws ch. 118E, sec. 15 — MA Code / Part I / Title XVII / Chapter 118E / Section 15
Medicaid benefits; rules and regulations; managed care; personal expenses
Status: in_force

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 regulations permit. The amount, duration and scope of the aforesaid care and services shall be determined by the rules and regulations of the division, provided such rules and regulations are consistent with the provisions of this chapter and Title XIX. Such rules and regulations may include appropriate limitations on care and services based on such criteria as medical necessity or utilization control procedures. The division shall develop regulations and procedures requiring a recipient of medical assistance under this chapter to participate in a program of managed care, upon determination by the department, pursuant to the provisions of 42 USC 1396n(a), subject to appeal by the recipient, that said recipient has demonstrated a pattern of excessive or inappropriate utilization of a covered benefit. Any person who is eligible for assistance under the provisions of this chapter who is not maintaining his or her own home and who is receiving care in a licensed nursing home, a licensed chronic hospital, a licensed rest home, an approved public medical institution, or a public psychiatric institution shall retain the first sixty dollars of monthly income for clothing, personal needs allowance, and leisure time activities. If there is no such income, or if such income is less than sixty dollars, the recipient shall be paid, in advance, the difference between such income and sixty dollars. A person who acts as a fiduciary for another person eligible for assistance and who fails to provide the first $60 of monthly income or to pay for the amount of income that a resident is required to contribute for their care as established by Medicaid shall be liable for the financial loss. The division shall provide by regulation that personal laundry costs shall not be charged to the amount retained by or paid to the recipient pursuant to this section. Personal laundry costs shall be reimbursed through rates paid to such institutions.

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 regulations permit.

The amount, duration and scope of the aforesaid care and services shall be determined by the rules and regulations of the division, provided such rules and regulations are consistent with the provisions of this chapter and Title XIX. Such rules and regulations may include appropriate limitations on care and services based on such criteria as medical necessity or utilization control procedures.

The division shall develop regulations and procedures requiring a recipient of medical assistance under this chapter to participate in a program of managed care, upon determination by the department, pursuant to the provisions of 42 USC 1396n(a), subject to appeal by the recipient, that said recipient has demonstrated a pattern of excessive or inappropriate utilization of a covered benefit.

Any person who is eligible for assistance under the provisions of this chapter who is not maintaining his or her own home and who is receiving care in a licensed nursing home, a licensed chronic hospital, a licensed rest home, an approved public medical institution, or a public psychiatric institution shall retain the first sixty dollars of monthly income for clothing, personal needs allowance, and leisure time activities. If there is no such income, or if such income is less than sixty dollars, the recipient shall be paid, in advance, the difference between such income and sixty dollars.

A person who acts as a fiduciary for another person eligible for assistance and who fails to provide the first $60 of monthly income or to pay for the amount of income that a resident is required to contribute for their care as established by Medicaid shall be liable for the financial loss.

The division shall provide by regulation that personal laundry costs shall not be charged to the amount retained by or paid to the recipient pursuant to this section. Personal laundry costs shall be reimbursed through rates paid to such institutions.