reglab/statecodes huggingface dataset:
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 10j - Coverage for Medical or Drug Treatments to Correct or Repair Disturbances of Body Composition Caused by HIV Associated Lipodystrophy Syndrome

Section 10J. The division shall provide coverage for medical or drug treatments to correct or repair disturbances of body composition caused by HIV associated lipodystrophy syndrome including, but not limited to, reconstructive surgery, such as suction assisted lipectomy, other restorative procedures and dermal injections or fillers for reversal of facial lipoatrophy syndrome. Coverage shall be subject to a statement from a treating provider that the treatment is necessary for correcting, repairing or ameliorating the effects of HIV associated lipodystrophy syndrome. The benefits in this section shall not be subject to any greater deductible, coinsurance, copayments or out-of-pocket limits than any other benefit provided by the division.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 10l - Filling of Remaining Portion of Prescription for Covered Drug That Is a Narcotic Substance Earlier Filled in Lesser Quantity

Section 10L. The division and its contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third party administrators under contract to a Medicaid managed care organization or primary care clinician plan shall provide, for any covered drug that is a narcotic substance contained in schedule II pursuant to chapter 94C and subject to cost sharing, that if a person receives a prescription filled in a lesser quantity pursuant to section 18 of said chapter 94C, said person shall not be subject to an additional payment obligation, including, but not limited, to co-payments, if said person fills the remaining portion of the prescription.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 10m - Coverage for Tobacco Use Cessation Counseling and Products

[Text of section applicable to policies, contracts and subscription certificates delivered, issued or renewed in the commonwealth on or after January 1, 2020. See 2019, 133, Sec. 26.]
Section 10M. (a) The division and its contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third-party administrators under contract to a Medicaid managed care organization or primary care clinician plan shall provide coverage for: (i) tobacco use cessation counseling; and (ii) all generic United States Food and Drug Administration-approved tobacco cessation products without cost sharing when prescribed by a health care provider.
(b) The division shall be permitted to employ reasonable managed care techniques consistent with state and federal law to determine the frequency, method, treatment or setting for the recommended item or service; provided, however, that covered persons shall have access to at least 1 tobacco cessation product without preauthorization.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 10n - Urgent Care Facilities; Referrals; Primary Care Providers

Section 10N. (a) For the purposes of this section, the following words shall, unless the context clearly requires otherwise, have the following meanings:-
''Division'', the division of medical assistance within the executive office of health and human services.
''Urgent care facility'', any entity, however organized, whether conducted for profit or not for profit, which is advertised, announced, established or maintained for the purpose of providing urgent care services in an office or a group of offices, or any portion thereof, or an entity which is advertised, announced, established or maintained under a name which includes the words ''urgent care'' or which suggests that urgent care services are provided therein; provided, however, that an urgent care facility shall not serve as a patient's primary care provider.
''Urgent care services'', delivery of episodic care for the diagnosis, treatment, management or monitoring of acute and chronic disease or injury that is: (i) for the treatment of illness or injury that is immediate in nature but does not require emergency services; (ii) generally provided on a walk-in basis without a prior appointment; (iii) available to the general public; and (iv) not intended as the patient's primary care provider.
(b) The division and its contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third-party administrators under contract to a Medicaid managed care organization or primary care clinician plan shall not require an enrollee to obtain a referral from a primary care provider prior to obtaining health care services from an urgent care facility; provided, however, that any urgent care facility providing health care services to an enrollee shall provide the enrollee with names of primary care providers contracted with MassHealth and practicing in the municipality of residence of the enrollee or an adjacent municipality.
Any urgent care facility that provides health care services to an enrollee shall notify the division, in a manner to be determined by the division, that the urgent care facility provided such services to the enrollee. The urgent care facility shall also notify the division, in a manner to be determined by the division, if the enrollee does not have a designated primary care provider, and the division shall send a notice to the enrollee that shall contain guidance on how to choose a primary care provider.
The division may promulgate regulations to implement this section.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 10o - Coverage for Mental Health Acute Treatment, Community-Based Acute Treatment and Intensive Community-Based Acute Treatment

Section 10O. For the purposes of this section, the following terms shall have the following meanings unless the context clearly requires otherwise:-
''Community-based acute treatment'', 24–hour clinically managed mental health diversionary or step-down services for children and adolescents that is usually provided as an alternative to mental health acute treatment.
''Intensive community-based acute treatment'', intensive 24–hour clinically managed mental health diversionary or step-down services for children and adolescents that is usually provided as an alternative to mental health acute treatment.
''Mental health acute treatment'', 24–hour medically supervised mental health services provided in an inpatient facility, licensed by the department of mental health, that provides psychiatric evaluation, management, treatment and discharge planning in a structured treatment milieu.
The division and its contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third-party administrators under contract to a Medicaid managed care organization or primary care clinician plan shall cover the cost of medically necessary mental health acute treatment, community-based acute treatment and intensive community-based acute treatment and shall not require a preauthorization before obtaining treatment; provided, however, that the facility shall notify the carrier of the admission and the initial treatment plan within 72 hours of admission.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 10p - Coverage for Mental Health or Substance Use Disorder Services Delivered Through Psychiatric Collaborative Care Model

Section 10P. (a) For the purposes of this section, ''psychiatric collaborative care model'' shall mean the evidence-based, integrated behavioral health service delivery method in which a primary care team consisting of a primary care provider and a care manager provides structured care management to a patient, and that works in collaboration with a psychiatric consultant that provides regular consultations to the primary care team to review the clinical status and care of patients and to make recommendations.
(b) The division and its contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third-party administrators under contract to a Medicaid managed care organization or primary care clinician plan shall provide coverage for mental health or substance use disorder services that are delivered through the psychiatric collaborative care model.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 10q - Coverage for Annual Mental Health Wellness Examination

Section 10Q. (a) For the purpose of this section, the following words shall have the following meanings:
''Licensed mental health professional'', a licensed physician who specializes in the practice of psychiatry, a licensed psychologist, a licensed independent clinical social worker, a licensed certified social worker, a licensed mental health counselor, a licensed supervised mental health counselor, a licensed psychiatric nurse mental health clinical specialist, a licensed psychiatric mental health nurse practitioner, a licensed physician assistant who practices in the area of psychiatry, a licensed alcohol and drug counselor I, as defined in section 1 of chapter 111J, or a licensed marriage and family therapist within the lawful scope of practice for such therapist.
''Mental health wellness examination'', a screening or assessment that seeks to identify any behavioral or mental health needs and appropriate resources for treatment. The examination may include: (i) observation, a behavioral health screening, education and consultation on healthy lifestyle changes, referrals to ongoing treatment, mental health services and other necessary supports and discussion of potential options for medication; and (ii) age-appropriate screenings or observations to understand a covered person's mental health history, personal history and mental or cognitive state and, when appropriate, relevant adult input through screenings, interviews and questions.
''Primary care provider'', a health care professional qualified to provide general medical care for common health care problems who: (i) supervises, coordinates, prescribes or otherwise provides or proposes health care services; (ii) initiates referrals for specialist care; and (iii) maintains continuity of care within the scope of practice.
(b) The division and its contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third-party administrators under contract to a Medicaid managed care organization or primary care clinician plan shall provide coverage for an annual mental health wellness examination that is performed by a licensed mental health professional or primary care provider, which may be provided by the primary care provider as part of an annual preventive visit. The examination shall be covered with no patient cost-sharing, provided, however, that cost-sharing shall be required if the applicable plan is governed by the Federal Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on cost-sharing for this service.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 11 - Cooperation With Federal Authorities

Section 11. The division shall, within the limits of the funds which have been appropriated for the purposes of this chapter, cooperate with the appropriate federal authorities in the administration of Title XIX, under which federal funds are available to the commonwealth for Medicaid, and accept for the commonwealth any benefits thereof. The state treasurer shall be the custodian of such funds allocated to the commonwealth.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 13 - Rate Changes; Review

Section 13. The commissioner shall review, and approve or disapprove, any change in Title XIX rates or Title XIX rate methodology proposed by the executive office of health and human services, which shall be called the ''executive office'' only for the purposes of this section or by a governmental unit designated by the executive office. The commissioner shall review such proposed rate changes for consistency with agency policy and federal requirements, and within the level of funding available as authorized by the general appropriation act prior to the certification of such rates by the executive office; provided, that the commissioner shall not disapprove a rate increase solely based on the availability of funding if the federal health care financing administration provides written documentation that federal reimbursement would be denied as a result of said disapproval and said documentation is submitted to the house and senate committees on ways and means. The commissioner shall, when disapproving a rate increase, submit the reasons for disapproval to the executive office together with any recommendations for changes. Such disapproval and recommendations, if any, shall be submitted after the commissioner is notified that the executive office intends to propose a rate increase for any class of provider under Title XIX; but in no event later than the date of the public hearing held by the executive office regarding such rate change; provided, that no rates shall take effect without the approval of the commissioner. The executive office and the commissioner shall provide documentation on the reasons for increases in any class of approved rates that exceed the medical component of the consumer price index to the house and senate committees on ways and means. The center for health information and analysis shall supply the commissioner with all statistical information necessary to carry out his duties under this section. Notwithstanding the foregoing, the commissioner shall not review, approve, or disapprove any such rate set pursuant to chapter twenty-three of the acts of nineteen hundred and eighty-eight. If projected payments from rates necessary to conform to applicable requirements of Title XIX are estimated by the commissioner to exceed the amount of funding appropriated for such purpose in the general appropriation act in any fiscal year, the executive office and the commissioner shall jointly prepare and submit to the Governor a proposal for the minimum amount of supplemental funding necessary to satisfy the requirements of the under Title XIX state plan.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 13b - Hospital Rate Increases; Quality Standards and Benchmarks

Section 13B. Hospital rate increases shall be made contingent upon hospital adherence to quality standards and achievement of performance benchmarks, including the reduction of racial and ethnic disparities in the provision of health care. Such benchmarks shall be developed or adopted by the executive office of health and human services so as to advance a common national framework for quality measurement and reporting, drawing on measures that are approved by the National Quality Forum and adopted by the Hospitals Quality Alliance and other national groups concerned with quality, in addition to the Boston Public Health Commission Disparities Project Hospital Working Group Report Guidelines. The office of Medicaid shall consult with the MassHealth payment policy advisory board established under section 16M of said chapter 6A, during the process of developing these quality standards and performance benchmarks.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 13d1/2 - Minimum 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

Section 13D1/2. (a) As used in this section, the following words shall, unless the context clearly requires otherwise, have the following meanings:-
''Behavioral health services'', the evaluation, diagnosis, treatment, care coordination, management or peer support of patients with mental health, developmental or substance use disorders.
''Community behavioral health center'', organizations that are designated by the executive office of health and human services, licensed clinics that hold a contract with the department of mental health to provide community-based mental health services and other licensed clinics designated by the department of public health.
''Division'', the division of medical assistance.
''Managed care entity'', health insurers, health plans, health maintenance organizations, behavioral health management firms and third party administrators under contract with a Medicaid managed care organization or primary care clinician plan; provided, however, that ''managed care entity'' shall also include accountable care organizations.
''Minimum payment rates'', rates of payment for services below which managed care entities shall not enter into provider agreements.
(b) Annually, not later than January 1, the division shall review the minimum payment rates to be paid to providers of behavioral health services delivered in community behavioral health centers by managed care entities and submit a report to the house and senate committees on ways and means, the joint committee on health care financing and the joint committee on mental health, substance use and recovery identifying the difference between the minimum payment rates decided by the division and the payment rates that managed care entities contractually agree to pay providers for all behavioral health services delivered in community behavioral health centers.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 13e1/2 - Contractual Arrangements With Acute and Non-Acute Hospitals

Section 13E1/2. All purchasers and third party payers, excluding purchasers and payers under the workers' compensation act, except as provided in chapter 152, may enter into contractual arrangements with acute and non-acute hospitals for services. No such arrangement, including, but not limited to, prices or charges which may be charged for non-contracted services or which may be negotiated in individual contracts between such purchasers or third party payers and such acute or non-acute hospitals, shall be subject to prior approval by any public agency; provided, however, that nothing in this chapter shall limit the authority of the executive office to establish rates of payment for all health care services adjudged compensable under chapter 152, and provided, further, that charges established by an acute or non-acute hospital for health care services rendered shall be uniform for all patients receiving comparable services.
Any acute or non-acute hospital that makes a charge or accepts payment based upon a charge in excess of that filed, required or approved by the executive office or that fails to file any data, statistics or schedules or other information required under this chapter or by any regulation promulgated by the executive office or which falsifies the same, shall be subject to a civil penalty of not more than $1,000 for each day on which such violation occurs or continues, which penalty may be assessed in an action brought on behalf of the commonwealth in any court of competent jurisdiction. The attorney general shall bring any appropriate action, including injunctive relief, as may be necessary for the enforcement of this chapter.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 13g - Hospital Assets Not to Be Considered as Resources for Purpose of Establishing Rates

Section 13G. The executive office, or a governmental unit designated to perform ratemaking functions by the executive office, shall not consider the following as resources of such hospitals in the establishment, review or approval of acute and non-acute hospital rates and charges: restricted and unrestricted grants; gifts; contributions; bequests; fund principle; term endowments and endowment balances; restricted gifts; unrestricted gifts; and all income from any of the foregoing, including unrestricted income from endowment funds and income and gains from investment of unrestricted funds. The following words shall have the following meanings as used in this paragraph:
''Income and gains from investment of unrestricted funds'', interest, dividends, rents or other income on investments, including net gains or losses resulting from investment transactions.
''Term endowment'', funds available upon termination of restrictions.
''Unrestricted gifts'', gifts, grants, contributions and bequests, upon which there are no restrictions imposed by the donor.
''Unrestricted income from endowment funds'', income earned on investment of endowment funds which have no restrictions on income.
An acute or non-acute care hospital aggrieved by any action or failure to act by the executive office under this chapter may file an appeal under section 13E.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 13i - Patients With Foreign Residency

Section 13I. Notwithstanding any provisions of this chapter to the contrary, all costs and charges for patients who are residents of other countries shall, as provided herein, be exempted from the limitations imposed by this chapter. Any hospital shall be allowed to impose a surcharge on the normal charges that would otherwise be allowed for such residents of other countries. Such surcharges shall not be included in the calculation of gross patient service revenues. The normal charge and the patient discharge statistics shall otherwise be included under this chapter.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 13j - Health Maintenance Organizations; Contracting Rights

Section 13J. A health maintenance organization organized under chapter 176G may; (i) negotiate directly with any hospital with respect to such health maintenance organization's rate of payment for hospital services; and (ii) enter into an agreement with such hospital reflecting such rate of payment without the approval of the executive office. The specification in this section of contracting rights of health maintenance organizations shall not be construed as affirming or denying such rights with respect to any other third party payer.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 13k - Adjustment of Facility's Rate

Section 13K. Upon petition of a receiver appointed under section 72N of chapter 111, the executive office shall, under regulations to be promulgated hereunder, adjust the facility's rate, if necessary, to insure compensation of the receiver and payment for a bond. Such adjustment shall not be in effect if the licensee is under the jurisdiction of the United States Bankruptcy Court.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 13l - Restriction of Hospital Access to Discounted Purchase of Prescription Drugs

Section 13L. The secretary of health and human services, hereinafter ''the secretary'', shall not restrict or limit an eligible hospital's access to the discounted purchase of prescription drugs to the full extent permitted under section 340B of the Public Health Service Act, as codified under 42 U.S.C. 256b unless the secretary provides the following not less than 180 days before the proposed effective date of the limitation or restriction: (i) notice to eligible hospitals of the proposed restriction or limitation; and (ii) a report with the joint committee on health care financing and the senate and house committees on ways and means detailing: (A) the proposed restriction or limitation; (B) the anticipated aggregate savings to the commonwealth; (C) the estimated fiscal impact of the restriction or limitation on each affected hospital; and (D) the manner in which the secretary plans to mitigate the fiscal impact, which may include measures to maintain savings already achieved by providers under said 42 U.S.C. 256b.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 14a - Reimbursement to Nursing Homes for Admissions to Acute Care and Chronic Disease or Rehabilitation Hospitals

Section 14A. The division shall treat admissions to acute care hospitals and chronic disease or rehabilitation hospitals as equivalent for purposes of reimbursing nursing homes to reserve beds for medical assistance recipients during brief absences from nursing homes by such recipients to obtain hospital care.
In the event that a nursing facility resident who is age 22 years or under and is a MassHealth recipient leaves the nursing facility for non-medical reasons, the facility shall preserve his bed for a period of up to 10 calendar days per year and the division shall pay to preserve his bed in the facility for a period of up to 10 calendar days per year.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 15 - Medicaid Benefits; Rules and Regulations; Managed Care; Personal Expenses

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.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 16 - Primary and Supplemental Medical Care and Assistance Program for Disabled Residents; Assistance Program for Chronically Ill or Disabled Persons Forced to Leave Employment or Substantially Reduce Work Hours

Section 16. The division shall establish a program of primary and supplemental medical care and assistance for certain disabled residents of the commonwealth including persons who are blind who are not eligible for medical assistance pursuant to Title XIX of the federal Social Security Act. The benefits of such program shall be available to all such persons (1) who are not covered for medical costs relative to their disability by an employer's group health insurance plan, (2) who are not eligible for medical assistance under any work incentive programs with federal participation, and (3) who, if not engaged in substantial gainful activity, would meet all eligibility requirements for supplemental security income under the provisions of Title XVI of said Social Security Act at the time of application for said program of medical care and assistance. Subsequent to their enrollment in said program, such disabled residents may continue in enrollment in said program notwithstanding the fact that they no longer meet the financial requirements of said Title XVI in accordance with income requirements established by the division. The cost of such program shall be funded, in part, by premium contributions, co-payments, and deductibles contributed by enrollees according to a sliding scale schedule designed by the division.
The division shall further establish a program of assistance for persons forced to leave employment due to the onset or worsening of a severe and chronic disability or illness or whose access to employer sponsored health insurance is jeopardized by a substantial reduction in work hours as a result of such disability or illness. The benefits of such program shall provide for assistance in paying health insurance premiums offered through a group plan of health insurance sponsored by the employer for those persons whose continuing disability or illness would likely result in their becoming eligible for benefits under this chapter; provided that the cost of such benefits shall be paid, in part, by payments from such persons according to a sliding fee schedule established by the division.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 16a - Medical Care and Assistance Program for Disabled Children

Section 16A. The division shall establish a program of medical care and assistance for certain disabled children of the commonwealth, including children who are blind. The benefits of such program shall be available to children who are not eligible for medical assistance programs with federal financial participation and who would meet the disability requirements for supplemental security income under the provisions of Title XVI of the Social Security Act. The cost of such program shall be funded, in part, by premium contributions, co-payments and deductibles according to a sliding scale schedule designed by the division.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 16a1/2 - Costs Incurred for Medical Programs Projected to Exceed Available Appropriations; Notice

Section 16A1/2. The commissioner shall notify the house and senate committees on ways and means and the secretary of administration and finance whenever costs incurred for any program of medical care authorized by sections 9A, 16 and 16A are projected to exceed available appropriations for the current fiscal year or for costs authorized for expenditure for prior fiscal years. Such notice shall be filed within five business days of the commissioner's determination of such projection. Any such notice shall be accompanied by the following information: (a) an explanation of the reasons for any such deficiency or insufficient authorization for prior year expenditures; (b) revised total expenditure projections for any such items of appropriation that shall update the budget neutrality plan required pursuant to section 9B; (c) revised member month caseload assumptions for any such program of medical care that is projected to incur such a deficiency; (d) revised per member per month cost assumptions for any such program of medical care that is projected to incur such a deficiency; and (e) a description of all cost control measures, including quantification of the savings therefrom, that the division would propose to implement to prevent or ameliorate any such deficiency.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 16d - Aliens or Persons Residing in United States Under Color of Law; Benefits

Section 16D. (1) Eligibility for benefits for aliens pursuant to this chapter shall be determined without regard to the availability of federal funding for such benefits or to the provisions of sections 401, 402 or 403 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996.
(2) A person who is not a citizen of the United States but who is either a qualified alien within the meaning of section 431 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 or is otherwise permanently residing in the United States under color of law may receive different benefits unless such person: (i) is residing in a nursing facility, as defined by 42 U.S.C. section 1396, as of June 30, 1997; (ii) was receiving services or benefits pursuant to this chapter as of June 30, 1997; (iii) had an application for long-term care services pending on July 1, 1997; or (iv) is eligible for federally reimbursed services or benefits; provided, however, that services or benefits other than emergency services shall not be provided to undocumented aliens unless required by federal law.
(3) Benefits for aliens under this section shall not be provided to persons age 19 or older; but the benefits shall not be terminated for persons described in clauses (i), (ii), (iii) and (iv) of subsection (2).
(4) Before termination of eligibility under the authority of subsection (3), the division shall review eligibility to assure that all federally eligible aliens are identified and their costs of coverage reimbursed by the federal Medicaid program to the greatest extent possible consistent with federal law.
(5) The division shall review all claims for services to aliens to assure that all emergency services are reimbursed by the federal Medicaid program to the greatest extent possible consistent with federal law, including coverage for chronic medical conditions, which, if left untreated, could reasonably be expected to place the persons' health in serious jeopardy, cause serious impairment to bodily functions or cause serious dysfunction of any bodily organ or part.
(6) Notwithstanding subsection (3), if appropriations permit, the division shall determine eligibility in accordance with subsection (1) and (2).
(7) Notwithstanding subsection (3), a person who is not a citizen of the United States but who is either a qualified alien within the meaning of section 431 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 or is otherwise permanently residing in the United States under color of law shall be eligible to receive benefits under MassHealth Family Assistance if such individual meets the categorical and financial eligibility requirements under MassHealth; provided further that such individual is either age 65 or older, or between age 19 and 64, inclusive, and disabled. Such individual shall not be subject to sponsor income deeming or related restrictions.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 17 - Reimbursements for Non-Generic Drugs

Section 17. Multiple source drugs listed in the Massachusetts list of interchangeable drug products established pursuant to the provisions of section thirteen of chapter seventeen of the General Laws and regulations adopted thereunder shall not be reimbursable except for the ''Massachusetts maximum allowable cost'', as defined by regulations of the department, unless the division grants prior authorization based upon the provision of written documentation by the practitioner to the division that satisfactorily demonstrates that a recipient's medical condition requires the use of a nongeneric drug and unless the practitioner writes on the face of the prescription in his or her own handwriting the words ''brand name medically necessary'' under the words ''no substitution'' in a manner consistent with applicable state law; provided that a pharmacist dispensing in accordance with this section shall be exempt from the provisions of the fourth paragraph of section twelve D of chapter one hundred and twelve.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 18 - Medical Insurance Purchases for Persons Eligible for Assistance

Section 18. The division may purchase on behalf of any person eligible for medical assistance under this chapter medical insurance furnished in accordance with the provisions of chapter one hundred and seventy-five, one hundred and seventy-six A, one hundred and seventy-six B or one hundred and seventy-six G, provided that such medical insurance, in conjunction with any supplemental coverage that may be available to such person by the division under this chapter, would enable such person to obtain medical care and services comparable to those afforded any other similar eligible person under this chapter, at no greater cost to such person or the division. The third party liability unit of the division is hereby authorized to establish services and procedures which seek to maximize and coordinate the utilization of health care benefits provided under any such purchase of medical insurance for such person.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 19 - Prior Approval of Medical Services; Methods; Rules and Regulations; Posttreatment Examinations

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 proposed recipients or of diagnostic information regarding proposed recipients by dental consultants of the department; (2) in the case of orthodontic services, procedures which assure that medical assistance will be provided only for severe handicapping malocclusions; and (3) in the case of transportation to obtain medical care, a statement from the attending physician certifying that such transportation is necessary due to a physical disability.
Assistance under this chapter for nursing services for persons twenty years of age or under may be available only after a medical review team under the supervision or with the approval of the department of public health, in cooperation with the division and the departments of mental health and developmental services, approves such services for such persons. The department of public health, in cooperation with the division and such other departments, shall promulgate rules and regulations for such services, and any person or facility offering such services shall receive prior certification from the department of public health.
The division shall establish methods of random posttreatment examination of recipients of medical care or services under this chapter in order to assure that the care or services for which the division is billed were actually performed as described.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 20 - Application; Forms; Application by Institution

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 name, address and social security number of any member of the family sixteen years of age and older, the total income from wages, salaries, pensions, fees, tips, bonuses and all other sources of income of all such persons, the ownership and description of any motor vehicle or boat, or trailer, or similar assets readily convertible into cash owned by any member of the family. Such form shall require that the applicant provide information to determine his or her eligibility for medical assistance under penalty of perjury.
An institution furnishing services under this chapter shall have the right to make such application on behalf of an individual only if, and to the extent, provided by regulations of the division.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 21 - Inquiry by Department; Notification of Applicant; Agreement

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 of such application for applicants who apply for medical assistance on the basis of a disability; and (2) within forty-five days after receipt of such application for all other persons. At the time of such initial decision, and in the event of any subsequent decision, the applicant or recipient shall be notified in writing of such decision and shall be informed of the reason therefor and of his right to appeal and of the method by which he may appeal under this chapter.
The division may enter into an agreement with the secretary, or with any government or private agency, whereby the secretary or agency shall determine on behalf of the division the eligibility for medical assistance under this chapter of all or certain applicants for such assistance.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 23a - Financial Institutions; Request for Deposit and Withdrawal Records; Penalty

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 under this chapter to any authorized employee or agent of the division or to the applicant or recipient. A treasurer who unreasonably refuses to provide these records within the time limit provided in the request or who willfully provides false information in the reply shall forfeit $50 to the commonwealth.
For the purposes of this section, ''financial institution'' shall mean a national bank, federal savings bank, federal savings and loan association or federal credit union, if such bank, association or credit union is authorized to transact business and has its main office or a branch office in the commonwealth; or a trust company, credit union, co-operative bank or savings bank, if such company, credit union or bank is organized and exists under the laws of the commonwealth or any other state of the United States or is otherwise authorized to do business in the commonwealth and has its main office or a branch office in the commonwealth; or a benefit association, insurance company or safe deposit company authorized to do business in the commonwealth.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 25a - Determination of Eligibility for Qualified Medicare Beneficiary, Specified Low-Income Medicare Beneficiary and Qualified Individual Programs; Consideration of Certain Income or Assets

[ Subsection (a) effective until July 1, 2023. For text effective July 1, 2023, see below.]
Section 25A. (a) 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 or assets in an amount equivalent to the federal resource limit for the Medicare Saving programs, each as adjusted annually, in determining eligibility for the Qualified Medicare Beneficiary, Specified Low-Income Medicare Beneficiary and Qualified Individual programs, described in 42 U.S.C. 1396a(a)(10)(E), also known as the Medicare Saving or Medicare Buy-In programs; provided, however, that until the division receives the federal approvals described in subsection (b), the division shall not consider income in the amount equal to 30 per cent of the federal poverty level. Enrollment in the Qualified Individual program shall be capped if the federal allotment for the program is exhausted.
[ Paragraph (1) of subsection (a) as amended by 2023, 28, Sec. 46 effective July 1, 2023. See 2023, 28, Sec. 115. For text effective until July 1, 2023, see above.]
(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 Medicare Beneficiary and Qualified Individual programs, described in 42 U.S.C. 1396a(a)(10)(E), also known as the Medicare Saving or Medicare Buy-In programs; provided, however, that until the division receives the federal approvals described in subsection (b), the division shall not consider income in the amount equal to 30 per cent of the federal poverty level. Enrollment in the Qualified Individual program shall be capped if the federal allotment for the program is exhausted.
[ Paragraph (2) of subsection (a) added by 2023, 28, Sec. 47 effective July 1, 2023. See 2023, 28, Sec. 115.]
(2) In determining eligibility for Medicare Saving or Medicare Buy-In programs described in paragraph (1) for individuals 65 years of age or older, the division shall disregard all assets or resources. Implementation of this paragraph shall be contingent upon receiving federal approvals described in subsection (b).
(b) Prior to implementing subsection (a), the division shall obtain all required federal approvals, including amending its state plan and amending its 1115 waiver, as necessary, and shall promulgate regulations to implement this section.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 26 - Identification Card

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 establish by rules and regulations such procedures as may be necessary for the purpose of recalling identification on termination of eligibility.